It has officially been one year since India diagnosed a new case of polio.
This week, India will cross the milestone of 12 consecutive months without any case of polio being reported – the onset of paralysis of the last case was on 13 January, 2011 in West Bengal.
India was once recognized as the world’s epicentre of polio. As recently as 2009, India had the highest burden of polio cases in the world (741), more than the three other endemic countries combined. Due to extraordinary measures to reach children with vaccine, India has not seen a case since a 2-year-old girl in the state of West Bengal developed paralysis on 13 January 2011.
As wonderful as this is, polio is not yet eradicated, and all of Indias success could go down the drain in an instant.
Polio could reenter India all over again from the other countries where polio is still endemic, Pakistan or Afghanistan (or less likely Nigeria).
And then we have another problem– The oral polio vaccine itself.
While the oral vaccine, composed of a live, attenuated polio virus was essential to generating a currently polio-free India, it could also ruin everything. That is because there are very few mutations in the attenuated strain vs the pathogenic strain. This means that sometimes, in a person who gets the vaccine, the virus reverts back to its wild-type state. That individual is still protected from polio, but they are shedding pathogenic polio in their feces, which can then go on to infect people who have not gotten the vaccine.
This is no big deal in the US, because everyone gets the vaccine and we have clean drinking water. But it could be a very big deal in India, where the people who need the vaccine the most (the poor, who dont have good drinking water sources regular health-care) do not have easy access to the vaccine.
The alternative is administering the killed vaccine during this almost-eradicated time. Dead virus = protection without the risk of reversion and transmission. But the killed vaccine comes with its own set of difficulties. Money. Again, in the US this was no big deal– we have needles and trained health care professionals to administer the killed polio vaccine. But sterile needles and health professionals are harder to come by in India.
The predicament India is in right now really highlights, again, the luxury of the anti-vax movement. While Jenny McCarthy is gushing about Nicki Minaj and Lady Gaga performing on New Years Eve and plugging the anti-vaccine Generation Rescue, parents in India would do anything to prevent their child from being the kid who breaks Indias polio-free streak, but cant do anything, because they dont have the money.