How India Eradicated Polio | Alter Magazine Alter Magazine Polio has been infecting humans for millennia. It begins in the gut, multiplying rapidly. It survives for weeks in water or sewage. Most who carry the virus never know. It travels with them. One such journey ended in Budaun, Uttar Pradesh. “How did you miss the drop?” Child’s Aunt: “How do I know? It is the will of God” scroll 02026-09-08 Words by Swati Saxena H o w I n d i a E r a d i c a t e d P o l i o Inside the Nation’s Largest Public Health Programme It was a particularly rainy and humid day in July 2008, when I waded down the waterlogged lanes of a small village in Budaun, Uttar Pradesh. Several other teams, from the WHO Geneva office, the National Polio Surveillance Project team from Delhi, and members from UNICEF, were visiting on the same day. Accompanying them were the representatives from the district administration and local doctors. The reason that this sleepy and neglected village had come into sudden focus was due to a recent polio type 1 case 1 : a 12-year-old girl. As a result of this dubious distinction, around 15 people sat in the backyard of the girl’s home. A dozen women stood huddled in a corner and were hushed several times as the local doctors relayed the child’s disease onset, travel and clinical history to the visiting team. It seemed that the child had contracted the virus from her father, who was a labourer in Okhla (Delhi), where he was staying with people from Bihar (who in turn had passed on the strain to him). Genetic sequencing of the strain had shown that it was an ‘orphan virus’, meaning that parents or immediate siblings of the virus had not been detected over the past 18-24 months, and the most closely related strains were seen in Bihar. Concerns were raised about the mop-up rounds 2 by the external team. It seemed that those were tackled satisfactorily by the district administration, and multivitamins were dispensed to the child. The origin of the virus could be traced because the polio eradication campaign built an extensive acute flaccid paralysis (AFP) 3 surveillance system, enabling health authorities to detect possible polio cases and trace the virus's movement. Yet, given the conditions of the village, the virus might have spread through faecal-oral route 4 on site. The locality lacked pukka roads and deep boring handpumps; community toilets were hardly used and situated next to shallow pumps, contaminating the water supply. Frequent waterlogging led to mosquito infestation, and children, including the affected girl, were enrolled in non-functional schools. 02026-09-08 Words by Swati Saxena Swati is a public health researcher interested in health systems and policy, vaccines, and cancer prevention. She holds a PhD from LSHTM and an MPhil from University of Oxford. Her work aims to bridge research and practice, and learn how public health programmes interact with institutions, politics, and people. When she isn’t researching or writing, she is usually reading crime thrillers and cozy mysteries, or finding yet another book for her two young children. Linkedin 𝕏 Archival photography, Budaun, Uttar Pradesh. Image credits: UNICEF, 2011 India’s polio programme, one of the longest-running and most coordinated public health efforts the country has ever witnessed, unfolded amid striking contradictions: a highly sophisticated intervention operating within a system still grappling with deep development challenges. When India launched the n