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MORADABAD, INDIA — The boy was set on the hard mud ground near a pile of manure. His grandfather arranged his tiny hands in front of him and his withered legs behind and pulled him up by the belly into a contorted fold.

Mounis, who is 3 years old, whimpered and his gaze drifted. When he was told to "walk" he reluctantly shuffled his hands and dragged his limbs a short distance and slumped. He was carried back to the dung pile and told to do it again.

With wide eyes and a blank expression he looked at the gathered crowd but did not cry. Flies pestered him but he did not stir. He seemed used to being a spectacle.

Mounis bears the distinction of being the last confirmed case of polio in his district. In 2009 when he was 17 months old the disease announced itself with a shiver and a fall. Mounis may never walk upright or on his own.

"He doesn't play with other children," said Mounis' mother.

Their village is near Moradabad in India's most populous state of Uttar Pradesh. It is hemmed by sewage that streams along every wall and is pooled near the only water pump. Poor sanitary conditions invite poliovirus to thrive and it is a reason why it has proven stubborn here.

(Polio-affected Mohammad Bilal, 12, and Farman, 11, display their limbs in their hometown near Moradabad, India. AP Photo/Kevin Frayer)

Moradabad was the epicenter of India's most recent outbreak but with aggressive immunization and tighter monitoring the district's cases are at zero and holding.

"If Moradabad can be free of polio," said Amar Singh, the district medical officer, "then the world can be free of polio."

India is one of only four countries left where polio is still endemic. But this month it marked its first-ever full year free of the disease. If no new data are revealed in the next few weeks then India will be removed from the list, leaving only Pakistan, Afghanistan and Nigeria as the notorious trouble zones.

The goal: If India's clean record stretches another two years there will be a declaration that polio is officially eradicated.

The greatest risk is infection from neighbouring Pakistan where there is an alarming rise in the number of polio cases. India has even set up immunization booths at its land border point and screens every child under the age of five crossing into the country.

"A constant flow of funds will be required to prevent the spread of polio menace in countries like China and Russia," said billionaire Bill Gates in a statement. Polio eradication is a top priority for his Gates Foundation which contributes $150 million annually to the cause.

For now the cautious control over polio is hailed as a remarkable public health achievement. Consider this: Around the time polio was eradicated in North America, there were some 220,000 cases here. The Indian government (with donors) has since spent billions of dollars to stem the disease long forgotten by richer nations.

So how is India winning? The government refined its strategy and with the World Health Organization, Unicef and groups like Rotary International pledged to vaccinate every single child with 6 to 8 doses.

More significant is that hospitals and teams are deploying with a better vaccine. A past formulation was designed to thwart three types of polio; the improved version now targets only the two types that are most prevalent.

It is administered in a series of drops into a child's mouth. Free clinics are routinely staged in alleys and squares throughout the country and there is a series of national immunization days. In rural areas health workers go door-to-door, leaving a tag with a "P" where they have visited.

Still, when vaccinating tens of millions of children every year, it is possible some may be missed.

"With other vaccines like small pox there is a scar," said one health official who could not be named, "but the record for polio immunization in India is based only on an oral history. We have to trust the family."

In Mounis' case, relatives claim he was immunized but that for some reason it did not work. Health officials concede that a small percentage of children may always be susceptible.

"I'm happy there is a last case," said Mounis' grandfather, "but I'm sad that it had to be my boy."

@janisctv

(Rahan Mohammad, 4, affected by polio, holds on to iron grilles on the window of a house in Moradabad, India. AP Photo/Kevin Frayer)