When Uttar Pradesh was still polio endemic, I worked on the polio programme in the state. I was there when the last reported case in India occurred in January 2011, and an year later when we celebrated one year of polio-free India. Now that I am working on TB and lung disease with a nation-wide programme, I find there are similarities in polio and tuberculosis – both as a disease and in the country’s response to it.
According to WHO, India has 27% of the global disease burden of TB. It is the number one public health problem in India. Until 2011, India was among the last four countries in the world where the polio virus was still endemic – in the not-so-august company of Afghanistan, Pakistan and Nigeria.
Both diseases are linked to other development challenges. Migration makes people vulnerable to TB and impacts treatment. It also causes spread of the disease. Children of migrants may get missed in the house-to-house campaign for polio immunization. While poverty, under-nutrition and poor housing conditions increase risk to TB, good water and sanitation practices and routine immunization helps prevent polio transmission.
Social mobilization by civil society and non-government partners has played a key role in addressing polio. The SMNET – Social Mobilisation Network set up by UNICEF and CORE – a network of over 5,000 community workers in UP and Bihar supported the government’s polio programme. By going house to house in vulnerable areas they kept track of pregnant women and under 5 children to ensure no child missed the dose.
The TB programme also recognises the need for community mobilization and civil society involvement. Project Axshya’s community workers go house to house in urban slums and vulnerable areas to do active case finding for TB, checking for people with symptoms and urging them to get sputum tested and treated at the nearest DOTS centre.
Clearly, the learning is that the health system cannot wait for people to seek services. Sometimes it needs to go to the door. Health seeking behavior is poor and with diseases like these posing a public health challenge, there can be no room for complacency.
Polio was the first disease where mosque ailaans — until now used solely for religious purposes — urged the community to immunize children for polio. Mosques are now active partners in the fight against TB. Muslim leaders played a key role in the fight against polio; just as church-based organizations are helping people seek diagnosis and treatment for TB in some of India’s remotest areas.
Polio was a notifiable disease; TB has been a notifiable disease since 2012.
While we are on similarities between India’s fight against polio and TB, we cannot miss Amitabh Bachchan. On radio and television, billboards and posters, for over a decade Big B urged people to ensure children received the polio vaccine, even scolded them for their complacency. More recently, Mr Bachchan is the brand ambassador for the fight against TB. Coming out as a survivor, he urges people to get tested, seek treatment, all the time dispelling stigma surrounding the disease.
Both TB and polio national programmes have used mass media and mid media effectively in raising awareness. From public service advertising to ‘educationment’ and fictional dramas, a range of formats have been used for radio and television. Unicef has had a long partnership with radio jockeys to raise awareness on polio and routine immunization. Project Axshay’s Bulgum Bhai campaign urged people to seek treatment; the programme has also used community radio effectively to raise awareness on TB.
There are stark differences between both diseases. TB is curable while polio is not. TB is highly contagious while polio is not. TB affects all age groups – men, women, children – while polio affects mostly infants and children under five. TB is widely prevalent across the country, while the polio virus was in its last years endemic only to western UP and the Kosi region of Bihar.
India has been polio-free for over six years now. But over the same time, the number of people diagnosed sputum positive for TB each year has dropped marginally: from 9.5 lakh cases in 2011 to 9 lakh cases in 2015.
The SDGs target that by 2030 the world will be able to end TB. Our generation has seen the end of polio in India. We must now unite to end TB.
– Sumita Thapar is a communication consultant currently associated with Project Axshya and previously with Unicef in Uttar Pradesh.
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