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Polio's Last Mile
India fights back after largest outbreak in recent history

Polio was meant to be gone. By 2002. That's what health officials hoped would be the result of the Global Polio Eradication Initiative, launched in 1988.

Although aggressive vaccination programs to protect children have cut an annual 350,000 polio cases worldwide to fewer than 2,000 in seven countries, the disease has made a comeback, mainly in Nigeria, Pakistan, and India. Cases in India rose from 268 in 2001 to 1,600 in 2002.

How did this disease that—by invading the spinal cord and brain can cause muscle weakness and atrophy or, in severe cases, permanent paralysis or death—return to India with such a vengeance after near eradication?

A majority of India's victims live in Uttar Pradesh, the country's most populous state and one of its poorest. People are crowded together, with open sewers the norm. Such conditions favor transmission of poliovirus, which lives and replicates in the intestines and spreads either from person to person or by ingestion of anything that is contaminated with infected fecal material.

Another contributing factor: Nearly two-thirds of polio sufferers in Uttar Pradesh are Muslims. The fact that male health care workers cannot enter Muslim homes has complicated immunization efforts by the Indian government and other organizations helping in the fight to eradicate the disease: the World Health Organization (WHO), the U.S. Centers for Disease Control and Prevention (CDC), UNICEF, and Rotary International. "Muslim women aren't supposed to let male strangers into their homes," says Monique Petrofsky, a CDC nurse epidemiologist who accompanied an immunization team.

Repeated visits from health care workers also raise suspicions in Muslim communities distrustful of the Hindu government's motives. "All of a sudden workers show up with these drops, and people wonder: Is this birth control? Will this make my child sterile?" says Bruce Aylward, WHO's coordinator for the Global Polio Eradication Initiative. Many parents refuse multiple vaccinations for their children, unaware that at least four doses are needed.

Still another cause of the upswing may have been overconfidence. With cases declining sharply, the Indian government in 2001 reduced mass immunizations everywhere, including in high-risk zones. In hindsight it was a tragic error.

But now the government has changed tactics, targeting the needs of the poor, including the country's Muslim minority. Trusted local schoolteachers, academics, doctors, and imams have joined immunization teams. Mosques announce vaccination days on the same loudspeakers used to call worshipers to prayer. And a woman is now included on nearly every team.

The hope is to eradicate polio from India—and from the Earth—by 2005. "We know villages and even specific blocks where children are not immunized," says a spokesman for the National Polio Surveillance Project in New Delhi. "We are closing in on this virus once and for all." 

—Bijal P. Trivedi

Web Links

Polio Eradication
The Global Polio Eradication Initiative website offers information on poliovirus, international efforts to eradicate the disease, the number of cases worldwide, and provides links to GPEI partner organizations.

U.S. Centers for Disease Control and Prevention
Need details on the treatment and prevention of a specific disease? Want to track down a health statistic? Curious as to what vaccinations are required when traveling abroad? What diseases are candidates for eradication in the future? Visit the CDC's website for the answers to these and many, many more of your health- related questions.

Global Health Council
The Global Health Council website provides a searchable database of news articles covering crucial health issues.

Free World Map

Beers, Mark. The Merck Manual of Medical Information. Simon and Schuster, 2003.

Boseley, Sarah. "Fear of polio revival prompts health experts to change tack," The Guardian, May 22, 2003.

"Polio eradication goal pushed to 2005," The Times of India, May 16, 2003.

"Polio: India's dramatic rise in new cases threatens global eradication program," Vaccine Weekly, June 18, 2003.

Pradhan, Sharat. "Uttar Pradesh has most polio cases in India," Indo-Asian News Service, December 29, 2002.

Waldman, Amy. "Distrust reopens the door for polio in India," New York Times, January 19, 2003.

World Health Organization. Global Polio Eradication Initiative: Progress 2002. Department of Vaccines and Biologicals, WHO, 2003.


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