ERADICATING POLIO IN INDIA

Two weeks ago India announced that 12-months had elapsed since the country last recorded a new case of polio. This is cause for celebration but unfortunately this week it appears that the disease may have resurfaced in West Bengal where an 18-month old girl has been admitted to hospital suffering from paralysis: a symptom of polio.

According to The Hindustan Times, it will be at least two weeks before results of a test can confirm if the child has the disease. WHO (World Health Organization) officials are playing down the likelihood of polio on this occasion but concern is inevitable because this incident has cropped up in the same state as India’s last recorded case of the disease in January 2011. If nothing else, this unfortunate news is a timely reminder that Nata Menabde, the India head of the WHO, was right when she cautioned,

“We are all subject to relaxing a bit when we have achieved some goal but we simply cannot allow that to happen with polio”
A congregation gathers to hear Naseem Ahmed, Vice Chancellor of Aligarh Muslim University, speak after Friday prayers at the Jamma Masjid in Moradabad. His speech is organised by Unicef and focusses exclusively on the subject of polio eradication. Urging people not to be pessimistic, Ahmed insists that polio is a disease that can only be defeated by unified action. ..India is one of only four countries in the world reported to suffer endemic polio. Only 66 new cases of the disease were reported in India in 2005. But in 2006 that figure leapt ten-fold. In September, UN Secretary General Kofi Annan wrote to Indian Prime Minister Manmohan Singh expressing concern at the new polio outbreak. The Indian government, together with partners including Unicef and Rotary International has embarked on a renewed effort to eradicate polio. Overcrowded areas of poor sanitation are particularly susceptible to the virus. Focusing on the poor north Indian states of Uttar Pradesh and Bihar which between them are home to more than 250 million people, Unicef is coordinating the largest public health drive in the world. The task is to vaccinate all children under the age of five during a series of vaccination rounds. Unicef has mobilised thousands of volunteers to administer and supervise the vaccination effort. Unicef has also recruited people with influence to encourage communities to have their children protected against polio. Misinformation, rumours and a frustration with the lack of other health services mean that many households, particularly in Muslim areas, resist vaccination. ..Photo: Tom Pietrasik.Moradabad, Uttar Pradesh, India..November 10th 2006 (Tom Pietrasik)

A congregation gathers to hear Vice Chancellor of Aligarh Muslim University, Naseem Ahmed encourage polio vaccination after Friday prayers at the Jamma Masjid in Moradabad. Uttar Pradesh. India ©Tom Pietrasik 2006

The polio eradication effort in India – the largest public health drive in the world – has been an enormous and sometimes controversial undertaking. Funding from the Indian government, several philanthropic groups, the US Centers for Disease Control and Prevention, and the UN ensures that nearly a billion doses of oral polio vaccine have been administered annually.

Evening activity at Patna's Gia Ghat neighbourhood, close to the banks of the Ganges river. This area has become an informal terminal where inter-district buses pass into the city. Migrating communities provide potential for the polio virus to spread from district to district and transit points like these are a focus for Unicef's polio vaccination effort...India is one of only four countries in the world reported to suffer endemic polio. Only 66 new cases of the disease were reported in India in 2005. But in 2006 that figure leapt ten-fold. In September, UN Secretary General Kofi Annan wrote to Indian Prime Minister Manmohan Singh expressing concern at the new polio outbreak. The Indian government, together with partners including Unicef and Rotary International has embarked on a renewed effort to eradicate polio. Overcrowded areas of poor sanitation are particularly susceptible to the virus. Focusing on the poor north Indian states of Uttar Pradesh and Bihar which between them are home to more than 250 million people, Unicef is coordinating the largest public health drive in the world. The task is to vaccinate all children under the age of five during a series of vaccination rounds. Unicef has mobilised thousands of volunteers to administer and supervise the vaccination effort. Unicef has also recruited people with influence to encourage communities to have their children protected against polio. Misinformation, rumours and a frustration with the lack of other health services mean that many households, particularly in Muslim areas, resist vaccination. ..Photo: Tom Pietrasik.Patna, Bihar, India..November 17th 2006 (Tom Pietrasik)

Buses, rickshaws, pedestrian’s and cyclists compete for space close to a bus terminal in Patna’s Gia Ghat neighbourhood. Migrating communities provide potential for the polio virus to spread. Patna, Bihar. India ©Tom Pietrasik 2006

 Whilst the programme of vaccination against polio is important, by itself it is not enough. It must be part of a wider political campaign to address the social determinants of health, reduce inequalities and eradicate poverty. As Svea Closse says in her book Chasing polio in Pakistan,”

The root problem underlying ongoing polio transmission is poverty, not lack of vaccination. Yet the Polio Eradication Initiative concentrates solely on immunisation. In doing so, it draws attention away from political sources of inequality to focus on technical interventions.”
Supplementary Immunisation Activity (SIA) by a transit team working at Maharani Chowk barricade at Fatuha block in Patna city. This is at transit point between Eastern Bihar, central Bihar and Jharkand. It is feared that polio is spread by migrant populations traveling routes like these. The bamboo barricade is manned by three police men especially for the SIA. Mobilisers include Unicef Block Mobilisation Coordinators (BMCs) together with partners including Care. The vaccinators are Suresh Prasad (in yellow vest); Sanjay Kumar (in yellow vest left); Nirmula Devi (not in photo) and Guria Devi (not in photo). The vaccinators immunised 538 children during this four hour shift...Photo: Tom Pietrasik.Patna, Bihar, India..November 15th 2006 (Tom Pietrasik)

