The Vaccine is Ready: Can India do it Again?
TL;DR: India has the potential to abolish COVID-19 by using its lessons from the polio eradication campaign such as pulse vaccination, celebrity/institutional promotion, and intra-governmental coordination. Read on to better understand how India was able to tackle polio, how COVID-19 is different, and what are the criteria that are integral to saving millions of lives.
On March 27th, 2014, the World Health Organization released an announcement on its goal of eradicating polio globally. After successfully recording its third year of a polio-free population, India declared victory in its six decade war against polio, marking the eradication of the disease across Southeast Asia. Almost seven years later, the nation finds itself tackling a similar issue under far different circumstances. India, with a population of almost 1.4 billion, is preparing for the strenuous task of eradicating the virus that has desecrated the economy and health of the country for close to a year: COVID-19. With substantially less resources, a suffering economy, and a severe time crunch to shut down the virus, Indian officials must act swiftly and decisively to protect the population.
Before delving into the lessons we can take from Indian polio eradication, it’s important to note the differences between polio and COVID-19. From the late 20th century until the 2010s, polio was fearsome not only because the virus posed a severe threat, but also because it thrived in the Indian climate. Polio is mostly transmitted through the ingestion of water that has been contaminated by fecal matter. This was especially concerning for India considering the dangerously low percentage of population with access to clean drinking water and toilet facilities back in the 1990s and 2000s. In 1991, only 55.5% of the rural population had access to clean drinking water, growing to 73.2% a decade later. Furthermore, a vast majority of the Indian population lacked access to toilet facilities for these two decades. This made rural India the perfect environment for polio growth. On top of this, the general lack of healthcare for rural India made polio very dangerous with the potential to cause permanent respiratory and nervous problems from muscle and joint pain to paralysis. COVID-19, though, is primarily spread through contaminated respiratory droplets. This becomes a particularly large problem for more urban areas in which population density is high. As we’ve seen, this is one of the reasons COVID-19 became a pandemic while (most would argue) polio did not. COVID-19 affects the functions of the respiratory system and in most cases will not be more severe than a cough, fatigue, and fever. The real threat that it poses is to vulnerable populations — people of certain age groups and people with preexisting conditions that face permanent effects such as breathing problems and cardiac inflammation. Because of the infectiousness of the virus, we’ve seen many deaths and permanent damages to vulnerable groups. When it comes to immunization, high priority groups for Covid are likely to be the elderly, the youth, and frontline workers as compared to polio in which high priority groups were primarily infants from the age of 0–5.
With a country as populated and diverse as India, administering vaccines can be incredibly difficult. In order to understand what India can expect as COVID-19 immunizations are slowly being disseminated, I talked with Anup Sharma and Dr. Samir Kapur, communication consultants who played a major role in UNICEF’s India Unite to End Polio Now (IUEPN), part of the India’s Pulse Polio Program (PPP).
For India, the biggest and most obvious challenge will be to distribute vaccines throughout the country. Because of India’s immense rural population, which makes up approximately 65% according to the World Bank, it can be costly and time-consuming to reach small villages considering the relative lack of infrastructure around rural areas. That is why the PPP, and pulse vaccination in general, is such an effective strategy. By designating specific time intervals to target high risk groups, pulse vaccination, officials have time where they can coordinate the production, gathering, preparation, and transportation of vaccines. Additionally, since high priority groups are getting vaccinated first, the risk that the virus poses decreases rapidly. It also allows groups that are approaching an age group that is considered vulnerable to receive the vaccine in time. This strategy was used with both polio and measles and proved to be incredibly effective in protecting vulnerable groups rapidly while also slashing the spread of the virus.
