My experience as a Surveillance Medical Officer

On 2^nd March 2015 I joined World Health Organisation (WHO)/ National Polio Surveillance Project (NPSP) as a Surveillance Medical Officer (SMO). I was posted in one of the western district of Uttar Pradesh, the region which was considered the Polio belt of India. I had my initial induction training by the sub-regional team leader and later on received formal induction training conducted for a whole batch of the newly recruited SMOs. I had my high and low moments working as SMO, but overall the experience was immense and incomparable. One day you are in the village with dogs and buffaloes behind and beside you, and the next day you are called to a five star hotel.  The different responses given when you knock doors during house to house visit was something unforgettable. It was also an opportunity and challenge to cater to those migratory population working and residing at brick kiln fields. It was the real field work that generated so much information for action. This was an opportunity that opened my eyes to so many areas of concern in public health and also taught me the art of communication to people from all spheres of life. Today, when I look back I am grateful to have served as SMO, even though it was only for a short period of one year and five months.

The last case of Polio in India was reported from Howrah, West Bengal on 13^th January, 2011. The WHO South-East Asia region, of which India is a member, was declared Polio free on 27^rd March, 2014.  So, when I joined as SMO it was more like to maintain the system that has already been well established and effectively helped to stop the disease transmission. My perception is that many people including health professionals do not understand the efforts that went into achieving Polio free status. The general comment that I use to hear was that Polio requires only two drop of vaccine to prevent it, so, what is the difficulty in achieving the status. Only after working as SMO and involving in all the planning, training, implementation and monitoring activities, do I realize that it was a huge task and well thought of action strategy that went into achieving the Polio free status. In fact, the global effort to eradicate Polio is considered the largest-ever internationally-coordinated public health effort in history. When we have achieved the free status, may we not forget the contributions done by so many especially the field workers/vaccinators who went house to house, door to door to give Polio vaccine to make sure that every child was safe from the disease.

It was in the year 1988 during the World Health Assembly that a resolution was taken that Polio should be eradicated by the year 2000. India was also a signatory to that commitment but the effort of implementation started only in 1995. It was estimated that annual numbers of cases were 200,000 to 400,000 at that time. Four main strategies that eventually proves successful:

1.  Routine Immunization campaigns: maintain a very high level of routine immunization with Oral Polio Vaccine (OPV). OPV was introduced in the routine immunization since 1979. The introduction of bivalent OPV in January 2010 drastically changed the Polio scenario in India.

2.  National Immunization Days (NID) also called as Pulse Polio Immunization campaigns: all children below 5 years of age get OPV throughout the country. Supplementary Immunization Activities (SIA) was carried out as NIDs when it happens all over the country on a particular fixed days and Sub-National Immunization Days (SNIDs) in particular regions. First Pulse Polio Immunization campaign was started in the year 1995.

3.High quality Acute Flaccid Paralysis (AFP) surveillance: NPSP was established in 1997 to carry out the surveillance activity which recruited SMOs to implement the activity. A high quality and sensitive surveillance system was needed to detect the transmission in the community. For this a very sensitive case definition is used for selection of cases. Acute flaccid paralysis is defined as “sudden onset of weakness and floppiness any part of the body in a child less than 15 years of age or paralysis in a person of any age in whom polio is suspected.” A large reporting network was established involving all possible places where the cases might report. 

4.  Mop-up campaigns: done when foci of polio transmission are left. 

On the recommendations of the World Health Assembly, the Global Polio Eradication Initiatives (GPEI) developed the endgame strategy plan for 2013-18. The plan had four objectives:

1. Virus detection and interruption

2. Routine Immunization strengthening and OPV withdrawal

3. Containment and certification 

4. Legacy planning

I consider it a privileged to have taken part in the implementation process of the plan. Inactivated Polio vaccine was introduced in RI in August 2015. Initially it was started as a single intramuscular (IM) dose given to those primed with OPV only later to be changed to two doses by intradermal (ID). This was followed by SWITCH activity. As a country we observed the ‘Switch Day’ on 25^th April 2016 when trivalent OPV was replaced by bivalent OPV. It is hoped that by 2020 OPV will be phased out.

Since August 2016 I have moved on from the programme, but the cause is still dear to my heart. The things that I learnt and the experiences that I had during my short phase will stay with me for a very long time in the call to public health.