Moradabad is a nondescript and scruffy city, 180km north of the Indian capital, New Delhi. Few have heard of it, despite its population of nearly 5 million, but it is about to become the site of an astonishing victory against a terrible disease.
Moradabad has long been the center of one of the most stubborn concentrations of polio in India.
The disease is passed on by person-to-person contact and, with Moradabad’s poor inhabitants frequently traveling far across the country in search of work, outbreaks elsewhere have often been traced back to the city.
The WHO stipulates that three years must pass without any cases of polio occurring before a region can be declared polio-free.
Moradabad, which only recently had 60 to 80 cases a year, is expected to qualify this year.
“This will be a wonderful thing — for us, for India, for the people of Moradabad,” said Mohammed Arif, a doctor, public health specialist and organizer of anti-polio campaigns in the area.
There is a bigger national milestone on the horizon. If in India as a whole there are no more confirmed cases before Jan. 13, the country will have completed its first year without a new victim.
And if polio is gone from India, the only countries where the disease is still endemic would be Nigeria, Afghanistan and Pakistan.
India’s likely achievement would be a big step towards the eradication of a global disease — the second after smallpox, which was officially defeated worldwide in 1979.
“That would really be something to be happy about,” Arif said.
It would also be a boost to a global effort that has been flagging in recent years, with key milestones repeatedly missed.
In the summer, Sir Liam Donaldson, the UK’s former chief medical officer who now chairs the independent monitoring board of the Global Polio Eradication Initiative, said the final success of the campaign to eradicate polio, which has seen cases reduced by 99 percent over 20 years, was “on a knife-edge.” In some places, particularly sub-Saharan Africa, polio has even made a comeback.
In India, a mass vaccination campaign involving more than a million volunteers reduced cases nationally by 94 percent between 2009 and 2010, from 741 to 42, and down to the single case last year.
The success is due to a combination of highly motivated local workers, philanthropy, the involvement of international health bodies and the sometimes inefficient, but nonetheless essential support of local government.
Equally important in overcoming the last bastions of the disease, as in many parts of the world, has been the consent of local religious figures.
Over the last decade one of the biggest obstacles to eradication of polio in India, as in Pakistan and Nigeria, has been the resistance of poor and largely illiterate Muslim communities such as those in and around Moradabad.
Even as the first campaigns got underway in the area in the late 1990s, local clerics began telling congregations that the vaccinations were part of a government plan, backed by the West, to make Muslim women infertile.
The febrile atmosphere of the early years of the past decade, against a backdrop of the Sept. 11, 2001, attacks on the US and wars in Iraq and Afghanistan, aggravated the problem.
The Karula neighborhood of Moradabad has seen some of the fiercest resistance to the campaign.
A quarter of a million people, including huge numbers of small children, are packed into Karula’s narrow lanes. With no proper sewage system and monsoon rains flooding streets with feces, polio — which is spread through poor sanitation — was endemic.