A health-worker checks whether children have received the polio vaccination while traveling by bus on a route linking the states of Bihar and Jharkand. Migrant populations, many of them traveling such routes in search of work have the potential to spread polio across state-boundaries. Patna, Bihar. India ©Tom Pietrasik 2006

It was in 2006, a year during which over 600 new cases of polio were recorded in India, that I was asked by UNICEF to photograph vaccination efforts among the 250 million people of Uttar Pradesh and Bihar. Across these two states that sweep through northern India, overcrowded living conditions, poor sanitation and poverty mean there is a particularly high risk of polio transmission.

Prior to a day of mass-polio-vaccination, volunteers listen to doctor Akileshwar Singh demonstrate the method of administering the vaccine. The workshop, funded by Unicef, is held in a community health centre in J.P. Nagar. These volunteers will administer the vaccine on trains and in buses. Transport hubs have been identified by Unicef as key sites for the transmission of polio across states...India is one of only four countries in the world reported to suffer endemic polio. Only 66 new cases of the disease were reported in India in 2005. But in 2006 that figure leapt ten-fold. In September, UN Secretary General Kofi Annan wrote to Indian Prime Minister Manmohan Singh expressing concern at the new polio outbreak. The Indian government, together with partners including Unicef and Rotary International has embarked on a renewed effort to eradicate polio. Overcrowded areas of poor sanitation are particularly susceptible to the virus. Focusing on the poor north Indian states of Uttar Pradesh and Bihar which between them are home to more than 250 million people, Unicef is coordinating the largest public health drive in the world. The task is to vaccinate all children under the age of five during a series of vaccination rounds. Unicef has mobilised thousands of volunteers to administer and supervise the vaccination effort. Unicef has also recruited people with influence to encourage communities to have their children protected against polio. Misinformation, rumours and a frustration with the lack of other health services mean that many households, particularly in Muslim areas, resist vaccination. ..Photo: Tom Pietrasik.J.P. Nagar, Uttar Pradesh, India..November 8th 2006 (Tom Pietrasik)

Training workshop for polio vaccination teams run by Dr Akileshwar Singh in Joya community Health Centre, J.P. Nagar. Uttar Pradesh. India ©Tom Pietrasik 2006

I discovered that a frustration with the lack of other health services means that many households resist vaccination. Unfounded concerns regarding the safety of the vaccine and rumours of an “American-campaign” of forced-sterilisation further undermine efforts to administer the vaccine. UNICEF’s strategy has been to concentrate efforts on communication as a means of addressing such obstacles while at the same time mobilising of thousands of volunteers to administer and supervise the vaccination. As I photographed communities in Moradabad and Patna, I realised that civic participation is fundamental to the success of any public health initiative.

The success of India’s polio eradication efforts would not have been achieved without the involvement of academics, religious leaders and others with local influence to mobilise communities to have their children protected against polio.

You can see more of my photographs on India’s polio eradication effort here.

Children lead a procession through the lanes of Hinduni Musahar village near Patna city. The procession, known as "social barricading" carries a message calling for parents to vaccinate their children against polio before going to harvest. The residents of the village and the children on the procession are from the very low-caste Musahar community. Without proper sanitation, and with literacy running at less than 2 percent, the Musahar are particularly susceptible to polio. They are one of the communities to which Unicef are directing their polio vaccination effort. ..India is one of only four countries in the world reported to suffer endemic polio. Only 66 new cases of the disease were reported in India in 2005. But in 2006 that figure leapt ten-fold. In September, UN Secretary General Kofi Annan wrote to Indian Prime Minister Manmohan Singh expressing concern at the new polio outbreak. The Indian government, together with partners including Unicef and Rotary International has embarked on a renewed effort to eradicate polio. Overcrowded areas of poor sanitation are particularly susceptible to the virus. Focusing on the poor north Indian states of Uttar Pradesh and Bihar which between them are home to more than 250 million people, Unicef is coordinating the largest public health drive in the world. The task is to vaccinate all children under the age of five during a series of vaccination rounds. Unicef has mobilised thousands of volunteers to administer and supervise the vaccination effort. Unicef has also recruited people with influence to encourage communities to have their children protected against polio. Misinformation, rumours and a frustration with the lack of other health services mean that many households, particularly in Muslim areas, resist vaccination. ..Photo: Tom Pietrasik.Patna, Bihar, India..November 16th 2006 (Tom Pietrasik)

Children lead a procession through the lanes of Hinduni Musahar village calling for parents to vaccinate their children against polio before going to harvest. The village and all the children photographed are from the Musahar community, a low-caste community working mainly as agricultural day-wage laboureres. Patna, Bihar. India ©Tom Pietrasik 2006