Rotarians from Tamil Nadu recall how their state pioneered India’s immunization effort.
Polio immunization begins in India.
Rotary launches PolioPlus to protect all the world’s children against polio. Many people think that India, where polio cripples an estimated 150,000 children annually, will be the last place on earth to stop transmission of the preventable disease, which renders its victims outcasts.
Rotary provides a US$2.6 million grant to Tamil Nadu State for the purchase of polio vaccine, marking the formal debut of PolioPlus in India. A year later, The Rotary Foundation makes $20 million available for vaccine, disease tracking, immunization campaign promotion, and technical support throughout the country.
Polio paralyzes more than 1,000 children worldwide every day. Rotary, the World Health Organization (WHO), UNICEF, and the U.S. Centers for Disease Control and Prevention (CDC) join together to form the Global Polio Eradication Initiative after the World Health Assembly resolves to eradicate polio. Rotary establishes the India PolioPlus Committee to steer its eradication efforts there.
Rotary clubs in India begin organizing local and regional drives to administer polio vaccine and to cover routine immunization. Over the next several years, Rotarians and partners lobby the Indian government to make the immunization program national, as other countries have done.
“Dear Rotarians: May God bless you for saving our children from polio.” -- Mother Teresa
The Delhi government takes the lead and holds an immunization day at the urging of 1987-89 RI Director Sudarshan Agarwal. Despite an outbreak of the pneumonic plague, members of all 40 Rotary clubs in Delhi participate by transporting vaccine from 40 storage facilities to 4,000 immunization booths and providing assistance at 150 booths, immunizing 1.4 million children ages three and under.
“I am now optimistic that the success of Delhi will be repeated ... and [that it] will
serve as a spark to ignite National Immunization Days all over India.” -- E.G.P. Haran, Rotary’s PolioPlus regional adviser for Asia and the Western Pacific
India reports 3,263 cases of polio, more than half the global total of 6,179. During the country’s first National Immunization Day, held in December, 87.8 million children receive vaccine. Because of the efforts of health workers and volunteers – including 100,000 Rotarians, spouses, Interactors, Rotaractors, and Inner Wheel club members –
the number of
cases in India drops 69 percent, to 1,005, in 1996.
“Today is a great success for India – and for Rotary. It is the culmination of nearly 10 years of advocacy and immunization efforts by India’s 1,600 Rotary clubs.” -- Rajendra K. Saboo, 1991-92 RI president
“Let a polio-free India be our gift to the children of our country.” -- P.V. Narasimha Rao, Prime minister of India
WHO recruits 57 medical officers to establish the National Polio Surveillance Project. The officers investigate cases of acute flaccid paralysis to determine whether they are caused by the poliovirus, to discover which types of poliovirus are circulating where, and to delineate high-risk areas. WHO also supports a lab network to aid in these tasks. By 2008, the project expands to 333 surveillance medical officers. Today, more than 35,000 public and private health facilities function as reporting sites. Each year they investigate more than 60,000 cases of acute flaccid paralysis.
last case of type 2 poliovirus is reported
in Uttar Pradesh State. By year-end, polio is down more than 800 cases from the previous year. The first Subnational Immunization Days are held in medium- and high-risk states.
Health workers begin to search from house to house to find children they’ve missed during immunization days. They use indelible ink to mark the left little finger of children who have received the polio vaccine. Homes where all the children have been immunized are marked with a P, and those where children were missed with an X. To ensure appropriate follow-up, the X-marked houses are categorized by reason, such as locked door, sick child, or refusal.
UNICEF establishes the Social Mobilization Network in Uttar Pradesh to rally community support for polio immunization. The network later grows to more than 7,000 grassroots mobilizers – mostly women – who go from house to house in Uttar Pradesh and Bihar, the hotbeds of the virus, to counsel parents on the vaccine’s importance and to develop partnerships with religious and community leaders.
“The job is almost done [in India].
But the most dangerous word in the dictionary
is almost .” -- Deepak Kapur, India PolioPlus Committee chair
Indian film star Amitabh Bachchan becomes an advocate for polio eradication. He is formally named a UNICEF goodwill ambassador in 2005.
His endorsement of polio immunization is widely recognized as a catalyst for community support. Over the next decade, the Global Polio Eradication Initiative engages dozens of other celebrities, in India and elsewhere, through efforts such as Rotary’s “This Close” ads and cricket
players’ Bowl Out Polio campaign.
