“We are not alone in this world. There are others hiding in plain sight.” Wait, don’t rush into your imaginary world of aliens & superheroes. I’m not going to talk about them. Instead, I will talk about something real, something which we cannot see but who make their presence count – the Microorganisms such as bacteria, viruses, etc. They have co-existed with us since eternity. Some are our friends, but mostly they are enemies – hiding & multiplying, waiting for the opportunity to attack us, then disable and even kill us slowly from the inside. They keep on increasing causing outbreaks & epidemics.
All of us are born with natural immunity. But clearly it was not enough. Initially we could not fight them back, so our only defense was isolation or quarantine. But then we evolved. We created our own weaponry – antibiotics, antisera, vaccines and so on. We created the observatories like WHO, CDC etc., and set a whole bunch of rules & regulations (IHR). Then finally we linked all of them to make a safety net to contain, eliminate & ultimately eradicate these microorganisms.
By definition, Eradication refers to permanent reduction to zero of the worldwide incidence of infection caused by a specific agent as a result of deliberate efforts; intervention measures are no longer needed. The one and only disease affecting humans which we were able to eradicate is smallpox dating back to 1980. Since then many diseases have been targeted for eradication, the current closest one being Guinea worm disease/Dracunculiasis.
Elimination, on the other hand, refers to reduction to zero of the incidence of a specified disease or infection caused by a specific agent in a defined geographical area as a result of deliberate efforts; continued intervention measures are required. Sometimes, it is also defined as reducing the cases of disease to such low levels that it ceases to become a public health problem. Different diseases have been eliminated in different countries. Like Malaria & Measles in USA, Yaws in India. etc. Elimination Certificate is given after 3 years of interruption of transmission (i.e., since the last case).
Though our ultimate goal is always ‘ERADICATION’ but as an individual country, we are responsible for ‘ELIMINATION’ followed by regular surveillance until eradication is achieved.
We recently managed to eliminate 2 diseases: a deadly crippling disease (Poliomyelitis) & a killer disease (Maternal & Neonatal Tetanus).
It is caused by the Polio virus which is spread through fecal-oral route, i.e., through contaminated fingers and/or food products. The only known reservoir is humans.
India was the largest endemic reservoir of the polio virus with about 50,000 to 1,00,000 paralytic cases per year from 1978 to 1995. It was more of a HUB rather than a mere HOME for polio. But with our weaponry (vaccine), manpower (dedicated health staff) & technology (communications) we succeeded in eliminating it. Of course this would have not been possible without the strong political commitment, international cooperation, support from the various NGOs & also from the people themselves.
The awareness generation campaigns were such a huge success that “Do boond zindagi ki” reached every nook and corner of the country & most people knew about ‘Polio Ravivaar’. This resulted in people bringing their children to the centers to get them vaccinated. Then there was the dedicated ‘Health Task Force’ who tirelessly went door-to-door to seek & vaccinate the missed children.
At last, we were finally able to eliminate this disease. The last reported case of polio was on January 13, 2011. But WHO has a policy that ‘No single country can be certified Polio-free. It is the term applicable to the entire WHO region’. So, the WHO South East Asia Region (harboring a quarter of world population) was certified Polio-Free on March 27th, 2014 (India being the last country in this region). Thus, with 4 of 6 WHO regions declared polio-free, 80% of the world’s population is now in the safe zone.
MATERNAL & NEONATAL TETANUS
Almost a year after achieving the historical milestone of polio-elimination, we had yet another cause for rejoicing – the breakthrough achievement of successfully eliminating Maternal & Neonatal Tetanus (declared on May 15th, 2015).
Tetanus is a disease caused by a toxin (exotoxin) released by the bacteria Clostridium tetani. The natural reservoir is the soil. It is spread through contamination of the wound by the spores of the bacteria.
MNT elimination refers to less than 1 NT case per 1000 live births in every district. MT is said to be eliminated when NT elimination is achieved.
The polio elimination strategy served as a role model. Apart from all the resources used as in the former case, here we had the Janani Suraksha Yojana (under National Rural Health Mission), which needs a special mention. It is a ‘Conditional Maternity Benefit Scheme’ which led to a significant increase in safe deliveries/deliveries conducted in clean, hygienic conditions (mostly health care facilities), apart from increasing the proportion of women seeking antenatal care (thus, the TT injections) & also improvement in postnatal care. This played a significant role in reducing the contamination & thereby eliminating the disease.
It is true that tetanus cannot be eradicated because the natural reservoir of the bacteria is soil, but we can effectively protect ourselves by getting properly vaccinated & taking correct precautions.
So, it looks like we are on an ‘Elimination-Spree’. After getting rid of 2 deadly diseases back-to-back in 2 years, let’s see whether we can keep it up for a hat-trick? Who will be the next to go down – Kala azar, Lymphatic Filariasis, or some other disease?
And maybe someday we could eliminate all of them ending up in a world free of drugs & diseases!!!