Less than two decades ago, the crippling disease polio claimed hundreds of thousands of victims every year. Today, public health officials say they have an unprecedented opportunity to eradicate the disease by 2005, but it hasn't been easy. More than $3 billion has been spent so far to drive polio out of every country on Earth but six. Officials say the last few places will be the hardest. VOA's Steve Baragona traveled to one of those last places, India to get an inside look at the world's largest public health campaign.
It's the day before the latest round of polio vaccination starts in the northern Indian state of Uttar Pradesh. To get the word out, street musicians in the rural village of Dumraila are singing about the hardships of polio. Here in Dumraila, they have a living example. As the musicians perform, a few villagers lead to the front of the crowd a shy, pretty and reluctant teenage girl on crutches. Mamta Berma is not officially part of the performance, but she is drafted into the show to remind villagers of what can happen to children who are not vaccinated. Ms. Berma said later that although she was a young child when she had polio, she's still not used to being handicapped.
"It's good that these polio campaigns are being done,? she said. ?Other children will be saved from having this disease."
She said that her paralyzed leg makes it hard to get around, especially going long distances. Polio takes a heavy toll on job and marriage prospects. The disease can even be fatal.
India has made tremendous progress in saving children from polio. Last year saw the smallest number of cases on record at 225, compared to nearly 5000 cases a decade ago. Massive national immunization drives are behind that success. Several a year aim to vaccinate the country's 165 million children under five years old.
Two years ago, the eradication effort suffered a major setback. Shoddy work plagued the 2001 immunization drives and the campaign conducted only two major drives. That was a bad idea according to Sanjeev Yadav, campaign leader in seven districts in Uttar Pradesh.
"I'll definitely say that [the] government plus planners, all of us made a mistake that we let off the pressure a little,? he recalled. ?The number of rounds decreased in 2001 [because we thought] that we had almost achieved it [eradication] and this mistake cost us dearly and in 2002 we had an outbreak again."
The 2002 outbreak claimed 1600 victims, a six-fold increase from the year before. Experts say the experience is a warning to other countries about the hazards of complacency. So India has redoubled its efforts.
The country is planning six major immunization drives this year. For each drive, that means setting up hundreds of thousands of vaccination booths all across the country, from the biggest cities to the remotest villages. The manpower needed to do the job is staggering. Sanjeev Yadav, campaign leader in seven districts in Uttar Pradesh, said that if you add up all the people in just his seven districts running booths and rallying people to go to them, it is an enormous number.
"I think it will come down to, maybe 60,000 or something,? he explained. ?It's a big operation. It's a very big operation."
More than one million people will participate nationwide and to watch that this big operation isn't wasted, there are monitors whose job is to make sure everything is done right.
On booth day, teams of monitors are driving around Uttar Pradesh and the whole country checking up on the vaccination booths. There are many things that can go wrong. At this booth, for example, the vaccine arrived two hours late and monitor Jaya Singh finds another problem. Children's fingers are marked with a permanent pen to show they've been vaccinated, but apparently that is not always an accurate indication.
"They are marking the child first and then they are giving the drops,? she said. ?This is the wrong procedure. You can see the mark that this child has taken the drops and that child has not really taken the drops. That is a real problem. I was saying as soon as the child takes the drops, then you put the mark on his finger." The monitors insist that mistakes like that are rare today and that most booth workers are properly trained. However, there are other potential issues. Vaccine can go bad quickly if it's left in the Indian heat for too long. A color-coded indicator on the side of each vial shows how fresh the vaccine is.
Booth day is really just the beginning of the immunization drive. Only about 50 to 60 percent of the population usually shows up for booth day, but the Indian government's polio program director, Sobhan Sarkar belieces that to eradicate polio that's not enough.
"In any other sector you can be satisfied with 60, 70, or 80 percent performance,? he explained. ?The performance in this sector [must be one] hundred percent and more importantly, is that it must be uniform all over."
So over the next several days, teams of vaccinators will go door to door delivering vaccine to those children who didn't get it on booth day.
Once every child in a house has been vaccinated, the team marks the house with a "P". If any child is missed for any reason, the house is marked with an "X". Some X-marked households have refused the vaccine because false rumors have spread that it will make children infertile. Dispelling those myths is part of the vaccinator's job. Vaccinator Rashida Naz said that they're persistent.
"If they don't understand the first time, we'll come again a second time, a third time,? she said. ?After some time, they'll be convinced to give the vaccine."
The campaign is convincing more and more reluctant parents that the rumors are false, but officials say vaccinators sometimes just get lazy and mark houses that refused the vaccine with a "P" anyway. So Subodh Kumar, the monitor, checks to be sure that houses marked with a "P" deserve it.
Two children in this X-marked house have already been vaccinated. After a brief discussion, he finds out why it's still marked "X".
"There is another child who has gone to his grandparents,? he explained. ?So it will be 'X' until that child gets the vaccine."
By the end of the door-to-door campaign, every single dwelling in India, from the grandest mansion to the humblest lean-to, will be marked with either an "X" or a "P". In a nation of more than one billion people, this in and of itself is a major achievement.
The real achievement will come if all that work succeeds and Mamta Berma is part of the last generation of Indians to suffer from polio.