Pulse Polio

A child is vaccinated on Pulse Polio Day in Gwalior.

A three-year-old in front of a Pulse Polio booth after vaccination.

Pulse Polio is an immunisation campaign established by the government of India to eliminate poliomyelitis (polio) in India by vaccinating all children under the age of five years against the polio virus. The project fights poliomyelitis through a large-scale pulse vaccination programme and monitoring for polio cases.

The Pulse Polio dates in 2016 were 17 January and 21 February on Sundays.

History

In India, vaccination against polio started in 1978 with Expanded Program on Immunisation (EPI). By 1984, it covered around 40% of infants, giving three doses of OPV to each.

In 1985, the Universal Immunisation Program (UIP) was launched to cover all the districts of the country. UIP became a part of child survival and safe motherhood program (CSSM) in 1992 and Reproductive and Child Health Program (RCH) in 1997. This program led to a significant increase in coverage, up to 95%. The number of reported cases of polio also declined from 28,757 during 1987 to 3,265 in 1995.

In 1995, following the Global Polio Eradication Initiative of the World Health Organization (1988), India launched Pulse Polio immunisation program with Universal Immunization Program which aimed at 100% coverage.

Elimination of polio in India

The last reported cases of wild polio in India were in West Bengal and Gujarat on 13 January 2011.^[1] On 27 March 2014, the World Health Organization (WHO) declared India a polio free country, since no cases of wild polio had been reported in for three years.^[2]

As of mid-2015, only Afghanistan and Pakistan have wild polio cases.

Key objectives

The Pulse Polio Initiative (PPI) aims at covering every individual in the country. It aspires to reach even children in remote communities through an improved social mobilisation plan.^[3]

Not a single child should miss the immunisation, leaving no chance of polio occurrence.
Cases of acute flaccid paralysis (AFP) to be reported in time and stool specimens of them to be collected within 14 days. Outbreak response immunisation (ORI) to be conducted as early as possible.
Maintaining a high level of surveillance.
Performance of good mop-up operations where polio has disappeared.^[3]

Steps involved

Setting up of booths in all parts of the country.^[3]
Initialising walk-in cold rooms, freezer rooms, deep freezers, ice-lined refrigerators and cold boxes for a steady supply of vaccine to booths.
Arranging employees, volunteers, and vaccines.
Ensuring vaccine vial monitor on each vaccine vial.
Immunising children with OPV on national immunisation days.
Identifying missing children from immunisation process.
Surveillance of efficacy.

Publicity was extensive and included replacing the national telecoms' authority ringtone with a vaccination day awareness message, posters, TV and cinema spots, parades, rallies, and one-to-one communication from volunteers. Vaccination booths were set up, with a house-to-house campaign for remote communities.^[4]

Two million healthcare workers and US$2.3 billion in government funding went into the campaign.^[5] It is estimated that global polio eradication would save more money than it has cost within a few years of polio's disappearance.^[6]

Difficulties

Testing showed that three doses of vaccine was enough to protect children in developed countries, but it became obvious that this was not enough in some areas of India. The Ministry of Health and Family Welfare recommended eight to ten doses for each child.

Children in some areas of India are weaker and often had diarrhoea, which reduced the efficiency of the vaccine. Open defecation, monsoon flooding, and a lack of water treatment made it easier for a child to swallow more polio virus. As a result, children with too few doses of vaccine were not fully protected and sometimes got polio.^[4]

The eradication program therefore gave drops over and over again, to boost children's immunity higher and as a precaution against missed children. Few parents initially knew that the vaccination campaign was trying to eradicate the disease, so they did not understand the reasons for the increasing intensity of vaccination. The increasing frequency of the drops and cases of polio among partially vaccinated children, caused rumours that the drops did not work.^[4]

On July 30, 2013 a nine-month-old boy from Navi Mumbai tested positive for vaccine-derived poliovirus (VDPV) type 2. This was the fourth such case recorded in the country in 2013.^[7]

Many parts of India are remote and hard to access. People in some areas had had poor and caste-discriminatory treatment by government health authorities, which made them less willing to assist in the vaccination programme. The time demands of polio vaccination sometimes left health care workers with less time for other services. The absence of any free health services other than polio vaccination and contraception lead to rumours that the drops caused infertility.^[4]

Rumours about vaccinations varied by area, but were clustered, so that there was a greater risk of a cluster of unvaccinated children. Some believed that vaccinating newborns, children who are ill, or previously vaccinated children was not safe;^[4] the last polio case in India was a girl who had not been vaccinated because she was sickly.^[8] There were also rumours that the polio drops were made from the blood of pigs, dogs, or mice, or from pig fat.^[9]

Poor participation of doctors and nurses, difficulty in maintaining and procuring vaccine, difficulty in procuring vehicles, and a lack of support from community members have caused problems in the program,^[10] as has fatigue at the length of the anti-polio campaign.^[4]

Support

The campaign was supported by organisations including the Indian federal and state governments, international institutions, and non-governmental organisations. It is part of the Global Polio Eradication Initiative, spearheaded by Rotary International, the World Health Organization, UNICEF, and the U.S. Centers for Disease Control and Prevention.

Actor Amitabh Bachchan volunteered with the campaign, filming TV and radio spots urging against complacency^[4]^[11] and personally vaccinating children.^[12]

The Indian and Afghan cricket teams have supported their national and international polio eradication efforts.^[13]

Opposition

The Gujarat case

In 1998, in Bhavnagar district of Gujarat, immunisation officers reported that 98 children out of the total of 2,000 missed the vaccine. Health workers were first prevented from coming to village. Later, when the booths were established and the program started, many parents did not bring their children. According to them, children from their village developed polio-paralysis even after the immunisation.

The Bengal cases

Health officers who visited a village in West Bengal saw utter discontent among the people as they stated that two children contracted the virus after the vaccine.

In another instance, parents of a two-and-a-half-year-old child who developed cellulites in the heel were convinced that it had been caused by the vaccine that was given a week before. The doctor who gave the vaccine was forced to pay the entire amount for the child’s treatment.

References

External links

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