Making polio history

One doctor’s dream: to keep India’s last polio ward empty

Polio once claimed thousands of victims a year in India. But it’s two years since the last case. Jeremy Laurance discovers why

After 20 minutes navigating the foetid alleyways of Old Delhi's market looking for someone to mend the broken winder on my watch (repair cost: 65p), I was picking my way through the river of humanity flowing down Chandi Chowk, the main shopping street, when a man perched on a toy trike emerged from the crowd and hurtled down a steep kerb straight towards me, grinning crazily. As I dodged and glanced down I glimpsed a pair of twisted limbs sticking out at an impossible angle, ready to fell all comers.

Was he a polio victim? Almost certainly. Many of those who crawl along the city's streets dragging useless limbs, begging for alms certainly are. They are a living memorial to a disease already banished from the West – and a warning of what lies in store should it ever return.

In the early 1990s there were 3,000 cases of paralytic polio each year in India. Now there are none.

In a country of 1.2 billion people, the monumental scale of that achievement – successfully vaccinating 95 per cent of children aged five and under – is a tribute to Indian diligence. India's passion for bureaucracy may burden businesses with paper work (and drive visa applicants to despair) but here has proved it can also save lives.

The centrepiece of the campaign is the national immunisation days (NIDs), begun in 1995, around which all other activities are organised. The aim is to vaccinate 172 million children under five on a single day, employing 2.5 million vaccinators who are moved in 155,000 vehicles (including boats, elephants and camels) carrying over six million ice packs (to keep the vaccine cool) and supplying over 700,000 vaccination booths – set up in hospitals, on street corners and out of the back of cars. The NID is followed by a five day mop up phase in which vaccinators move from house to house, following a meticulously planned route, seeking out those missed.

The task is a logistical nightmare. The local distribution centre for Mukundpur, north west Delhi, is in a dingy office in the Jagiwan Ram Government hospital where the boxes of vaccine are kept in a freezer. At 6.30am last Sunday the vaccine was loaded into insulated containers with a packet of ice – it must be kept between four and eight degrees centigrade – and dispatched in one of 15 vehicles to supply 160 booths. We followed one of the routes down narrow streets thick with mud after heavy rain, stepping carefully – in the absence of toilets, the roadway must serve. Feral dogs picked over piles of rubbish, waterbuffalo lolled in a weed-covered swamp nuzzling bags of waste, while a pair of drowned goats floated nearby, their bellies already swollen.

We found the first booth on an empty lot sandwiched between ramshackle breezeblock dwellings – four tables and a few chairs under an imposing red and yellow awning festooned with posters proclaiming in English and Hindi: "End polio now".

It was already mobbed with children attracted by two westerners, UK rotary club members from a group of 50 visiting the programme (at their own expense) to see how their donations were being spent – £30m raised since 1985 and counting. They had also come to provide moral support to Indian colleagues whose passion for the cause might be waning after a decade and a half of continuous effort. Their yellow polo shirts and foreign appearance were as big a draw as the plastic balls Rotary provided for each child as a reward.

Your reporter was asked to volunteer and donning the Rotary colours, a yellow and red waistcoat, I held the vial of pink vaccine, lifted straight from the ice bucket, above the head of 17-month-old Angel as her father, Raju Chaurasia, 32, struggled to hold her still.

I shook a couple of drops into the nozzle and squeezed. Angel scowled, licked her lips and grimaced (the vaccine has a bitter taste). One down, only 171,999,999 to go.

How did Raju know about the vaccination day? He had seen it on TV. Why had he come? "She is my daughter, and polio is deadly and I didn't want her to suffer." Angel had been several times before, he said. In high risk areas such as this the NIDs are followed by local immunisation days, as many as 10 times a year. Maintaining the momentum of the campaign is crucial to success – a country is only declared polio free three years after its last case which will fall in February 2014 in India's case.

Chris Yates, who has been bringing groups of UK Rotarians to participate in the NIDs for almost a decade, described how in Uttar Pradesh, a polio hotspot, a resurgence of the disease in 2007-8 was only curbed when Muslim religious leaders were persuaded to join a committee to promote the vaccine locally.

On a visit to Pakistan he was warned that western volunteers would not be welcome – their presence likely to fuel rumours of a Western plot against the Muslim community.

