A tale of two diseases

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India is the shining star in the global battle to eradicate smallpox. It is also a branded villain as far as polio is concerned. How is it that we managed so well against a disease more virulent than polio? Why does Uttar Pradesh today contribute to about 88 per cent of all polio cases worldwide?

On January 2, 1967 the World Health Organization (who) launched the intensified Smallpox Eradication Programme. In order to exterminate the disease, a 100 percent vaccination strategy was undertaken. This was a necessity. In 1966 western Nigeria, where 90 per cent of the population had been vaccinated, had an outbreak (supposedly originating from a religious group that resisted vaccination). India did not wake up till a similar incident in Gulbarga, Karnataka in 1970. A smallpox epidemic affected 1200 people and claimed 123 lives in five city municipalities and in the outskirts. This prompted a military-like operation, using every health worker in the area to do a house-to-house search of cases and carry out compulsory vaccination.

The Gulbarga experience was India's first real success with surveillance and containment in a densely populated area. This strategy was slowly understood; thereafter rapid action became possible. In Bihar and Uttar Pradesh for example, it was worked out only in 1973; village-to-village searches found 10,000 new cases. India's health administration was too slow