Disbanding the polio surveillance network may undermine all gains, disrupt disease control efforts
At a time when 99 polio cases were reported in Pakistan and Afghanistan last year and 18 cases as of July 15, 2025, and 297 circulating vaccine-derived poliovirus type 2 (cVDPV2) cases were reported last year, with the majority of them being from six countries, the decision to wind down the polio surveillance programme in India would undo the hard-gained achievement
The decision to dismantle the National Polio Surveillance Network (NPSN), established as a collaborative effort between the World Health Organization (WHO) and the Government of India, has unsettled the public health community. While the country rightly celebrates being polio-free since 2014, shutting down this vital surveillance system, rather than expanding it into a comprehensive, global disease monitoring network, is a historic missed opportunity.
NPSP surveillance strengthened for other diseases too
In 1997, the National Polio Surveillance Project (NPSP) was launched by the Indian government with WHO. Based on the rigorous evidence generated by the surveillance platform, India was able to improve and sustain the quality and coverage of supplementary immunisation activities and build capacity for India’s disease control programmes. Over time, the polio surveillance programme evolved its mechanisms to monitor and enhance capacity for other critical health programmes, such as measles and Japanese encephalitis vaccinations, as well as India’s Universal Immunisation Programme. The lessons learned from the project have helped establish surveillance systems for other life-threatening diseases, including measles. Additionally, its effective training and programme monitoring have improved cold chain management, facilitating the introduction of hepatitis B and Japanese encephalitis vaccines into India’s immunisation programme, boosting measles-rubella vaccination efforts, supporting routine immunisations, and strengthening surveillance for other diseases.
The polio surveillance project was established specifically to address the inadequacy of India’s former disease surveillance systems, which struggled to meet the stringent demands of polio eradication. Since its launch, the project has evolved into a model system, widely recognised globally for its effective monitoring and rapid response.
Confronted with several criteria that traditional government systems often struggled to meet, the polio surveillance project achieved success through specialised expertise, a committed staff, and rigorous, strict operational standards. When such a high-performing vertical programme is integrated into broader routine structures, there is a significant risk of diminishing its quality and responsiveness. Instead, moving forward is to safeguard and enhance the exceptional infrastructure of the project while simultaneously developing complementary national systems, thereby ensuring that India not only maintains its polio-free status but also improves its capacity to address a wider array of public health challenges.
Turning India into a global leader in disease control
Formerly known as NPSP and rechristened as National Public Health Support Network (NPSN) after India eradicated polio, the WHO-Indian government partnership exemplifies how technical expertise can serve the public good. Supported by the CDC, WHO, and others, the Network consistently demonstrates self-reliance, as it is entirely conceived, developed, and managed by Indian professionals. While several other health programmes are externally driven, NPSN is a truly swadeshi and homegrown Atmanirbhar initiative, showcasing Indian public health expertise at its best. The surveillance officers, infrastructure, data systems, and operations have all been indigenously developed and managed by Indian professionals, delivering global centres of excellence in field, laboratory, and environmental surveillance and aiding in supplementary immunisation activities.
With an average of 500-1,000 children getting paralysed daily, India was hyperendemic for polio until early 1990s and was once known as the world’s epicentre of polio. From 741 cases in 2009, which was more than the three other endemic countries combined and over 60% of all polio cases globally, India sharply transitioned to just one case in 2011, and no more polio cases reported since then. Among the endemic countries, India not only stopped polio transmission but has also prevented new cases thus continuing to be polio-free. In stark contrast, Pakistan, Afghanistan, and Nigeria continue to have polio outbreaks. While externally led initiatives in other countries are yet to eradicate the disease, the ingenuity, rigor, resilience, and expertise nurtured within the programme safeguarded India’s status as a polio-free country. This is one global health programme where India holds an unequivocal leadership, and is a respected global health authority.
Some of the best seasoned professionals in polio eradication, trained in the organisation, have ascended to spearhead polio and disease surveillance initiatives across Africa, Southeast Asia, and beyond, actively contributing to international efforts aimed at disease control and health promotion. This cadre of highly skilled professionals, trained and validated in India, has strengthened the country’s position as a global leader in public health surveillance. Disbanding the programme now would threaten India’s capabilities and reputation as a key player in disease prevention and control. Maintaining and elevating this institution is crucial to ensure our national resilience and uphold India’s international reputation in public health.
