Director-General

WHO Director-General celebrates polio-free India

Dr Margaret Chan
Director-General of the World Health Organization

Address at the “India celebrates triumph over polio” event
New Delhi, India

11 February 2014

His Excellency, the President of India, the honourable Prime Minister of India, honourable Minister of Health and Family Welfare, the President of Rotary International, distinguished guests, ladies and gentlemen,

I am most pleased to join others in celebrating India’s triumph over polio. Everyone loves a success story, especially one of this magnitude. India has now gone three consecutive years without a single case of polio.

Confidence in this achievement is supported by a world-class surveillance system and a level of vigilance and preparedness ready to manage any imported case as a public health emergency.

In fact, the surveillance system in India not only meets all international standards for high-quality performance. It surpasses them.

After three years, we can say with certainty that the soil of this vast and densely populated country is now free of a virus that killed and crippled children for centuries.

Many critics believed that this day would never come, that the polio virus was too firmly entrenched in India, that India would never be polio free. In their view, India had limited means and unlimited challenges.

They could point to the country’s huge population, high birth rate, dense pockets of poverty, poor sanitation, widespread diarrhoea, difficult terrain, and resistance to vaccination among some groups.

These were real and daunting challenges, but the doubters missed one decisive factor: the power of India’s determination to achieve the impossible, to go from the world’s heaviest burden of polio cases to zero.

Viewed against the challenges, India’s achievement is an epic success story, a proof that any country that really wants to can defeat polio.

Government ownership of the eradication initiative, at union, state, and district levels, was decisive, as were the billions of dollars poured into the effort by the government.

India worked together seamlessly with its international partners, including Rotary International, the US Centers for Disease Control and Prevention, UNICEF, and WHO, with support from the Bill and Melinda Gates Foundation.

A can-do attitude was another reason for success, as witnessed by the unwavering dedication of millions of front-line workers. Vaccinators and religious leaders: I thank you for your service to your own people.

Let me illustrate the magnitude of this achievement with just a few statistics. In the 1970s, India was home to as many as 200 000 polio cases each year. Each nation-wide polio campaign involved the vaccination of nearly 170 million children by an army of 2.3 million vaccinators.

The reporting of suspected polio cases relied on a network of more than 39 000 health facilities from the public, private, and non-traditional sectors.

The need to reach every child meant that every nook and cranny of this vast country was criss-crossed by tireless polio workers. It also meant reaching every child in marginalized and migrant populations.

India, arguably facing the toughest challenges of any polio-endemic country, met each problem with creativity and innovation. In so doing, this country pioneered key operational and technical strategies as lessons for other countries.

India quickly took advantage of new technologies and served as a proving ground for their effectiveness. When better systems to support high-quality performance were needed, India built them. With support from the WHO country office, India built its world-class surveillance system. An efficient and reliable network of laboratories was established to support poliovirus testing and the rapid confirmation of cases.

Millions and millions of vaccinators were supervised and motivated. India also made very good use of another unique asset: its Bollywood film-stars and celebrities.

As the number of cases dwindled and the polio map began to shrink, independent monitoring of progress was introduced to provide a framework for accountability. Meticulous micro-plans were prepared to guide each and every vaccination team, on each and every day of an immunization campaign, ensuring logistical support down to the last detail.

Surveillance and monitoring generated high-quality data. Constant research produced the evidence for the fine-tuning of strategies, another strength of India’s polio programme.

Research improved understanding of the dynamics of transmission in different populations and environments, the effectiveness of different vaccines, and the reasons why some children were being missed. When research determined that vaccine efficacy was compromised in children with severe diarrhoea, social mobilization, led by UNICEF and supported by other partners, was used to educate households on diarrhoea prevention.

Pressure on the poliovirus increased each time a problem was uncovered and solved. In the end, it was the best of human creativity, ingenuity, determination, and perseverance that pushed the poliovirus out of India.

Ladies and gentlemen,

India has shown the world that there is no such thing as impossible. This is likely the greatest lesson, and the greatest inspiration for the rest of the world.

India’s leadership in polio eradication is widely appreciated and warmly welcomed, especially among the 194 Member States of WHO. The country has shared its experiences, best practices, lessons learned, and expert staff with the remaining endemic countries.

The defeat of polio in India paves the way for certification of the entire South-East Asia region as polio-free, possibly at the end of March. When this happens, nearly 80% of the world’s population will be living in countries that are certified polio-free.

The polio-free status of every country remains under threat as long as poliovirus is still circulating anywhere in the world. We still have some way to go. But India provides the decisive proof that eradication is feasible, technically and operationally.

India is fully aware of the need to safeguard its magnificent achievement. Immunization against polio remains high, and emergency preparedness and response plans are in place to respond urgently to any importations.

India will continue its role as a global leader as the Polio Endgame is implemented, including through the introduction of inactivated polio vaccine and the stepwise phasing out of oral polio vaccine.

Right now, the country is using the legacy of its polio success to intensify routine immunization, with a special emphasis on reaching underserved and marginalized populations. The elimination of measles will likely be the next permanent improvement for the health of India’s people.

The 13 January news that India had now gone 3 years without a polio case made headlines around the world. This is a monumental achievement that fully deserves today’s celebration.

Thank you.

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