While India prays polio will not return, for some the vaccine has come too late. The disease robs those afflicted of hope of an independent life – and their families too.

At St Stephen's Hospital in the north of the city, Dr Matthew Varghese runs the only ward dedicated to polio sufferers in all of India, where he attempts to restore independence even to those worst affected, who may have been crippled for decades.

He showed a picture of a young boy whose trunk was so grossly twisted he could sit up only by supporting himself on his hands. His father's wish was that his son should go to school. But as long as the boy needed his hands to support himself, he could not hold a pencil.

"My dream is to make sure this ward remains empty," Dr Varghese said.

The virus: a childhood scourge

Until the 1950s polio outbreaks occurred regularly across the world, terrifying parents and causing death and disability to thousands of children.

The polio virus infects nerve cells, destroying muscle function and eliminating tendon reflexes, especially in the legs, leaving the victim severely paralysed. In the worst cases it spreads into the brain stem, destroying the nerve cells that control breathing and swallowing. Survival then depends on artificial ventilation – thousands were treated in iron lungs – and tube feeding until the acute phase of the illness is past.

It is an intestinal virus that penetrates the lining of the gut and becomes lodged in the lymph nodes. There it causes fevers and stomach upsets, and passes back into the faeces. It can survive for up to 60 days outside the body, and in the absence of good hygiene and sanitation it can contaminate drinking water.

Jeremy Laurance

The vaccine: a miracle cure

Albert Sabin argued that his oral polio vaccine, launched in 1960, could be used to eliminate the disease. Coming five years after Jonas Salk’s vaccine (made from killed virus and injected), it had two advantages: it was easy to administer and, as a live virus, produced a mild contagious illness that spread immunity.

A trial in the 1950s in Toluca, Mexico, a town with a 100,000 population in which polio had broken out, proved its potential. In four days Sabin’s team vaccinated 26,000 children and in weeks polio disappeared from Toluca.

The oral vaccine provides “mucosal” immunity in the gut. It prevents the virus – transmitted when children put dirty fingers in mouths – penetrating the gut wall multiplying and causing disease. But this immunity is limited, hence the need for repeated doses.

In 1995 India used a trivalent vaccine against three types of the virus. Type 2 was eradicated in 1999, but not Type 3 and Type 1. Single vaccines were introduced in 2005 for each type and alternated each year, but Type 3 spiked in 2007-8. In 2010 a bivalent vaccine was introduced –and within a year, India had recorded its last polio case.

Jeremy Laurance

Life and Style
tech
Sport
Farah returns to the track with something to prove
Commonwealth games
News
John Barrowman kisses his male “bride” at a mock Gretna Green during the Commonwealth Games opening ceremony
peopleBarrowman's opening ceremony message to Commonwealth countries where he would be sent to prison for being gay
Voices
voicesGood for Lana Del Rey for helping kill that myth, writes Grace Dent
PROMOTED VIDEO
Life and Style
ebookA wonderful selection of salads, starters and mains featuring venison, grouse and other game
Sport
Shinji Kagawa and Reece James celebrate after the latter scores in Manchester United's 7-0 victory over LA Galaxy
football
Arts and Entertainment
The Tour de France peloton rides over a bridge on the Grinton Moor, Yorkshire, earlier this month
film
Life and Style
fashion Designs are part of feminist art project by a British student
News
Very tasty: Vladimir Putin dining alone, perhaps sensibly
news
Life and Style
Listen here: Apple EarPods offer an alternative
techAre custom, 3D printed earbuds the solution?
Arts and Entertainment
Top guns: Cole advised the makers of Second World War film Fury, starring Brad Pitt
filmLt-Col Steven Cole is the man Hollywood calls when it wants to borrow a tank or check a uniform
News
Snoop Dogg pictured at The Hollywood Reporter Nominees' Night in February, 2013
people... says Snoop Dogg
News
The University of California study monitored the reaction of 36 dogs
sciencePets' range of emotions revealed
Arts and Entertainment
A scene from Shakespeare in Love at the Noel Coward Theatre
theatreReview: Shakespeare in Love has moments of sheer stage poetry mixed with effervescent fun
News
Joining forces: young British men feature in an Isis video in which they urge Islamists in the West to join them in Iraq and Syria
newsWill the young Britons fighting in Syria be allowed to return home and resume their lives?
Arts and Entertainment
The nomination of 'The Wake' by Paul Kingsnorth has caused a stir
books
Independent
Travel Shop
the manor
Up to 70% off luxury travel
on city breaks Find out more
santorini
Up to 70% off luxury travel
on chic beach resorts Find out more
sardina foodie
Up to 70% off luxury travel
on country retreats Find out more
Latest stories from i100
Have you tried new the Independent Digital Edition apps?