However, one large issue during the PPP that Sharma points out has more to do with the ideology of many Indians. “Religious taboos in administering vaccines was [one of] the biggest challenges.” Because of the alleged use of bovine and porcine cultures in creating vaccines, some religious leaders had condemned the vaccines. There was a false doctrine that administering the polio drop was unethical and “against the ethos of religion”. This problem more or less vanished with the success of the PPP. The criticism of cultural and religious leaders that spoke against vaccines was not powerful enough to create a resistance that could prevent the nation from developing herd immunity, and as the polio-caused mortalities and health issues decreased, the anti-vaccine doctrine dissipated. However, with the perceived volatility of the COVID-19 vaccine and the lack of orally administered vaccines, it seems that many will refuse the vaccine because of concern over safety. According to the Edelman Trust Barometer 2021, approximately 51% of Indians said they would be willing to take the vaccine immediately upon availability. 29% have said they would wait 6–12 months. That leaves 20% of Indians that would refuse a vaccine. For polio, approximately 80% of the population needed to be vaccinated to achieve herd immunity. For Covid, however, the number is not known. If not enough Indians take the vaccine to achieve herd immunity, it’s likely that Covid persists as a disease. It is vital that enough of the population takes immunizations in order to protect vulnerable people that may have allergies or other adverse reactions to the COVID-19 vaccine and can’t be vaccinated themselves.
Another factor in India’s ability to eradicate Polio was the role of NGOs and foreign aid. The World Health Organization, UNICEF, and Rotary International played an integral part in aiding the Indian Government, particularly in mobilizing resources. External aid was one of the reasons that, financially, India could afford to start multiple regional campaigns against polio — the cost of personnel and vaccine mobilization was covered. With the urgency of COVID-19 globally, it is unlikely that the UN and multinational NGOs can concentrate the same efforts on India in the near future. With less aid to do so, it will be more important than ever for local, state, and central governments to work together in the effort of coordinating the production, gathering, preparation, and transportation of vaccines. Kapur concurred, saying it was vital to “ensure the involvement of central and state resources and for [governments] to work in tandem for a common cause.” NGOs based within India itself will also be integral to aiding efforts, especially in high priority areas like Maharashtra and potentially UP and Bihar due to the large populations and high population density.
There are a lot of lessons that can be learned from the polio eradication campaign. A Pulse Program, as mentioned above, was and will be vital in order to mobilize resources for COVID-19 eradication. This gives officials enough time to coordinate next steps, import vaccines, and mobilize personnel to distribute and administer the vaccines. With a population of 1.4 billion people (140 crore), there is the need for an immense amount of immunizations. The feat of rapidly producing vaccines will be difficult, and until then, India will need to plan and prepare several pulses targeting vulnerable populations. There is another significant strategy used in the polio eradication campaign that can be emulated with COVID-19: “Utilizing various celebs across all strata of society.” As Kapur pointed out, marketing the campaign with celebrities and leaders was a significant reason that India was able to eradicate polio. Because actors and religious leaders play a major role as societal role models, the UN reached out to a number of individuals and institutions to collaborate to appeal for vaccines. Amitabh Bachhan, one of the most influential and well-known Indian actors and celebrities in the world, became an ambassador for UNICEF to promote the benefits and necessity of the polio drop. His voice was one reason that the nation united in order to eradicate polio. Similarly, the UN turned to a number of religious institutions such as Aligarh Muslim University to appeal about the safety of the polio drop. This partnership and many others were instrumental in eliminating stigma.
This type of collaboration between the Indian government and national leaders/celebrities can help call attention to the need for the vaccine, especially in those that are deterred because of misinformation and religious reasons.
In 2014, India accomplished a monumental task. In a country that faced innumerable disadvantages, it seemed that polio eradication was a fairy tale. Despite this, through the leadership of the government and unity of the nation, India went from being responsible for 60% of all polio cases to being entirely polio-free. Today, as millions are vaccinated, the people of India must once again unite in order to eradicate Covid. Using its experience with polio, India has the ability to be a model nation as the world watches how the second most populated country in the world handles COVID-19. We look on optimistically, praying for the frontline healthcare workers and the health of the nation as we venture forth in the effort to eradicate Coronavirus and return to normalcy.
Interview with Anup Sharma and Dr. Samir Kapur