India Plans Phased Exit from Polio Surveillance Network

India Plans Phased Exit from Polio Surveillance Network

Why in the News?

The Indian government, in collaboration with WHO, has proposed a phased reduction of the National Polio Surveillance Network (NPSN) starting June 2025. The move raises concerns among public health experts due to ongoing global polio threats and job uncertainties, potentially impacting India’s polio eradication efforts and acute flaccid paralysis surveillance.

Government’s Transition Plan and Rationale:

• The National Polio Surveillance Network (NPSN), established by WHO for polio eradication, will be gradually phased out.
• Current strength of 280 units (2024–25) will reduce to 190 (2025–26) and further to 140 (2026–27).
• WHO’s India Representative, Dr. Roderico H. Ofrin, assured a structured transition to avoid gaps in polio surveillance and AFP case definition practices.
• Government systems are expected to eventually absorb the NPSN’s functions under the Integrated Diseases Surveillance Programme.
• The drawdown includes a corresponding reduction in financial support from the government for the polio program and supplementary immunization activities.

Expert Concerns and Risks Involved

• Experts believe the decision is premature, especially as wild poliovirus remains active in neighbouring countries, potentially threatening polio eradication progress.
• Dr. Jacob John, leading virologist, criticized the move, stressing it’s too early to dismantle a steady surveillance system crucial for polio eradication and acute flaccid paralysis surveillance.
• He advocates replacing Oral Polio Vaccine (OPV) with Injectable Polio Vaccine (IPV), also known as inactivated poliovirus vaccine, before any withdrawal from the polio program.
• The global resurgence of polio, including vaccine-derived polioviruses and circulating vaccine-derived poliovirus type 2, heightens risks if India relaxes its polio surveillance infrastructure.

Impact on Human Resources and Job Security

• The transition plan has unsettled NPSN staff, many of whom are employed under Special Services Agreements, leading to job insecurity concerns.
• Each NPSN centre employs at least four staffers, raising concerns about widespread job insecurity in the polio eradication workforce.
• Dr. Ofrin’s letter, though mentioning staff retention, lacked concrete assurances, adding to anxiety among those involved in polio surveillance and acute flaccid paralysis surveillance.

Universal Immunization Programme & Polio Prevention:

• Universal Immunization Programme (UIP) provides free vaccines for 12 preventable diseases; launched in 1985, expanding immunization beyond urban areas and improving routine immunization coverage.
• Annual Polio Campaigns like National and Sub-National Immunization Days (SNID) maintain high immunity levels. The pulse polio campaign and polio immunization day efforts, including polio sunday and national polio day events, have been crucial for polio eradication. SNID, which stands for Sub-National Immunization Days, plays a vital role in these campaigns.
• Border Vaccinations continue to prevent re-importation from endemic nations, supporting the polio eradication initiative through transit-point vaccination.
• Inactivated Polio Vaccine (IPV), also known as inactivated poliovirus vaccine, introduced in 2015, strengthens protection, especially from type 2 virus. This complements the OPV vaccine (oral poliovirus vaccine) in the polio program.
• Mission Indradhanush (2014) targets 90% immunization in underserved areas, contributing to overall polio eradication efforts and improving routine immunization coverage.
• Polio spreads via the faecal-oral route, mainly affects children under 5, may cause paralysis.
• Wild Poliovirus Type 1 remains in Pakistan and Afghanistan, posing challenges to global polio eradication.
• Types 2 and 3 are eradicated.
• Vaccine-derived polio arises from mutated OPV strains, necessitating continued environmental surveillance and acute flaccid paralysis surveillance.

The proposed changes to India’s polio surveillance network come at a critical time in the global polio eradication effort. While India has made significant strides in its polio program, including successful implementation of the pulse polio campaign and maintaining high coverage on national immunization day, experts warn against premature scaling back of surveillance efforts. The transition must be carefully managed to ensure that the progress made in polio eradication is not compromised, and that both AFP surveillance and environmental surveillance remain robust to detect any potential resurgence of the virus.

To maintain the effectiveness of the polio program, the government should consider:

• Continuing door-to-door vaccination campaigns and polio camps to ensure comprehensive coverage, especially in security-compromised areas and conflict-affected areas where military operations may impact access.
• Maintaining mobile teams for hard-to-reach areas and supplementary immunization activities, implementing a mobile & migrant strategy to address inaccessibility issues.
• Preserving the polio drops day initiative, also known as Booth Day, as part of the ongoing routine immunization coverage efforts.
• Ensuring that any reduction in the NPSN does not compromise the ability to respond to potential outbreaks or conduct thorough acute flaccid paralysis surveillance.

As India moves forward with its plans to reduce the NPSN, it must balance the need for efficient resource allocation with the imperative of maintaining vigilance against polio. The success of India’s polio eradication efforts thus far should not lead to complacency, especially given the ongoing presence of wild poliovirus and vaccine-derived polioviruses in the region. Continued commitment to strong surveillance and vaccination programs remains crucial to protect India’s polio-free status and contribute to global eradication efforts.

To address the challenges in reaching all populations, the government should focus on:

• Implementing a robust underserved strategy to ensure vaccination coverage in marginalized communities.
• Enhancing the social mobilization network to increase community engagement and awareness about the importance of polio vaccination.
• Conducting thorough microplanning for vaccination campaigns, including identifying high-risk areas and populations.
• Employing a site-to-site approach and negotiations for access in areas where vaccination teams face difficulties due to ongoing military operations or security concerns.
• Strengthening outbreak response capabilities to quickly address any potential polio cases or environmental detections.
• Continuing to organize regular health camps that include polio vaccination along with other essential health services. These polio camps serve as a cornerstone of the vaccination strategy, especially in remote areas.
• Regularly updating the polio vaccine date schedule to ensure timely immunization for all children.

By maintaining these comprehensive strategies and remaining vigilant in its polio eradication efforts, India can safeguard its progress while adapting to the changing landscape of global polio surveillance and prevention. The country’s success in eliminating polio has been hailed as polio gold in public health achievements, but maintaining this status requires ongoing commitment and adaptability in the face of new challenges.