A watershed moment occurred in global health Thursday: The World Health Organization said that its Southeast Asian region is now officially polio-free.
The milestone means that 80 percent of the world's population now lives without fear of the paralyzing disease.
The certification came on the heels of India's successful fight against the disease. The huge nation hasn't reported a case of the wild polio virus in three years. Not long ago, India had more cases of polio than any other country in the world.
Questions still remain, though, about how India will stay free of polio and whether the country can apply the strategies against polio to other preventable diseases.
India's polio-free status is the culmination of a grueling battle that sent millions of health workers down alleys, up mountains and across deserts to reach every child in India during the course of the last 19 years.
But for many young men and women now in their 20s, the country's achievement comes too late. India's suffering at the hands of polio is still readily apparent in the reconstructive surgery ward of St. Stephen's Hospital in Delhi.
Mushtareen Khan lies in the women's ward. She caught polio two decades ago when she was 10 months old and recalls what it felt like to grow up with no use of her legs. "Everyone can walk and go, and I'm not able to," she says.
Khan came to this hospital crawling, unable to even stand up, says Dr. Mathew Varghese, who has operated on thousands of polio patients. "She has both her hips and both her knees severely deformed," he says.
In the hope of being able to walk, Khan has already undergone four surgeries on her legs, and will need two more before they are completely straightened.
"She's almost there," Varghese says. "Another maybe two, three weeks, she'll be straight."
Khan's mother seems to overflow with happiness at her daughter's prognosis — which, Varghese points out, will make the young woman more eligible to be married.
Down the road from St. Stephen's Hospital, a ceremony unfolded at the WHO headquarters that thrilled the doctor. Health care workers who had toiled to end polio were lauded while medallions were handed out to members of an independent panel that reviewed evidence that showed 11 countries in Southeast Asia, including India, have eradicated polio.
But the battle against the virus is far from over. While reported cases have declined in Afghanistan and Nigeria, Pakistan, India's neighbor, now has the highest number of cases in the world.
Despite the progress in India and South Asia, WHO's Assistant Director General for Polio and Emergencies, Dr. Bruce Aylward, says there can be no respite if the goal of global eradication of polio is to be achieved by 2018.
"Now the big danger is switched to another virus, called complacency," Aylward says. "And it's as hard to get rid of, sometimes, as the polio virus was. So the challenge, then, is maintaining coverage afterwards, until the whole world is certified polio-free."
But still, India's success against polio is already paying off, says Dr. Poonam Khetrapal Singh, the deputy director of WHO's Southeast Asia regional office. She says the polio campaign has laid the foundation to better protect children from illness and premature death by providing a template for more rigorous routine immunizations. "The polio eradication experience now can be used for other vaccine-preventable diseases," she says. She'd like to eliminate measles next.
ROBERT SIEGEL, HOST:
Today, a milestone in global health. India, Indonesia and Thailand are all officially polio free. In fact, the World Health Organization says that about its entire Southeast Asian region, and that accounts for a quarter of the world's population. It moves the world closer to global eradication of polio. An independent commission certified the finding today in New Delhi and NPR's Julie McCarthy reports the achievement is especially hard won there.
Just a few years ago, India had more cases of polio than any country in the world.
JULIE MCCARTHY, BYLINE: India's polio-free status is the culmination of a grueling battle that sent millions of health workers down alleys, up mountains and across deserts to reach every child in India for the past 19 years. For many young men and women, now in their 20's, that achievement comes too late. India's suffering at the hands of polio is readily apparent still in the reconstructive surgery ward of St. Stephen's Hospital in Delhi.
Mushtareen Khan is a polio victim struck down when she was 10 months old. Dr. Mathew Varghese says she came into this hospital crawling.
What's involved in her reconstruction, how many surgeries does she have to go through?
DR. MATHEW VARGHESE: This young girl, Mushtareen, she's in her 20's. She came crawling. She couldn't stand. And she has both her hips, both her knees severely deformed. So four surgeries, essentially.
MCCARTHY: Petite Mushtareen will undergo two more surgeries at no cost on her legs as thin as matchsticks. She recalls what it was like to have to crawl when one knee was up around her ear.
MUSHTAREEN KHAN: (Foreign language spoken)
VARGHESE: (Foreign language spoken)
MCCARTHY: Everyone can walk and go and I'm not able to. I'm crawling.
Doctor, when will she walk out of here?
VARGHESE: She's almost there. Another maybe two, three weeks she'll be straight. And next time if you come she'll be standing upright.
MCCARTHY: India's new polio-free status means it has not reported a single case of wild polio virus in three years. Mushtareen's mother demurs on that news, but seems to overflow with happiness at her daughter's prognosis which, Dr. Varghese points out, will make her more eligible to be married.
UNIDENTIFIED WOMAN: We know begin with Bangladesh. His Excellency, Mr. Zahid Malik...
MCCARTHY: Down the road from the hospital, a ceremony unfolded at the WHO headquarters that thrilled Dr. Varghese, who has spent a career operating on thousands of polio patients. Health workers were lauded for their success and medallions were handed out to members of an independent panel that reviewed evidence that 11 countries have eradicated polio.
Panel chairman Dr. Supamit Chunsuttiwat declared...
DR. SUPAMIT CHUNSUTTIWAT: The Southeast Asia region is free from wild polio virus transmission.
MCCARTHY: The WHO says as of today, 80 percent of the world's population is free of polio but the battle's not over. Hotspots remain in Pakistan, Afghanistan and Nigeria. Despite the progress in India and South Asia, the World Health Organization's Dr. Bruce Aylward said there can be no respite in the momentum if the goal of global eradication of polio is to be achieved by 2018.
DR. BRUCE AYLWARD: Now the big danger is switched to another virus called complacency and it's as hard to get rid of sometimes as the polio virus was. So the challenge then is maintaining coverage afterwards until the whole world is certified polio-free.
MCCARTHY: Dr. Poonam Khetrapal Singh, the WHO's Southeast Asia regional director, says the polio campaign provides strategies for routine immunization that will better protect children from illness and premature death.
DR. POONAM KHETRAPAL SINGH: The polio eradication experience now can be used for other vaccine preventable diseases.
MCCARTHY: She'd like to the next priority to be eradicating measles.
Julie McCarthy, NPR News, New Delhi.
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