Bangladesh: home-grown solutions helped stop polio and keep this country polio-free

Bangladesh – once known for its poverty and dense population – is now one of the world’s vaccination stars. The country’s success in protecting its people from vaccine-preventable disease has its roots in the late 1950s, with campaigns against tuberculosis. By 1979, Bangladesh entered a new era of vaccination through the Extended Program on Immunization (EPI).

The EPI drive began at a time when the world’s most densely populated country was battered by high disease and mortality of children, mostly from vaccine preventable diseases. Polio came as an additional challenge to the already fragile health system. More and more children were diagnosed with paralysis in late 1980s.

Health staff in Bangladesh transport vaccine carriers on a bike.
Health staff in Bangladesh transport vaccine carriers on a bike.
Rajiv Kumar

By the year 2000, however, Bangladesh was able to stop transmission of polio, despite the country’s considerable challenges. This achievement was made possible by the government’s strong commitment to routine immunizations, quality surveillance, regular National Immunization Days (NIDs) and facilitation of strong multi-sectoral collaborations.

Unfortunately, Bangladesh became yet another reminder that polio respects no borders when the disease re-emerged in Bangladesh via importation from neighboring India in early 2006. After 6 months of extensive operations, which included 6 rounds of special immunization days and mop-ups, polio was, once again, eradicated by November 2006.

Bangladesh has been enjoying polio-free status ever since.

Routine immunization as the root of polio success

Routine immunization had always been the foundation to popularize oral polio vaccines among parents in Bangladesh, says an EPI official in the country. “Routine immunization is the root of polio success in Bangladesh.”

Only 2% of Bangladeshi children under 5 years old were immunized before 1985, but this number jumped to 60% within 10 years following the introduction of routine immunizations in 1985. “This was the time when more and more people became confident of the positive impact of vaccines on their children’s welfare,” says the EPI official.

The motivation of parents and caregivers for child vaccination made polio immunization events more popular and successful. The country has to date observed 21 National Immunization Days for polio; the one in January 2014 reached confirmed coverage of 100%.

Home-grown solutions and micro planning

The country has followed the principle of “Think Globally, Act Locally,” with an importance on micro planning, the process of mapping the community down to the most basic level to ensure all children can be reached. Micro planning was done in each sub-district with the active participation of field workers, non-governmental organization (NGO) workers, municipal workers and supervisors. Trained managers, NGO trainers and WHO’s training and technical support network provided a micro-plan that addressed well in advance issues such as vaccinating special groups and solutions for hard to reach areas.

Effective communication and social mobilization

Bangladesh has a long reputation for effective communication in the fields of child immunization and family planning. Based on very active print and electronic media campaigns, the communication plan was devised accordingly to create a festival-like excitement to the immunization campaigns. This method has not only influenced policy levels, but also motivated over 250 000 young volunteers to support the programs. Loudspeaker announcement, or ‘miking’ as known locally, hyped up the level of anticipation at rural and semi-urban sites in the lead-up to immunization events.

Quality surveillance strengthens case detection

In addition to immunization campaigns, focus was also given to develop a strong, quality surveillance system to detect wild polio-virus cases. Bangladesh has implemented acute flaccid paralysis (APF) surveillance since 1996 to develop the desired surveillance system from primary healthcare to tertiary care levels, ensuring certification standards.

In 2013, a total of 2 412 AFP cases were detected, but none of those were found to be caused by wild polio-virus or vaccine derived polio-virus. Bangladesh has achieved all indicators of AFP surveillance performance and has been sustaining this achievement for over 10 years.

Two-pronged national preparation for sustenance

Bangladesh has developed a two-pronged plan of sustainability for after the anticipated certification of polio-free status of the World Health Organization South-East Asia Region. Dr Thushara Fernando, WHO Representative to Bangladesh, observes, “Now it is important to strengthen the surveillance and further improve routine immunization to sustain our progress.”