After polio, India battles measles

Polio eradication success storyneeds to be replicated to tackle deadlier diseases

Having crossed a monumental milestone by eradicating polio, India cannot rest on its laurels. It still has to traverse a long road in tackling many other deadlier diseases, such as measles, that pose danger to the people’s health. It needs to build, more vigorously, on the success of the polio eradication strategy to ensure that more children are immunised against other dangerous illnesses.

Eradication of measles demands immediate attention. A highly-contagiousvirus-causing severe disease, measles could cause illness,disabilityor death.  It continues to be a major cause of childhood morbidity and mortality. Nearly 80,000 Indian children die each year due to measles and its complications, amounting to four percent of under-five deaths, recent studies show. The disease spreads like wildfire in communities where children are not vaccinated. Since the virus reduces immunity, children who have had measles–mainly those who are undernourished–may die of pneumonia, diarrhoea and encephalitis later on.

Measles vaccines are safe, effective andprovide long-lasting protection. Globally,  the crucial strategies being followed for reducing death due to measlesincludehighcoverage of measles first dose, sensitive laboratory supported surveillance, appropriate case management, andproviding second dose of measles vaccine.

Prior to 2010, India was the only country that had not introduced a second dose of measles vaccine in its national immunisationprogramme. However, in November 2010, with support from WHO, India launched a massive polio-style measles vaccination project in 14 high-burden states, in a three-phase campaign.

The biggest public health success, the anti-polio campaign, was achieved through a massive and sustained immunisationprogramme, It began in 1995 with severe disadvantages. Since thenintense, six-day polio vaccination campaigns were run several times a year across the country. During each campaign, 2.3 million vaccinators went door-to-door, visiting 191 million homes to vaccinate 172 million children a year.

The polio eradication campaign, led by the Government and its partners, including the World Health Organization, UNICEF and Rotary International, remains one of the biggest, most complex, and the most meticulously implemented vaccination campaigns in human history.

The best practices and lessons learned from the polio eradication initiative are being applied to get rid of measles. It has been demonstrated that it is possible to achieve ambitious health goals through high vaccination coverage, even in areas with weak health systems.

Measles being highly infectious, it is imperative that at least 95 percent of all children receive two doses of the vaccine. In case 15 percent of vaccinated children fail to develop immunity from the first dose it would mean that only 80 per cent are fully immunized; and hence an outbreak is likely.

Trained health workers found an unexpectedly high number of infections. The Government responded by establishing a system to ensure that every child who receives a first dose of the vaccine routinely gets a second. It also initiated ‘catch-up’ campaigns in areas where first-dose coverage was less than 80 percent.With two phases of the measles vaccination campaign completed, the third phase is on.

Experts say it is not yet possible to assess the national impact, as the campaign is in different phases in different states. In some states the impact has been dramatic, they add. According to DrNataMenabde, WHO Representative in India, the lessons learnt through the polio programme are working. ‘The laboratory-based field surveillance network, which we are supporting, is providing vital assistance for measles control activities in the country,’ she says.

However, hardly any awareness about the disease and its eradication is being created.  During the different phases of the polio campaign, mass awareness was generated through banners, posters and hoardings. Celebrities motivated the masses through television and radio, and adsappeared in regional newspapers. More importantly, vaccinators were trained to enhance their interpersonal skills, so that they could mobilise communities better.In some areas where communities remained hesitant, local, religious and opinion leaders were involved in spreading the campaign.

Similar strategies need to be adopted in eradicating measles. Fighting the disease poses many other challenges, including the need for increasing the strength of trained staff at all levels;  raising public demand for and confidence in vaccines;improving vaccine stock and cold chain management: anddeveloping a strong reporting and management system.Since, more than one-third of all measles deaths worldwide are among children in India, the meagre spending on public health, barely one percent of GDP, is quite low.

The phenomenal success of polio eradication was due to political will, commitment of adequate financial resources, technological innovation and the tireless and strenuous efforts of millions of workers, including more than 2.3 million vaccinators. It remains to be seen if the next government accords high importance to eradicating more diseases starting with measles.