Up until this point, donors, including Rotary, have provided much of the funding for polio eradication. Now the government of India takes the lead in financing immunization activities in the country.
After cases in India drop to 268 in 2001, a large spike occurs, to 1,600.
Rotarians host the Kolkata Conclave, the first meeting of senior health administrators from India’s polio-endemic states, to draw up strategies to tackle bureaucratic and technical obstacles. A similar meeting is held later in the year with officials from states threatened by a resurgence of the disease.
In India, the Muslim community accounts for a large proportion of polio cases. Rotary establishes partnerships with key Muslim institutions to reach religious congregations through strategies such as praying for polio eradication and immunizing children at religious festivals, and making announcements and appeals in mosques and on religious calendars.
Delegations of senior Rotarians hold historic meetings with the prime minister and president of India and receive their personal pledges of support for polio eradication. As the campaign progresses, Rotarians continue to meet with health officials and government ministers to update them on the polio situation and secure their continued backing.
“We cannot be complacent. Rotary is carrying out a very honorable effort in removing the pain of the people and the pain of the children.” -- A.P.J. Abdul Kalam, President of India
Until now, the polio vaccine attacked poliovirus types 1, 2, and 3 all at once. New, more effective monovalent vaccine, which targets one strain at a time, is introduced. Officials use monovalent vaccine to focus on type 1, the more dangerous and prominent of the two remaining strains. Type 1 cases account for 95 percent of polio cases in India until 2006, but plummet to record lows by 2007.
Rotary forms the Ulema Committee for Polio Eradi-cation in Uttar Pradesh. Composed of senior Muslim scholars and religious leaders, it helps address rumors and myths contributing to resistance to the vaccine in the Muslim community. Working with the group, the India PolioPlus Committee publishes a booklet linking polio immunization to the duties of parents as explained in the Quran. The publication includes the names and phone numbers of ulema committee members who can be contacted to clear up
any misconceptions. The booklet is shown to parents who have questions about the polio vaccine.
Rotary and the Bill & Melinda Gates Foundation commit a combined $200 million for
“Misconceptions and rumors that were widespread in the community against polio [immunization] have almost been removed ... and we will continue with our efforts until polio is eradicated.” -- Maulana Khalid Rashid Firangi Mahali, President of the Ulema Council of India
Rajashree Birla, whose late husband, Aditya Birla, led one of India’s largest businesses, commits $1 million to polio eradication. The move spurs others in India’s corporate sector to contribute.
To increase immunization rates in remote, high-risk areas of northern Bihar, workers construct makeshift shelters where families can rest overnight during journeys to immunization booths.
“Despite the challenges, I’m more convinced than ever that India will lead the way to the successful eradication of polio.” -- Bill Gates, Cochair of the Gates Foundation, on a visit to India
As part of a new plan for Uttar Pradesh and Bihar, social mobilizers promote strategies to address underlying
factors that allow the poliovirus to thrive. The methods include ensuring routine immunization, improving hygiene and sanitation, providing medication for diarrhea, and promoting breastfeeding.
Rotary and the Gates Foundation boost their combined commitment to $555 million for
While the monovalent polio vaccine had helped reduce the transmission of poliovirus type 1 to record-low levels, India experiences an outbreak of type 3, reporting 741 cases, almost half the worldwide total of 1,604.
A new bivalent polio vaccine is introduced to tackle poliovirus types 1 and 3 simultaneously.
Rukhsar Khatoon, an 18-month-old from Howrah, West Bengal, is paralyzed by polio –becoming the last case reported in India. This immediately triggers a large-scale response, with three additional immunization rounds conducted within seven weeks of the case’s confirmation.
All of India’s states and union territories develop Emergency Preparedness and Response Plans to act on any case of wild poliovirus as a public health emergency.
Rotary meets its pledge to raise $200 million for polio eradication, set in 2009. To date, Rotary has contributed $164.5 million to the cause in India, and more than $1 billion worldwide.
After a full year without any cases of polio, India is removed from the list of polio-endemic countries, a major milestone for the eradication effort. The declaration is made at a polio summit hosted by Rotary and the government of
India in February. Before it can be certified polio-free, India must go two more years without another case.
“Rotarians have worked diligently to help reach millions of children with the oral polio vaccine. As an Indian, I am immensely proud of what Rotary has accomplished.” -- Kalyan Banerjee, 2011-12 RI president