New Delhi: India is set to take over polio surveillance activities from the World Health Organization (WHO) and hand over the responsibility to the National Centre for Disease Control (NCDC), two people familiar with the matter said, citing directions to “dismantle” the 30-year-old joint programme that was instrumental in India eradicating the disease.
Till date, India’s National Polio Surveillance Programme (NPSP) was headed by the WHO, and the country achieved its polio-free status in 2014 in strong partnership with the UN agency. The plan now is to hand over the work to India’s Integrated Disease Surveillance Programme (IDSP), headed by the NCDC.
Directions to this effect came from the finance ministry to the health ministry. The shift will start from 1 April and is planned to be completed within two years.
The reason for the shift is to achieve self-sufficiency as the government now feels that there is proper infrastructure and enough capabilities for disease surveillance, both the people said.
Finance is not a factor, as India has been funding the WHO for polio surveillance in India.
The plan has been in consideration for the last 6-7 months, and the finance ministry has directed the health ministry to make its own system technically independent.
The matter was discussed in the 31st India Expert Advisory Group meeting for polio eradication held earlier this month, where concerns were expressed that the transition should be very structured.
Government officials say India combatted the covid-19 pandemic with the help of Indian agencies, so the system is capable of taking the surveillance programme for polio.
A 30% cut in terms of manpower, technical support and surveillance activities will start from 1 April.
The move comes amid a period of uncertainty for the UN agency, with one senior WHO official recently saying the decision by the Trump administration to take the US out of the WHO could deal blow to the global fight against polio.
At the same time, ‘wild polio’ cases in neighboring Pakistan and Afghanistan are a matter of concern for India, given porous border with Nepal, Bhutan, Bangladesh and Myanmar.
Wild polio cases in neighborhood
“Pulse Polio surveillance is very important component. WHO’s unit NPSP was developed to do the monitoring and surveillance of polio and support the respective state governments. Three of our neighboring countries are having a lot of wild polio cases (Afghanistan, Pakistan and Bangladesh) and our borders with some of the neighboring countries may pose a huge challenge,” said a person said who attended the meeting one of the two cited above.
“The department of expenditure, in the ministry of finance has given directions to the health ministry to dismantle NPSP and that the government of India and states have to take the responsibility themselves. The deadline is next two years in a phase-wise manner; however, the process of NPSP dismantling is planned to start from April 1, 2025,” this person said adding that the NCDC is drawing up a roadmap how to execute this.
In 2004, the government developed the Integrated Disease Surveillance Program (IDSP) situated at the NCDC, Delhi, to detect and respond to disease outbreaks quickly. IDSP surveillance units are spread in all the districts of the country.
For Polio surveillance, WHO’s NPSP was launched in 1997 to support polio eradication efforts in India. Along with polio surveillance, NPSP does measles-Rubella surveillance, vaccine preventable disease surveillance, support India’s routine immunization in the field and concurrent monitoring of India’s routine immunization coverage.
Once it is taken over from WHO’s, all the activities which WHO does will be done by the Indian agency.
Routine immunization coverage (which also included polio vaccination) is looked after the health ministry.
Transition should be in a structured, phased, monitored and accountable manner
“India gives 100% funds to the WHO for polio surveillance programmes and the role of the WHO is of good governance, manpower, technical support, flexibility, accountability and that is why India has achieved polio free status. The Indian government wants to make our own system technically independent and want to strengthen its IDSP,” said the second person adding that this is policy-level decision focused on India’s self-reliance ambition.
“India is polio free now. Our indicators are also correct now. There are 750 districts in the country, out of which 120-125 districts (20-25%) need focus as polio surveillance indicators are not as per international standards. Extensive work is required in several districts in Manipur in Northeast, UP, Bihar, Madhya Pradesh, Rajasthan, Telangana, Andhra Pradesh etc. These inter-district variations are reflecting poor indicators in terms of Acute Flaccid Paralysis, stool collection rate and vaccine coverage which is less than 80%, but should be above 80%. The polio surveillance indicators should be 2 per 100,000 children below 15 years. But it is less than than 2 in some districts and should be 2 or above.
“For country level, it should be 5-6. But there is no polio case in India. Our country is polio free now,” the second person said.
“This transition should be in a structured, phased, monitored and accountable manner to ensure that at every step international benchmarks are achieved by Indian DSP and it should also IDSP as an organization should be ready to take over the responsibility, so that all the states are on board, work in harmony and with proper coordination,” said the person adding that even if it is a structured transition, it may take upto 3-4 years.
What is polio?
Notably, India has maintained polio-free state since 2011 and the WHO declared India as a polio free nation in 2014. India is offering OPV-I & OPV-III to children under the age of 5 years. For OPV-2, IPV injection comprising all three serotypes is being given 6 weeks, 14 weeks and 9 months.
Experts advocate caution, given outbreaks in the region.
“India has a long history of high quality polio surveillance. However, because some of our neighbouring countries still have wild polio, we need to continue to be vigilant and ensure high quality surveillance is maintained, coordination and governance are clear and monitoring and evaluation are in place,” said Dr Soumya Swaminathan, former chief WHO scientist and currently principal advisor at the health ministry’s for the National Tuberculosis Elimination Programme.
“There should be a proper handholding to the Indian agencies, capacity building and training because there is a risk involved if not done in a planned way with good monitoring and evaluation plan. This is a very sensitive decision as if we have any loose ends, any time we may have outbreak,” said Dr Naveen Thacker, President, International Pediatric Association.
Every year, India administers polio vaccines to around 170 million children in a week.
Queries sent to the Health Ministry secretary, Health ministry spokesperson, Finance ministry spokesperson and World Health Organization remained unanswered despite multiple reminders.
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