Bill & Melinda Gates Foundation

Q&A: Gates Foundation's Orin Levine on What We Can Learn From Ending Polio in India

February 11, 2013

Dr. Orin Levine is the Director of Vaccine Delivery at the foundation. He recently traveled to India to learn more about how the Ananya program work is progressing. Shelley Thakral, Senior Communications Officer for the India Country office, talked to him about this trip.

What brings you to India?

There are a number of reasons for someone interested in vaccines to come to India. It’s home to some of the most important vaccine manufacturers in the world, it’s home to tremendous scientific progress and research and development. It’s not home to polio anymore, because polio has been eliminated from India for two years now!

But on the downside, India is still home to more un- or under-immunized children than any other country in the world, and to considerably more vaccine-preventable diseases than anybody would like. So there are various reasons for coming, but my main purpose was to observe the experience of Bihar, a state in Northern India, where the polio effort is now being leveraged to strengthen routine immunization in ways that are really exciting.  I think Bihar could provide a model for other parts of the world.

Can you say more about this model to strengthen what we call “routine immunization” in other parts of the world?

What I saw in Bihar was that three critical pieces have come together. First, you have the building blocks of the systems – Anganwadi workers, ASHAs (accredited social health activists) and ANMs (auxiliary nurse midwives). They are the critical frontline workers who are responsible for mobilizing communities, delivering vaccines, counseling parents and all those kind of things. Lots of places have that.

But what is special and makes the difference in Bihar is that in addition you have top-level political commitment and across-the-board engagement of the administration and civil services who say that routine immunization is incredibly important for our communities.

And the third piece is that the polio monitoring and surveillance apparatus is now being used to help those frontline workers do their job and give feedback to an engaged government that wants to see where progress is being made and responds when additional efforts are needed. So it’s those three components of the solid infrastructure and human-resource base, high-level political will, and the feedback mechanism that I think are coming together in Bihar.

Since polio has now been wiped out of India, communities may be looking at other diseases where they can fill the gap. Can new vaccines help save lives and improve health in India?

The most immediate effect of the polio eradication effort for communities throughout India is the strengthening of the routine immunization delivery that provides the complete package of vaccines and serves as the fundamental basis for primary health care. For me as a parent, taking my kid to get vaccinated was the thing that first brought me into contact with a pediatrician, and in the same way, immunization systems in India are often the initial point of contact between the health system and women and their children.

That’s why I love working on routine immunization. It brings the moms and the young kids in. You can counsel them on breastfeeding. You can talk about birth phasing. You can do a whole bunch of different things which you can’t do without that initial contact. Routine immunization brings mothers and children into the health care system and provides them the services they want.

Even when we increase routine immunization coverage rates, there will still be important opportunities for improving health through the introduction of new vaccines. Pneumonia and diarrhea are the two most important killers of children in India, but they are vaccine-preventable diseases; some of the new vaccines like the pentavalent vaccine are being rolled out in India, and the rotavirus or pneumococcal vaccines are coming. These present great opportunities.

Of course, the science and technology field that is so strong in India is also producing vaccines against important diseases like Japanese encephalitis, and we hope in a few years to have a dengue vaccine, so there are a lot of vaccine-preventable diseases that we can tackle in the future by building these strong immunization systems now.

Learn about the work UNICEF India is doing and how you can get involved to support improving child health in India: http://www.unicef.org/india/

 
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