Somalia is again polio-free, the Global Polio Eradication Initiative (GPEI) announced today, calling it a 'historic achievement' in public health. Somalia has not reported a case since 25 March 2007, a major landmark in the intensified eradication effort launched last year to wipe out the disease in the remaining few strongholds.
Against a backdrop of widespread conflict, large population movements and a dearth of functioning government infrastructure, transmission of poliovirus in the country has been successfully stopped. This landmark victory is a result of the efforts of more than 10 000 Somali volunteers and health workers who repeatedly vaccinated more than 1.8 million children under the age of five by visiting every household in every settlement multiple times, across a country ranked one of the most dangerous places on earth.
The use of innovative approaches tailored to conflict areas was pivotal in stopping polio in the country. These included increased community involvement and the effective use of monovalent vaccines to immunize children in insecure areas with several doses within a short period of time.
"This truly historic achievement shows that polio can be eradicated everywhere, even in the most challenging and difficult settings," said Dr Hussein A Gezairy, Regional Director for the WHO Regional Office for the Eastern Mediterranean.
Polio, which can cause lifelong paralysis, has been stopped nearly everywhere in the world following a 20-year concerted international effort. Only four polio-endemic countries remain – Afghanistan, India, Nigeria and Pakistan – and the eradication of polio globally now depends primarily on stopping the disease in these countries.
Poliovirus travels easily and, in the world of modern travel, can cover long distances. Until transmission of the virus has been interrupted in the four remaining endemic countries, the risk to the rest of the world remains high. Somalia, which had already eradicated the disease in 2002, became re-infected in 2005 by poliovirus originating in Nigeria. This repeated success in Somalia indicates the disease can be stopped even in areas with no functioning central government.
“Somalia beat polio in the midst of more widespread conflict and poverty than that affecting Afghanistan and Pakistan,” according to Dr Maritel Costales, Senior Health Advisor, UNICEF New York. He cites insecurity and large population movements in those countries as challenges to reaching all children with vaccine. “But Somalia shows that when communities are engaged, children everywhere can be reached.” Afghanistan and Pakistan could be the first of the remaining endemic countries to stop polio; between them they account for 5% of all cases of polio in 2007.
Consistent financial commitment continues to be crucial to completing polio eradication. The global effort currently faces a shortage of US$ 525 million for 2008-2009, funding urgently needed to fight the disease in the remaining endemic areas and protect children in high-risk polio-free areas. Rotary International, the top private sector contributor and volunteer arm of the GPEI, has contributed US$ 9.2 million for polio eradication in Somalia, and US$ 700 million worldwide since 1985. “Somalia clearly shows that the tailored tools and tactics of the intensified eradication effort are working,” commented Mohamed Benmejdoub, Chair of Rotary's Eastern Mediterranean PolioPlus Committee. “A polio-free world is a feasible public health goal and a global public good. I urge governments across the world – and in particular the G8 countries – to rapidly make available the necessary resources. Together, we can ensure that no child need ever again suffer the terrible pain of lifelong polio-paralysis.”
The GPEI is spearheaded by national governments, WHO, Rotary International, the US Centers for Disease Control and Prevention (CDC) and UNICEF. Since 1988, the incidence of polio has been reduced by more than 99%. At the time, more than 350 000 children were paralysed every year, in more than 125 endemic countries. Today, four countries remain which have never stopped endemic transmission of polio: Afghanistan, India, Nigeria and Pakistan. In 2007, 1308 cases have been reported worldwide (data as on 18 March 2008).
One of the 10 000 Somali volunteers and health workers is Ali Mao Moallim, who – more than 30 years ago on 26 October 1977 – became the last person on earth to contract smallpox. Over the past few years, working with WHO, he has travelled extensively throughout Somalia to immunize children against polio and foster community engagement during immunization campaigns. "Somalia was the last country with smallpox. I wanted to help ensure that we would not be the last place with polio too," he said.
Somalia's last case of indigenous polio was in 2002. On 12 July 2005, the country was re-infected by poliovirus originating in Nigeria, resulting in an outbreak of 228 cases in total. Systematic and widescale outbreak response activities, including intensive community engagement, successfully stopped the epidemic, and the last case was reported on 25 March 2007 in Mudug Province, in central Somalia.
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