Reaching every child: Wiping out polio in Mumbai
— By Amitabh Bachchan
For 10 years, I have been telling India the life-saving message that every child should take two drops of oral polio vaccine every time it is offered. And it is working.
Today, India stands on the brink of eradicating polio – arguably the greatest public health achievement in its history. When the polio eradication campaign started, India was reporting around 500 polio cases per day. Since then, more than 4 million children have been saved from paralysis or death. All our hard work is paying off. But the simple truth is that as long as polio exists anywhere in the world, the threat will persist.
I am immensely proud that independent studies have shown that the ‘Every child, every time’ slogan is one of India’s most recognizable messages. I am even more proud that Indian parents have answered that call. During two annual National Immunization Days, normally held each January and February, approximately 170 million children under 5 are vaccinated by immunization teams going door-to-door to every house in the country. Then, every month from March to December, almost all children under the age of 5 in India’s two traditionally polio-endemic states and highest-risk areas are vaccinated during polio immunization campaigns – campaigns that reach 40–80 million children a year. Pause for a second to examine those numbers. Then consider what characterizes the highest-risk areas for poliovirus transmission: high-density living, poor sanitation, poor access to clean water, poor access to toilets, poor breastfeeding rates and poor nutrition.
Polio now is a virus of the poorest, making its final stand in the most forgotten places, among the most forgotten people. Reaching these people – the slum dwellers, the nomads, the migrants, the brick kiln workers, the families of construction workers living beside the plush high-rises they build (for a dollar a day) under a sheet of plastic – is one of the greatest challenges in public health. The polio eradication programme is actively following a detailed ‘underserved strategy’ to target India’s hardest-to reach people, including those living in urban slums, in order to raise immunity among those populations at highest risk. It is not an easy task – literally millions of migrant families move back and forth across the country each week, and in the traditionally polio-endemic states of Uttar Pradesh and Bihar, around 750,000 children are born each month. In order to eradicate polio in India, it is essential to reach and immunize every last child. And in the swelling slums of India’s heaving cities, every last child is hard to find.
Consider Dharavi, one of the largest slums in my home town of Mumbai – home to a million people in just 3 square kilometres. Here, poliovirus immunization teams must follow carefully developed micro-plan maps, walking single file along the tiny lanes, scrambling up rickety ladders to reach the children living in corrugated iron homes stacked one on top of the other, three or four stories high. The immunization teams then mark those corrugated iron walls with chalk, so that the monitors who will follow in the coming days can see which houses have been reached – and which children have been immunized. Additional teams return to cover any children who were missed.
Mumbai, India’s financial capital and home to its film industry, is among the world’s biggest and richest cities. It is also believed to contain the highest proportion and largest absolute number of slum dwellers. By some estimates, between 100 and 300 new families arrive each day in search of work. All too often, migrant families of low socio-economic status find themselves in a slum. All too often, these arrivals are never tracked, never chartered, never given a name. All too often, the hardest-to-reach children in our country are living right under our noses.
India’s polio eradication programme demonstrates that it is possible to ensure equity in the availability of health services in even the poorest, most densely populated environments. It proves that you can find every last child in the city. And it means that in Mumbai, while the children of the slums continue to face many threats, polio need not be one of them.