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Polio Outbreak in Somalia Threatens East African Region

In 2012 there were just 250 cases of polio worldwide. In the past three months, there have already been over 100 new reported cases in Somalia.
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A woman and her child are reigstered at a UNICEF-supported health centre in Mogadishu, Somalia. Photograph by UNICEF/Iman Morooka.

Despite having been eradicated in all but three countries of the world, there has been a worrying outbreak of polio in Somalia recently, raising fears of a new front in the battle against the disease. In 2012, there were only 250 cases across the whole world – virtually all of which were in Nigeria, Pakistan and Afghanistan – but in just the past three months over a hundred new cases have already been reported in the East African nation.

Polio is a debilitating and potentially fatal infectious disease. There is currently no cure, but vaccination initiatives have helped to reduce the prevalence of the disease greatly over the past 30 years. In 1988, 350,000 people – primarily young children – were being paralysed by polio annually, but now wild strains of the virus only persist in Nigeria, Pakistan and Afghanistan, where the disease remains endemic.

In Somalia, there had been no reported cases of polio for the past six years, but the outbreak, which has stemmed from an imported strain of the virus, has already crippled many of the children affected and is a threat to an estimated million more who have not been vaccinated.

A regional worry

Somalia is under particular threat from polio given that it has the second-lowest vaccinated coverage in the world. With less than half of the population protected against the virus, UNICEF has warned that “the outbreak in Somalia, if not controlled quickly, could jeopardize global efforts to wipe out polio once and for all”.

Sikander Khan, the UNICEF Somalia Representative, told UNICEF media: “The poliovirus in such a large reservoir [of unvaccinated people] has the potential to result in a catastrophic outbreak, the likes of which are beginning to be seen and as such constitutes an international emergency”.

Yet the outbreak of polio in the country is not just bad news for Somalia; it also threatens neighbouring states in East Africa. Evidence of polio now spreading beyond the borders of Somalia has emerged. Ten cases of the disease have also been reported in Dadaab, the Kenyan refugee camp complex that is host to around 400,000 people, many of whom are from Somalia. The presence of a disease that is transmitted by person-to-person contact in such a densely populated area, especially one containing people who may be particularly vulnerable to infection, is a worrying development.

International reaction

In reaction to the outbreak and requests for additional support, both the Japanese and British governments have donated additional aid to fight against polio this August: $1.3 million and £10 million ($16 million) respectively. This is being used to fund urgently needed vaccinations for at-risk children in Somalia, northern Kenya and other countries in the surrounding region.

With the help of oversees donations, “Somalia will keep the fight against polio and will make every effort possible to overcome the prevailing security challenges and obstacles” Yasin Nur, Manager of the Somali Health Ministry's Expanded Programme on Immunisation, tells Think Africa Press. “The solution to the current crisis is to ensure that every child has full access all the time to the polio vaccine, irrespective of the geographical location”, he says, adding that in order to prevent future outbreaks in the country, “routine immunisation also needs to be strengthened as well as other childhood health promotion, disease prevention and provision of care interventions.”

A setback, but hopefully a short one

Despite the speed of the outbreak, it is hoped that swift international action may be able to mitigate some of the worst possible outcomes of the crisis. “The UK and Japanese support are crucial as they allow for a timely response, crucial to containing outbreaks”, Heidi Larson, a senior lecturer from the London School of Hygiene and Tropical Medicine explains. “Timing is everything in these situations, and particularly as we are getting so close to finally eradicating polio.”

Although Larson acknowledges that “the recent outbreak of polio in Somalia and Kenya is indeed a setback to the Global Polio Eradication Initiative”, she hopes that with the help of emergency donations that can fund rapid and appropriate action, it will be “a short one”. And based on previous cases of outbreaks, she is hopeful. “In the past”, she says, “the polio initiative has done well – always in collaboration with the relevant countries – in containing polio outbreaks countries which have imported cases.”

“It is in the persisting endemic countries – Nigeria, Pakistan and Afghanistan – where the deeper challenges lie”, she continues. In these countries, polio has proven very difficult to eradicate, partly due to the distrust of immunisation programmes amongst certain communities. “Every outbreak which is due to imported polio takes attention away from the persisting endemic ones”, Larson explains.

What is vital, she insists, is that the imported strain of the virus in Somalia be dealt with swiftly and effectively, but also that the situation there should not result in a loss of concentration in the global effort to completely eradicate this preventable, but deadly disease.

Correction note (9/8/13): In the original, Yasmin Nur was described as a health minister rather than the manager of the health ministry's Expanded Programme for Immunisation.

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In the last few days, MSF has been reported to have left the country. Where does that leave the efforts to tackle polio in Somalia? Won't this hamper international attempts to contain the outbreak?