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February 27, 2012

WHO takes India off polio-endemic list

But warns against importations of virus circulating in Pakistan, Afghanistan & Nigeria 

New Delhi, February 25
Hailing India’s anti-polio efforts, the World Health Organisation (WHO) today took the country off the list of nations with active endemic wild polio virus transmission. That leaves only Pakistan, Nigeria and Afghanistan on the list.
Health Minister Ghulam Nabi Azad broke the news after Prime Minister Manmohan Singh opened the two-day Polio Summit this morning.
“The WHO has taken India’s name off the list of polio-endemic countries in view of the remarkable progress made during the past year,” Azad said as the PM credited the feat to 23 lakh volunteer vaccinators who work to cover every single child. That led to an unprecedented 99.3 per cent immunisation coverage in the problematic states of Uttar Pradesh and Bihar last year.
The PM today hinted at increased public spending on health with the WHO pegging the global deficit for polio eradication at $1.09 billion. “The 12th Plan will be one of health and education. We need to increase public expenditure on health to 2.5 per cent of the GDP,” the PM said.
He, for the first time, stressed on cashless OPD health care in government hospitals as recommended by the Planning Commission’s expert group on Universal Health Coverage (UHC).
“We need to work towards hassle-free and cashless OPD care in public hospitals and accelerate efforts to achieve universal health care for all. Two-thirds of private health care expenditure is on outpatients, diagnostic care and medicines. Insurance schemes mainly target in-patient care. We need to work towards cashless OPD care in public hospitals,” the PM said.
India’s removal from the polio-endemic nation list follows a year of zero infections. The last case, detected on January 13, 2011, involved Rukhsar Khatoon of West Bengal’s Howrah district. The child had never received polio drops.
WHO’s recognition comes with a warning. Assistant Director General, Polio, WHO, Bruce Aylward, who is here for the summit, said India must guard against importation of the virus circulating in Pakistan, Afghanistan and Nigeria.
“India has a high risk of importation. Till the virus is circulating in other countries, it can return by the same route it went. China saw an outbreak in October 2011 after 10 polio-free years.
The virus was traced to Pakistan and infected 21 persons aged four months to 53 years. The risk of importation is as significant as the risk of resurgence. We recommend vaccinating everyone who are moving to and fro between endemic countries,” said Dr Aylward.
Pakistan had 198 infections in 2011 and 11 so far in 2012. Afghanistan had 80 cases last year and Nigeria had 27 cases in 2011 and three so far in 2012. By 2011, the world had only four polio-endemic countries but over 40 countries saw importations.
India has come a long way since 1999 when the last wild polio virus 2 was reported globally from UP’s Aligarh district. “That’s what makes today’s accomplishment special,” Aylward said.
The WHO last month declared a public health emergency plan for global eradication of polio. The plan seeks to help Nigeria, Pakistan and Afghanistan reach necessary coverage to stop the transmission of polio virus by the end of 2012 and sustain the anti-polio momentum in Chad, Democratic Republic of Congo and Angola which saw outbreaks (lasting over a year) from imported viruses.
Marching ahead
India’s removal from the polio-endemic list follows a year of zero infections
The last case was detected on January 13, 2011 in West Bengal’s Howrah district. Rukhsar Khatoon had never received polio drops
India has come a long way since 1999 when the last wild polio virus 2 was reported globally from UP’s Aligarh district
In 1988, half of the world’s 3.5 lakh children paralysed annually by polio were in India.

Pak to take lessons from India
FIGHTING POLIO: To send teams to get trained in vaccine delivery strategies
New Delhi, February 25
Pakistan today blamed the war on terror for delay in the eradication of polio and said it would seek India’s help in eliminating this disease from the country.
Pakistan’s Federal Minister for Inter-provincial Coordination Mir Hazar Khan Bijrani, here to attend the Polio Summit, said his government would soon send teams to India to get trained in vaccine delivery strategies that enable health workers to target high risk populations like migrants.
“I have spoken with the Health Minister of India and will send our experts to learn from the Indian experience,” Bijrani said on the sidelines of the summit.
Persistent pockets of polio transmission on the border between Afghanistan and Pakistan and northern Nigeria are the current focus of polio eradication initiative of the WHO. Pakistan, Afghanistan and Nigeria remain polio endemic countries although it is huge progress since 1988 when 125 countries were endemic. An endemic country is one where the wild poliovirus has never stopped circulating.
Bijrani said the war on terror was hampering vaccination of children as health workers were unable to reach remote areas. “A major obstacle is Pakistan’s fight against terror which has made a number of areas in Khyber Pakhtunkhwa and Balochistan Provinces bordering Afghanistan highly volatile. We are talking to tribal chiefs to help us reach children for immunisation. They realize that this is important,” Bijrani said.
Pakistan is, meanwhile, not concerned about any import of cases from India and said Afghanistan was more of a challenge. “We don’t have a very sealed border with Afghanistan. That is a concern, not India,” he said. In Pakistan, polio has been declared a public health emergency.
As long as a single child remains infected, children in all countries remain at risk of contracting polio. In the past three years, 40 previously polio-free countries have been re-infected due to imports of the virus.
Another challenge for Pakistan is large influx of population out of the troubled areas and routine seasonal migration from one region of the country to another. This allows the poliovirus to move from endemic districts to those free from polio.
“We have identified vulnerable districts and will focus there,” Bijrani said, considering India faces the risk of importation of the poliovirus from across the border.
The minister added that Pakistan wanted to follow in India’s footsteps. “We want to learn from India its experiences in reaching the goal of zero case of polio and in raising its routine immunization coverage which is the backbone not only of polio eradication but also elimination of measles and neonatal tetanus,” he said, terming as dismal Pakistan’s polio infection scenario.
The country saw 198 infections in 2011. This year it has seen 11 so far.

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