To now allow this system to wither away in the name of self-reliance is paradoxical; it would mean dismantling one of the most successful self-reliant public health models India has ever built. Genuine self-reliance is about maintaining and strengthening robust local institutions, not just starting anew.
In the next two years, the programme will be scaled-down from about 280 units in 2025 to 190 next year and 140 in 2027 with a corresponding reduction in financial support from the government. However, the real consequences include diminished capacity, disrupted operations, and a lack of preparedness for future outbreaks. It also raises concerns for the workforce, many of whom are uncertain about their futures. Years of experience in data reporting, community health, and field epidemiology risk are being overlooked instead of being used to advance public health goals. There is still hope. The programme can be transformed rather than retired if policymakers make informed decisions with vision. This lasting legacy can continue to benefit the country and the world, potentially even more, through investments in technology, integration, and training.
Ill-timed
Pakistan and Afghanistan have reported 99 type-1 polio cases last year and 18 polio cases till July 15 this year (and 379 virus reported from other sources in 2025). Also, circulating vaccine-derived poliovirus type 2 (cVDPV2) has been detected in underimmunised communities even in polio-free countries. In 2024, 297 cVDPV type-2 cases were reported, with the majority of them being from six countries. As per WHO, from January 1 to May 12, this year, already 49 cases cVDPV2 have been reported from eight countries. Poliovirus is still designated as a Public Health Emergency of International Concern (PHEIC) by WHO.
If wild poliovirus type 1 and circulating vaccine-derived poliovirus continues to be reported in neighbouring countries, any weakening of the polio surveillance programme in India would undo the hard-gained achievement. Expanding the surveillance network strategically could have helped track enteroviruses, respiratory viruses, and drug-resistant organisms and improved public health readiness by enabling broader pathogen monitoring, including emerging viruses like SARS-CoV-2. At a critical time when global health initiatives are struggling due to funding cuts in the U.S. and elsewhere, India and other countries were expected to increase investments in disease surveillance and public health. However, the decision to disband the polio surveillance network undermines previous gains, disrupts disease control efforts, and creates vulnerabilities for both new and re-emerging health threats.
An opportunity for India
Instead of phase-wise undoing as stated, the polio surveillance network can be rapidly elevated to a next-generation surveillance network by building on its current strengths and incorporating innovative technologies. A global prototype of a surveillance platform can be built to predict and prevent future pandemics. The country can elevate the surveillance network by expanding and integrating ICMR’s fever-based syndromic surveillance system, utilising the successful lab algorithms for early detection and case differentiation. The existing institutional processes and operational culture of the surveillance network can be maintained and scaled up by utilising the existing network of surveillance medical officers to establish a formal national group of field epidemiologists. This approach integrates public and private reporting, improving real-time investigation, data analysis, and response.
By integrating with the laboratory capabilities of the Integrated Disease Surveillance Project (IDSP), additional enhancements can be made using multiplex testing across all district-level IDSP public health labs, with Integrated Disease Research Laboratories acting as reference centres. Using the polio surveillance network, the Emergency Operations Centre can serve as a centralised hub for coordinated detection and rapid response. The network must be able to handle advanced tools such as genomic surveillance, environmental sampling, One Health approaches, and AI analytics, all of which should be developed within a collaborative, interoperable framework. Ongoing capacity building through the Field Epidemiology Training Programme, along with targeted training from the National Centre for Disease Control and ICMR-NIE, can ensure a skilled and adaptable workforce. Lastly, the public health schools in the country can partner with an integrated platform, including the polio surveillance network, to create a future cadre of public health professionals that the world can look up to. Such a platform can facilitate the forecasting of disease trends and inform proactive, data-driven strategies. Collectively, there is an opportunity to transform the polio surveillance network into a resilient, modern surveillance system rooted in Indian expertise, one that can establish global standards.
This is also a personal loss for most of us. Through the National Polio Surveillance Project, we developed a deeper understanding of public health in practice. It served as a training ground, a community, and a mission, while also acting as a surveillance system. My professional identity has been shaped by lessons in field epidemiology, community engagement, data integrity, and teamwork. For us, NPSN was both our public health classroom and our workplace. We continue to greatly value this exceptional network, its members, and the principles it upheld. India achieved something extraordinary beyond defeating polio. The greatest setback to public health is the loss of this strong network.
