Six months have passed since the most recent case of polio was reported in the Horn of Africa. The outbreak, which was first reported in April 2013, paralysed 199 children over 2013 and 2014 against the backdrop of insecurity, barely functioning health systems, large population movements and very low levels of routine immunization spanning over the last 20 years.

The polio programme, a partnership between the Somalia Ministry of Health, WHO and UNICEF, has mounted a strong outbreak response in the face of incredible challenges. Somalia, which eradicated the disease in 2002, became re-infected in 2005 from wild poliovirus originating in Nigeria, and then again in 2013.
The most recent case was detected on 11 August in Budud village of the coastal district of Hobyo in central Somalia. The child was 18 months old and had received just one dose of oral polio vaccine, meaning that he had missed many vaccination opportunities and consequently not developed full immunity against polio. Most of the 2014 cases, including the most recent, were found in nomadic communities who were consistently being missed on vaccination campaigns.

By identifying travel patterns, working with community elders and specifically targeting the children of nomads, the polio team in Somalia has made progress reaching previously unreached children. Further innovations have been used to combat the outbreak, including pilots in Puntland of the use of mobile technology in monitoring and improving the methodology of post campaign assessments.

In January, The Islamic Advisory group for Polio Eradication brought together 26 Somali religious and community leaders with prominent Muslim scholars from several countries to discuss community engagement in activities to address the outbreak. Action groups were formed in three Somali regions to encourage and support such immunization programs and tackle barriers and misconceptions.

Insecurity, resulting in inaccessibility to almost 400,000 children in central and southern zones of Somalia, is a major challenge that the polio team is facing in ending the Horn of Africa outbreak. Despite this, continuous efforts have been made to reach children in these areas, and the numbers of missed children were reduced by 40 per cent over the course of 2014.

From the 10 – 12 February, the Horn of Africa Technical Advisory Group (TAG) met in Nairobi with a specific focus on closing the outbreak in Somalia. They concluded that significant progress had been made in the outbreak response. The TAG commended the reduction of inaccessible children in the last year, but warned that with 200,000 children remaining unreached in south central Somalia the possibility of low level undetected transmission couldn’t be ruled out. The highest risks for the coming months were outlined as the complex humanitarian emergencies in neighbouring South Sudan and Yemen, and the gaps in surveillance. Key recommendations for the coming months were all targeted at reaching missed children: utilising communities in hard to access areas for both campaigns and surveillance, taking opportunities for joint interventions with other programmes and addressing low Routine Immunization coverage, drawing on the polio infrastructure where possible.

Polio, which can cause lifelong paralysis, has been stopped nearly everywhere in the world following over 25 years of concerted international effort. Only three polio-endemic countries, where the virus has never yet been stopped, remain – Afghanistan, Nigeria and Pakistan. The eradication of polio globally now depends primarily on stopping the disease in these countries and ending outbreaks in high risk areas of the world. This January marked six months since the last polio case in Nigeria, indicating that significant steps are being taken across the African continent towards a polio-free future.
While polio continues to exist anywhere in the world, countries with under-immunized populations remain at risk of the virus. Care and vigilance are crucial across the African continent to ensure that children everywhere are vaccinated, despite the challenges posed by inaccessibility and insecurity. In addition, strengthening surveillance systems so that polio cannot continue to be transmitted undetected is crucial in moving towards confidence that polio has been eradicated in Africa for good.

The tremendous effort of Government of Somalia and its partners in containing the outbreak is highly commendable. But polio has not yet been stopped for good, and efforts must continue to ensure polio free status for children across Africa.