India has been recognised as polio-free since March 27, 2014, following a massive and successful vaccination campaign that began in 1994.

This achievement was made possible by ensuring equitable vaccine access across the country, including in remote and marginalized communities, and by addressing social and cultural concerns to overcome vaccine hesitancy. Vaccinations were conducted in close to 700,000 booths staffed with around 1.2 million vaccinators and 180,000 supervisors on Polio Ravivar (Polio Sunday), who worked with the support of partners and volunteers from WHO, UNICEF, Rotary and other civil society organizations.

As India marks the completion of a decade as a polio-free nation, Health On Air engaged in a detailed conversation with Mr Deepak Kapur, Chairman of Rotary International’s India Polio Plus Committee (INPPC).

In our discussion, Mr. Kapur provided a comprehensive overview of the concerted efforts and strategic initiatives that have sustained India’s polio-free status. He also highlighted the ongoing vigilance and preventive measures essential to protect this achievement, especially considering the polio challenges in the surrounding regions.

Excerpts from the interview: 

Q: What is the status of polio eradication and has polio been eradicated or eliminated? What were the challenges or barriers?

Mr. Kapur: The current status of polio eradication highlights both achievements and ongoing challenges. Wild poliovirus types 2 and 3 have been declared eradicated, with type 2 eradicated in 2015 and type 3 in 2019. Additionally, the World Health Organization’s Southeast Asia Region was declared poliovirus-free in 2014, and the WHO African Region achieved this status for wild poliovirus in August 2020.

However, challenges persist, particularly with the circulation of vaccine-derived poliovirus (cVDPV) and in the final steps towards complete eradication. The two remaining wild poliovirus type 1 (WPV1) endemic countries are Pakistan and Afghanistan. Recent updates include two WPV1 cases reported in Balochistan, Pakistan, with ongoing outbreak response efforts. Meanwhile, there were no new WPV1 cases in Afghanistan as of the last report, maintaining their total at six cases for 2023.

The Global Polio Eradication Initiative (GPEI) continues its efforts to interrupt the transmission of WPV1 in Afghanistan and Pakistan and to stop the transmission of cVDPV globally. The strategy for 2022-2026 emphasizes collective ownership, accountability, and the implementation of comprehensive actions to address programmatic and epidemiological challenges. This includes focusing on reaching ‘zero dose’ children—those who have not received any vaccines—and increasing vaccination efforts in regions with the highest risks of poliovirus transmission.

Q: Is there a potential return of polio in India, considering that neighboring countries are still facing outbreaks?

Mr. Kapur: There is a possibility, given that India has previously exported the polio virus to every continent. The primary precaution we need to maintain is to keep our immunization levels as close to 100% as possible, ensuring that every child is immunized.

Secondly, we must maintain a state of readiness to respond swiftly should the virus threaten, enabling us to control any emergence swiftly. This includes the implementation of intensive immunization campaigns if necessary.

Furthermore, India boasts top-tier surveillance systems, considered among the best globally, facilitated by the National Polio Surveillance Project—a collaborative effort between the Government of India and international partners. The key to keeping the virus at bay lies in maintaining high immunization coverage and ensuring that our surveillance systems remain vigilant.

Q: What measures are in place to prevent the re-importation of polio?

Mr. Kapur: There are comprehensive measures in place. Our strategy aims to maintain a robust defence against the potential re-introduction of the polio virus. By staying vigilant and promptly responding to any threats, we hope to sustain our polio-free status.

Q: What are the primary obstacles to achieving global polio eradication, especially in regions with ongoing transmission?

Mr. Kapur: The remaining countries in the world, notably Afghanistan and Pakistan, reported polio cases in 2024. This situation underscores the persistence of the virus in the environment. Our experience in India and observations worldwide indicate that the presence of the virus in the environment is likely to result in polio cases. These cases are primarily clinical, involving children who become victims of the virus, which is a scenario we aim to avoid entirely.

Q: So how can we achieve global eradication of this disease?

Mr. Kapur: The best practices employed in India, which both Afghanistan and Pakistan are striving to implement, are crucial. However, Afghanistan faces unique challenges due to its accessibility issues and ongoing conflict, unlike India, which did not have these obstacles. Similarly, Pakistan faces its own set of challenges, including high population density and sanitation issues, similar to those we encountered in India.

Global eradication of polio is achievable only when every country, especially the remaining endemic countries like Pakistan and Afghanistan, eliminates the wild virus. As long as the virus exists anywhere, children worldwide remain at risk due to the potential for the virus to be exported.

Historically, we’ve seen the polio virus travel from one country to another, impacting continents far from the source. Therefore, maintaining near 100% immunization coverage for all children up to the age of 5 and ensuring top-notch surveillance are essential measures. This way, we can detect and respond to any polio cases promptly to prevent further spread.

Q: Could you elaborate on Rotary’s contribution to India’s polio eradication efforts and how the organization is leveraging its experience to address polio in the remaining endemic countries? How is India contributing to this global effort?

Mr. Kapur: From the inception of the Global Polio Eradication Initiative (GPEI), with Rotary, WHO, UNICEF, and CDC as the founding partners, followed by the Bill and Melinda Gates Foundation and GAVI, Rotary’s contributions have been multifaceted. To date, Rotary has raised over two billion US dollars for polio eradication. Its efforts include widespread fundraising and unique advocacy, engaging political leadership, senior bureaucrats, and religious leaders to overcome resistance to immunization.

Rotary’s involvement also extended to operational support, setting up booths across India that mimicked the festive atmosphere of a carnival, making immunization a community event. This approach included the use of flags, posters, banners, and giveaways like whistles, caps, and balloons to draw families to the booths.

A critical aspect of Rotary’s contribution was in vaccine delivery, where Rotarians personally transported vaccines from central depots to local booths, ensuring the cold chain was maintained. This task saw the use of various transportation methods, from vehicles to animals and boats, showcasing Rotary’s commitment to reaching every child.

These innovative strategies and experiences in India are now being applied to overcome challenges in the remaining endemic regions, demonstrating Rotary’s integral role in the global fight against polio. India’s contribution extends beyond its borders, with the nation sharing its successful strategies and learnings to support polio eradication efforts worldwide.