Surveillance, at the heart of India’s polio success story

Woman and child after vaccination

Surveillance was the game-changer in the fight against polio. It marked a strategic shift in India’s polio eradication efforts.

“The setting up of a surveillance system proved to be the most important milestone in the journey of polio eradication in India as it formed the backbone of the eradication drive by helping identify areas and populations that were at risk and the type of poliovirus circulating in different areas besides measuring progress,” explains Dr Nata Menabde, WHO Representative to India.

“This information in turn led to the development of various strategies that helped to cover these populations and areas better,” she further elaborated.

New strategies

Examples of such strategies include the development of the underserved strategy to improve coverage of the underserved and marginalized populations, the Kosi operational plan to vaccinate children living in the access compromised areas around the Kosi river in Bihar and approaches to cover the most vulnerable children such as newborns and those that belonged to migrant populations.

National Polio Surveillance Project

Polio surveillance started in 1997 with WHO setting up the National Polio Surveillance Project to support the government with early detection and prompt investigation of children with recent paralysis. Investigations included testing stool samples of paralysed children in WHO accredited laboratories to identify polio cases.

Polio surveillance in India is a highly sensitive and high quality surveillance model. It is a laboratory-backed system that extends to all parts of the country and has enrolled more than 40 000 health facilities from the public, private and non-formal sector to report paralytic cases. Stool specimens from these cases are collected and sent to one of the eight WHO accredited laboratories in the country to rule out polio. The surveillance system is instrumental in generating real time, credible data that helps to identify areas and populations at risk. Tailored strategies to ensure high coverage in these areas are subsequently developed.

To further strengthen the system, environmental surveillance was initiated in 2001 in Mumbai. This was later extended to Delhi in 2010 and subsequently to Patna and Kolkata (2011). This was further strengthened with the inclusion of Punjab and Gujarat in 2013.

“The WHO supported surveillance system for polio in India not only meets all of these requirements but also surpasses all quality performance indicators and standards that are recommended globally for such a system,” said Dr Menabde.