ES Rentals

    Independent Dating
    and  

    By clicking 'Search' you
    are agreeing to our
    Terms of Use.

    iJobs Job Widget
    iJobs General

    General Cover Teacher

    £100 - £105 per day: Randstad Education Cardiff: Secondary Teachers of all sub...

    Associate Recruitment Consultant

    £18000 - £23000 per annum + OTE: SThree: SThree are a global FTSE 250 busines...

    English Teacher

    £110 - £130 per day + Pay between ?110 - ?130 Day: Randstad Education Cardiff:...

    SAP Deployment Manager

    £480 per day + competitive: Progressive Recruitment: SAP Deployment Manager-Ta...

    Day In a Page

    Screwing your way to the top? Good for Lana Del Rey for helping kill that myth

    Screwing your way to the top?

    Good for Lana Del Rey for helping kill that myth, says Grace Dent
    Will the young Britons fighting in Syria be allowed to return home and resume their lives?

    Will Britons fighting in Syria be able to resume their lives?

    Tony Blair's Terrorism Act 2006 has made it an offence to take part in military action abroad with a "political, ideological, religious or racial motive"
    Beyoncé poses as Rosie the Riveter, the wartime poster girl who became a feminist pin-up

    Beyoncé poses as Rosie the Riveter

    The wartime poster girl became the ultimate American symbol of female empowerment
    The quest to find the perfect pair of earphones: Are custom, 3D printed earbuds the solution?

    The quest to find the perfect pair of earphones

    Earphones don't fit properly, offer mediocre audio quality and can even be painful. So the quest to design the perfect pair is music to Seth Stevenson's ears
    US Army's shooting star: Lt-Col Steven Cole is the man Hollywood calls when it wants to borrow a tank or check a military uniform

    Meet the US Army's shooting star

    Lt-Col Steven Cole is the man Hollywood calls when it wants to borrow a tank or check a military uniform
    Climate change threatens to make the antarctic fur seal extinct

    Take a good look while you can

    How climate change could wipe out this seal
    Should emergency hospital weddings be made easier for the terminally ill?

    Farewell, my lovely

    Should emergency hospital weddings be made easier?
    Man Booker Prize 2014 longlist: Crowdfunded novel nominated for first time

    Crowdfunded novel nominated for Booker Prize

    Paul Kingsnorth's 'The Wake' is in contention for the prestigious award
    Vladimir Putin employs a full-time food taster to ensure his meals aren't poisoned

    Vladimir Putin employs a full-time food taster

    John Walsh salutes those brave souls who have, throughout history, put their knives on the line
    Tour de France effect brings Hollywood blockbusters to Yorkshire

    Tour de France effect brings Hollywood blockbusters to Yorkshire

    A $25m thriller starring Sam Worthington to be made in God's Own Country
    Will The Minerva Project - the first 'elite' American university to be launched in a century - change the face of higher learning?

    Will The Minerva Project change the face of higher learning?

    The university has no lecture halls, no debating societies, no sports teams and no fraternities. Instead, the 33 students who have made the cut at Minerva, will travel the world and change the face of higher learning
    The 10 best pedicure products

    Feet treat: 10 best pedicure products

    Bags packed and all prepped for holidays, but feet in a state? Get them flip-flop-ready with our pick of the items for a DIY treatment
    Commonwealth Games 2014: Great Scots! Planes and pipers welcome in Glasgow's Games

    Commonwealth Games 2014

    Great Scots! Planes and pipers welcome in Glasgow's Games
    Jack Pitt-Brooke: Manchester City and Patrick Vieira make the right stand on racism

    Jack Pitt-Brooke

    Manchester City and Patrick Vieira make the right stand on racism
    How Terry Newton tragedy made iron men seek help to tackle their psychological demons

    How Newton tragedy made iron men seek help to tackle their psychological demons

    Over a hundred rugby league players have contacted clinic to deal with mental challenges of game