With India On Board, Southeast Asia Could Soon Be Declared Polio-Free

India celebrates three years since its last recorded polio case today, marking an anniversary that could mean the disease is no longer endemic to Southeast Asia.
A child gets polio drops during a vaccination campaign in Nepal. Adam Bjork, CDC

Three years ago today, India reported its last case of polio. Five years ago, the country was home to nearly half of the world’s cases of poliovirus, 741 cases out of 1,604 worldwide. And before the launch of the Global Polio Eradication Initiative in 1988, the illness crippled an estimated 200,000 children in India every year.

“It’s really quite extraordinary,” Carol Pandak, an epidemiologist with the community-service group Rotary International, tells Popular Science. “India was a country where it was once thought polio could never be eradicated.”

So this is a huge win for the country. It also means that the World Health Organization could soon declare its South-East Asia Region, which includes 11 countries, officially polio-free. WHO’s South-East Asia Regional Certification Commission plans to meet to review its data in March, the WHO Country Office for India wrote to me in an email. If the region checks out, it would be an official recognition that polio no longer arises in that part of the world endemically, although the virus still could creep in over borders, especially from neighboring Pakistan, which is one of the three countries in the world in which polio is endemic. (The others are Afghanistan and Nigeria.)

For Pandak, the successes in India mean public health organizations have got a good chance in polio’s remaining hideouts. Rotary International works with the World Health Organization, the U.S. Centers for Disease Control and Prevention, and the United Nations as a part of the Global Polio Eradication Initiative. “The ability to eradicate polio from there gives hope and inspiration to other countries that may have some similar challenges like highly densely populated slum areas, issues with water and sanitation, et cetera,” she says.

“India was a country where it was once thought polio could never be eradicated.”

Getting rid of polio in a region mainly means ensuring everybody is vaccinated against the virus, including every new generation of children. Those places where the virus is still endemic have struggled with vaccine resistance, including among some Taliban groups in Pakistan and Afghanistan. For example, some Taliban leaders have questioned whether U.S.-led vaccination efforts are actually covers for spying. But through working in India, Rotary members have learned some lessons they think will work elsewhere, Pandak says.

In two of India’s northern states, where vaccinators encountered some resistance and suspicion, local Rotary members gathered a committee of several dozen religious leaders and talked to them about why it was important to get vaccines. Once those leaders were on board, their community members were on board, too.

For the rest of India, Rotary focused on a different kind of leader—popular movie star Amitabh Bachchan (In U.S., he’s appeared in The Great Gatsby), who became a polio vaccine advocate. Rotary has recruited Pakistani cricket star Shahid Afridi and Nigerian actors Sani Danja and Funke Akindele to do the same for their own countries.

The Global Polio Eradication Initiative’s work is not done in India, either. To maintain India’s and other southeast Asian nations’ polio-free status, workers must continue vaccinating children. They’ll have to until polio is wiped from the world, because of the constant danger of the virus traveling from Pakistan, Afghanistan and Nigeria. Although the world now sees just a few hundred polio cases a year, if countries began vaccinating incompletely, they could start to see 200,000 cases of paralytic polio every year within 20 years, according a study published in 2007. “Worldwide eradication of wild polioviruses is likely to yield substantial health and financial benefits,” the study’s authors wrote in their paper, published in the medical journal The Lancet, “provided we finish the job.”

Such a full-court press will be expensive. As cases dwindle, the cost per case becomes extraordinary—nearly $2.5 million per case in 2012, as Wired reports. Researchers from the Global Polio Eradication Initiative argue that by 2035, eradication efforts will have saved countries $40 billion to $50 billion, much more than the estimated total campaign cost of $9 billion to $10 billion. Much of the savings will come from productivity gains in people in low-income countries no longer becoming crippled.

Should the day come when polio is truly gone from the world, it would be the second vaccine-preventable disease that humans have eradicated. The only precedent is smallpox. The next, Pandak thinks, may be measles and rubella. There are a couple of reasons those diseases are promising. Like polio and smallpox, they don’t have any animal carriers, which means no wrangling with microbes lying in wait in monkeys, bats or mosquitoes. There are also safe, effective vaccines for measles and rubella that work in children.