By Ravi Nessman
The Associated Press
TILKESHWAR, India (AP) — Tilkeshwar is one of India’s forgotten villages.
It’s 20 miles from the nearest paved road, untouched by electricity, running water, sanitation, and even the barest of health care. Nearly all adult men leave to search for menial work for their families’ survival.
Here, deep in the floodplains of the Kosi River, the polio virus has stubbornly hidden. And it is here where the long-stalled global fight to eradicate the crippling disease might be on the verge of a badly needed victory.
The sudden optimism has been stoked by a startlingly effective campaign by the government and aid groups to finally drive polio out of India. In just five days last month, 2 1/2 million workers visited 68 million homes to inoculate 172 million children.
Similar campaigns have fallen short in the past, but two factors this time are different. Health workers are armed with a new, more effective vaccine, and nearly airtight monitoring means virtually no child is missed, not even in the most remote of villages.
For India, defeating a disease long forgotten in richer countries would be a crucial step in its transformation into a global power.
“It’s a stigma for India,” said Dr. Lakhindra Prasad, chief medical officer of India’s Darbhanga district, which covers Tilkeshwar.
For the rest of the world, success in India would create a precedent for bringing health services to even the poorest and most remote people.
“[It shows] what we think is impossible is actually possible in public health,” said Bruce Aylward, the head of the World Health Organization’s global polio campaign.
Across India, one of four nations where polio remains endemic, only 42 cases were recorded in 2010, a drop of 94 percent from the year before.
In the Kosi floodplains of central Bihar, there hasn’t been a case since last January. In Uttar Pradesh, the other region in India where polio remains endemic, there hasn’t been a case since April.
“We think the end of polio is near, we definitely feel it,” said Dilip Kumar Mukhiya, a member of the Tilkeshwar village council.
India’s near success, and a similar plunge in cases in Nigeria, has brought a surge of energy to the long-stalled global campaign against a disease that has paralyzed millions.
Last month, philanthropist Bill Gates pledged $102 million to eradication, which he called his top priority. Abu Dhabi’s crown prince, Sheik Mohammed bin Zayed Al Nahyan, pledged another $50 million to vaccinating children in Afghanistan and Pakistan against polio and other diseases. Rotary International, which has already given more than $1 billion to eradication, unveiled a fundraising campaign entitled “This Close.”
“This is the best situation I’ve ever seen,” said Tim Peterson, a polio expert with the Gates Foundation. “I certainly think there’s light at the end of the tunnel.”
The withered, twisted limbs of poliovictims are common among the teenagers and adults of Tilkeshwar.
Lalti Kumari, a shy 3-year-old, limps alongside her grandmother. She had been vaccinated 12 times, but still caught the disease in March 2009, likely because malnourishment or diarrhea made the doses ineffective.
“I don’t know how it happened,” said her mother, Sharmila Devi.
Kumari’s case is vexing but also represents hope — she is one of the last people to have come down with polio here.
The battle against polio dates back to the development of modern sanitation in the 19th century. This public health triumph stopped the spread of many fatal illnesses, but also turned polio from a relative rarity into a raging menace.
In 1953, Jonas Salk developed an injectable vaccine from dead polio virus. A few years later, Albert Sabin developed an oral vaccine from weakened, live virus that was even easier to administer. In the United States alone, cases plunged from 21,000 in 1952 to 61 in 1965.
The World Health Assembly started a global effort in 1988 to eradicate the virus by 2000. It was wiped out across the Americas by 1991, the Western Pacific by 1998, and Europe by 1999.
But the drive stalled in Africa and south and central Asia. About 1,000 people a year fell prey to the disease, a huge drop from 350,000, but far short of eradication.
And the four countries where polio remains endemic presented other challenges. In Afghanistan and Pakistan, lawlessness and conflict made it difficult for vaccinators to reach children. In northern Nigeria, Muslim religious leaders boycotted the vaccine as a Western plot to sterilize their children. In India, malnutrition and chronic diarrhea made children too weak to properly process the vaccine.
Early on a winter morning, Marta Dodri, a maternity ward nurse, trudged 20 kilometers through a frigid, pre-dawn gravy of dust and fog, crossing a patchwork of rivers and streams in rickety boats to reach Tilkeshwar.
“I’m doing this because I want to get rid of polio. I want to do something good for society,” she said.
During immunization drives, vaccinators in yellow vests go to schools, train stations, bus depots, and roadside nomadic enclaves. The vaccinators are often female so mothers will trust them with their children. Health workers give zinc and oral rehydration solution to stop diarrhea and help children absorb the vaccine.
Dodri and her colleague Sanjana Shoba take along a cooler filled with ice packs and vaccine vials delivered by couriers who rode bicycles for hours over pitted trails to arrive here. The women methodically work their way to 60 homes of mud and cow dung.
Later in the day, Dodri and Shoba will loop back to the “X” houses to vaccinate the missed children. If any slip through, they come back again the next day.
Villagers complain that the vaccinators are the only health workers they ever see. One asked why they didn’t bring other medicine. Another demanded clean drinking water.
Perhaps the greatest change in the eradication campaign was in the vaccine.
The traditional formula targeted three polio variants, including one already eradicated, but was less effective against the remaining two. Last year, a new vaccine aimed only at the remaining strains was rolled out. Infections plunged and hopes soared.
However, caution needed to be exercised. “In the global sense, as long as it’s anywhere it’s not over,” said Ellie Ehrenfeld, who sits on WHO’s Advisory Committee for Polio Eradication. “As long as there is some place, some pocket, of poorly immunized people, it’ll spread like wildfire.”
Another problem is the oral vaccine itself, which causes polio in rare cases. The injectable vaccine doesn’t have such side effects, but also costs 20 times more.
“The magnitude of the task of getting from where we are right now to the end should not be underrated,” said Dr. Donald Henderson, who headed WHO’s smallpox eradication program. “We have quite a ways to go.”
Despite the challenges, Aylward, the head of the global eradication drive, said that for the first time, hope seems to be winning out. When the WHO board met last month, there were few of the usual impatient demands for a new polio strategy, he said.
“Everyone can see the numbers, everyone can see the big drops,” he said. “Now, they were saying, ‘Gosh, this can be finished.’ ” ♦