After independence, India began building national public health systems that could deliver vaccines at scale. This capacity-building set the stage for later disease-specific campaigns, including smallpox and polio, which required strong logistics, reporting, and community outreach.
India launched the National Smallpox Eradication Programme (NSEP) in 1962, initially focusing on mass vaccination. Early results showed that vaccination alone was not enough where coverage was uneven and case reporting was incomplete.
Beginning in mid-1973, India’s smallpox effort moved toward intensive case finding and rapid containment. This approach centered on active searches for fever-and-rash illness, isolation of cases, and targeted vaccination around outbreaks (“ring vaccination”).
In 1973–1974, reported smallpox cases in India rose sharply, largely because active searches found infections that had been missed before. The surge reinforced why surveillance mattered: you cannot stop transmission if you cannot see where the disease is spreading.
India’s final known naturally transmitted smallpox case occurred in May 1975, marking the interruption of endemic transmission. The end of cases reflected years of vaccination and the late-phase emphasis on finding and containing every outbreak.
After a required period of continued intensive surveillance, an international assessment commission declared India free of smallpox. Certification mattered because it confirmed not just the absence of cases, but also that surveillance was strong enough to detect hidden transmission.
In 1978, India initiated the Expanded Programme on Immunization (EPI) to reduce illness and deaths from major vaccine-preventable diseases, including poliomyelitis. EPI helped normalize routine immunization delivery, which later supported mass polio campaigns.
India launched the Universal Immunization Programme (UIP) in 1985–1986, expanding immunization services and adding measles vaccine during the acceleration of EPI. This broadened the national platform that polio eradication efforts would build upon in the 1990s.
India began Pulse Polio (National Immunization Days) in December 1995, using two rounds of oral polio vaccine to reach tens of millions of children. The strategy aimed to raise population immunity quickly and interrupt virus transmission during the low season.
In 1997, India set up an active surveillance system for polio using acute flaccid paralysis (AFP) as the key warning sign, supported by the WHO National Polio Surveillance Project (NPSP). This shifted the program from relying mainly on passive reporting to systematically searching for and investigating suspected cases.
By the early 2000s, India remained among the countries with ongoing wild poliovirus transmission, prompting very large supplemental immunization activities. These campaigns combined booth-based dosing with house-to-house visits to reach children repeatedly and close immunity gaps.
India’s last reported case of wild poliovirus occurred in West Bengal, with paralysis onset on 13 January 2011. After this, India maintained high-quality surveillance and rapid response capacity to ensure the virus was no longer circulating unnoticed.
On 27 March 2014, WHO certified the South-East Asia Region as polio-free after at least three years without indigenous wild poliovirus transmission. Because India was the last affected country in the region, this certification marked the closing outcome of India’s polio eradication campaign within the 1948–2014 scope.
Public Health Campaigns: Smallpox and Polio Eradication in India (1948–2014)