Maintaining polio eradication in India: physicians play key role in countering parental misconceptions

When India was struck from the list of polio-endemic countries by the World Health Organization (WHO) in February 2012, the hard-won designation was one of India’s greatest public health accomplishments. Now, the focus has shifted from achieving eradication to maintaining it.


“It was an important accomplishment for India to be removed from the WHO list of polio-endemic countries. Now, Indian physicians can help maintain this status by helping in strengthening routine immunization and continue to advocate polio immunization.”
-Naveen Thacker, MD, FIAP, director, Deep Children Hospital and Research Centre, Gandhidham, India; past president of the Indian Academy of Pediatrics; and member of mdCurrent-India’s Editorial Advisory Board


“It was an important accomplishment for India to be removed from the WHO list of polio-endemic countries,” said Naveen Thacker, MD, FIAP, whose efforts were pivotal to polio eradication in India. “Now, Indian physicians can help maintain this status by helping in[s2If !is_user_logged_in()]…

[/s2If][s2If is_user_logged_in()] strengthening routine immunization and continue to advocate polio immunization,” said Thacker, who is director, Deep Children Hospital and Research Centre, Gandhidham, India; past president of the Indian Academy of Pediatrics; and member of mdCurrent-India’s Editorial Advisory Board.

Key Point: If polio eradication is to be maintained in India, it is important to further increase physician and parent confidence in eradication efforts. Indian physicians are respected members of the community and are in a position to counter barriers to immunization and encourage parents to vaccinate their children.

A recently published study focused on the attitudes and perceptions of public sector primary health center (PHC) physicians and community-based pediatricians in Uttar Pradesh and Bihar, India, to identify any barriers to polio eradication. The study examined clinician knowledge about polio disease, immunization, and eradication.

Uttar Pradesh and Bihar were the most polio-endemic states in India prior to eradication, with 98% of cases reported in these regions. They also were the states with the lowest routine immunization rates; only about half the children in the 12-month to 23-month age group were vaccinated. In fact, it was the resurgence of polio cases in these 2 states in 2002 and 2006 that led to serious setbacks in the national eradication effort.

PHC physicians included in the study treated at least 1 confirmed polio case between January 2006 and June 2009; researchers interviewed them in person. Pediatricians were members of the Indian Academy of Pediatrics (IAP) and were interviewed by telephone or mail.

Approximately 82% of PHC physicians and 63% of pediatricians (P<.0001) reported that they believed an unvaccinated child was susceptible to polio. Both groups expressed confidence in the protectiveness and safety of the oral polio vaccine, and nearly all physicians in both groups said they believed it was important to eradicate polio.

Maintaining eradication: potential barriers

The most commonly reported barrier to vaccination reported by both physician groups was the parents’ lack of awareness of the importance of polio eradication efforts. Other barriers noted were parents’ lack of confidence in the vaccine, fear of side effects of the vaccine, and cultural beliefs.

Research has shown the critical role that healthcare providers play in improving immunization rates. In India, both public sector PHC physicians and private sector pediatricians are key healthcare providers for children and are respected leaders in their communities. In addition, they are key opinion leaders for healthcare at both the state and national levels. Because of this, their perceptions and practices regarding polio immunization are extremely important in maintaining polio eradication, the authors stated.

If polio eradication is to be maintained in India, the authors asserted, it is important to further increase physician confidence in eradication efforts, as they have influence on both the policy-makers who plan eradication strategies and the parents who responsible for their children’s vaccinations.

Global considerations

The Global Poliomyelitis Eradication Initiative has reported substantial progress in eradicating polio. Now that polio is eradicated in India, only 3 countries in the world remain that have never stopped indigenous wild poliovirus transmission—Afghanistan, Nigeria, and Pakistan.

As long as a single child remains infected with polio anywhere in the world, children in all countries are at risk, according to WHO. To minimize the risk of outbreaks from “polio importation” (eg, via global travel), countries must maintain high immunity levels, according to officials.

Sources: Thacker N, Choudhury P, Gargano LM et al. Comparison of attitudes about polio, polio immunization, and barriers to polio eradication between primary health center physicians and private pediatricians in India. Int J Infect Dis. 2012;16(6):e417-e423. doi: 10.1016/j.ijid.2012.02.002.

World Health Organization. Poliomyelitis. Media Centre, Fact Sheet No. 114. http://www.who.int/mediacentre/factsheets/fs114/en/. Updated February 2012. Accessed July 9, 2012.

Access the original journal information here:
http://www.ncbi.nlm.nih.gov/pubmed/22464934
Journal publishers are independent from mdCurrent-India and may require a subscription or charge a fee to download the full article.

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