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India without polio

That is a big success. India’s anti-polio campaign began in 1995 with severe disadvantages. The country spends little on public health, barely 1% of GDP, and has been awful at immunising children. Too few parents know the basics of hygiene and nutrition, let alone the benefits of vaccines. India has bad sanitation, large remote populations and vast migration from village to slum.

Yet much has gone right. The anti-polio campaign received over $3 billion, mostly from within India itself, and deployed 2.4m vaccinators. Unicef, the World Health Organisation (WHO), Rotary International and the Gates Foundation (both charities) gave technical help. Religious leaders reassured people suspicious about vaccinations, and politicians knocked on doors to make sure children took their medicine.

At the peak of coverage, 99.7% of the target population swallowed anti-polio drops, says Anuradha Gupta of the national health ministry. That is startlingly high, considering that a decade ago “universal” vaccination coverage for seven preventable diseases (such as diphtheria, tetanus, hepatitis B) was a pitiful 30% in Bihar, a big, poor northern state.

India’s campaign has been successful enough for its lessons to be applied in Pakistan, Afghanistan and Nigeria, the last places with endemic polio (foreign fighters may have reintroduced it to Syria, too). Vaccinators learned to attend especially to mobile populations, like seasonal workers at brick kilns, and found that many migrants are best reached not at home but in bus and railway stations.

Good monitoring was crucial, too. In Uttar Pradesh and Bihar, vaccinators visited 60m households several times a year, says Hamid Jafari of the WHO. To compile data on recipients, some 400,000 hard-to-reach population groups were carefully tracked and plotted, down to each household. Data passed early to decision-makers, at the district-official level, allowed a quick response to new cases.

India now looks more capable of fighting other, deadlier, diseases. It plans to eradicate measles by 2020. That killed 66,000 children a year as recently as 2010, half the world total that year. In the past three years 140m children have been injected with extra doses of measles vaccine, so the toll should have fallen. Universal vaccination coverage is rising, too. In Bihar it has reached 70%. Ms Gupta suggests that nationally it is above 78%.
The next step is to give the army of vaccinators more tasks. A vaccine is being developed against diarrhoea—responsible for the deaths of many of the 1.4m Indian infants and toddlers who still die every year (see chart). The vaccinators could also lead a planned campaign on hygiene and nutrition. A screening programme, launched in 2012, involves 5,000 mobile health centres. These have diagnosed 700,000 children with one of 30 common medical conditions and treated, so far, 100,000 of them. Spreading education, as well as care, would bring greater success yet.

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