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Polio eradication

Reaching every last child

Our mission is to maintain a polio-free status by boosting immunity in children under 5 years of age and improving coverage of oral polio vaccines in the routine immunization programme, while continuing to search for polioviruses circulating in the human population and the environment.

Who we are

The Polio Eradication Programme is a partnership that brings together the World Health Organization (WHO), the United Nations Children’s Fund (UNICEF) and the Ministry of Health (at all levels) with the aim of protecting every child from polio and eradicating the disease from the country. These partners are supported internationally by of the Global Polio Eradication Initiative, including the Bill and Melinda Gates Foundation, United States Centers for Disease Control and Prevention and Rotary International, who are committed to eradicating poliomyelitis globally.

As the technical lead, the WHO country office is involved in the following areas: mass vaccination campaigns; nationwide surveillance for acute flaccid paralysis in children under 15 years; capacity development of field staff; containment (during collection, handling and storage) of potentially infectious polio materials; promotion of childhood vaccination provided under the Expanded Programme on Immunization (EPI); and support of the Somali Government for implementation of policies on poliomyelitis in the International Health Regulations (2005).

What we do

Conduct vaccination

In collaboration with health authorities and partners, we work to eradicate polio, primarily through the following actions: Respond to Polio Outbreaks by conducting vaccination campaigns. The last outbreak of wild poliovirus in Somalia was in 2014. However, since December 2017, two concurrent outbreaks of circulating vaccine-derived polio virus (cVDPV) have occurred, resulting in the detection of 19 children with paralysis. In order to interrupt the spread of polio virus and avoid additional infections and disabilities in vulnerable Somali children, we conduct nationwide and smaller, case- response immunization campaigns that aim to reach every child to boost their immunity.  Maintaining a high level of immunity in the entire population, including mobile populations and across borders, is essential to prevent future outbreaks.

Detect acute flaccid paralysis

We search for acute flaccid paralysis in children under 15 years to ensure that, if found, no cases of poliovirus spread any further. Polio teams visit health facilities included in the active surveillance network (793 of 1267 health facilities). As part of passive surveillance, polio teams also liaise with focal persons in 413 other health facilities to report (zero reporting) on any suspected cases. Village polio volunteers support house-to-house surveillance in hard-to-reach and insecure areas.

Detect polioviruses in the environment

We complement surveillance of acute flaccid paralysis by searching for polioviruses in the environment. Samples are collected from sewer systems at four sites in Banadir region, and analysed at the Kenya Medical Research Institute in Nairobi. This surveillance helps signal whether people are infected and are shedding virus in their stool.

Build capacity

We develop the capacity of field staff (including WHO, UNICEF and health ministry staff) in the areas of surveillance and outbreak response.

Support routine childhood immunization

We support routine immunization of children by sharing resources, such as staff, systems and infrastructure with country's EPI. We integrate activities during vaccination campaigns and help strengthen the capacity of the Somali EPI.

Raise awareness of immunization

We work with authorities, UNICEF and local media outlets to raise awareness of the benefits of vaccines and vaccination, the campaigns that are being conducted and vaccination schedules, and to encourage caregivers to vaccinate children. Health workers use Somali information, education and communication materials to raise awareness among caregivers. Manage information. We collect data from acute flaccid paralysis and disease surveillance, EPI and vaccination activities, and other work streams, including from partner agencies (such as mapping of internally displaced people from the International Organization for Migration). This information guides decision-making and allows us to assess the quality of work done across the country. We post the information collected and the high-quality maps produced on the website www.somaliapolio.org. Polio teams are progressively using real-time, electronic means of reporting for data management (Open Data Kit software).

Support other health interventions

We provide support to other health interventions by sharing resources and systems established by the polio eradication programme in the past 22 years. For example, our systems are used to improve surveillance for diseases (including measles) and outbreak control (such as cholera).

Our impact

Working with the Somali Ministry of Health and partners

  • Kept the free country of wild polioviruses since 2014
  • Spread of two outbreaks of circulating vaccine-derived polioviruses types 2 and 3 stopped through 19 intense polio vaccination campaigns
  • Environmental surveillance introduced in Banadir, which helped detect vaccine-derived polioviruses in sewer water samples
  • Strong partnerships with Kenya and Ethiopia forged to work jointly to eradicate polio from the Horn of Africa, which led to synchronized supplementary immunization and cross- notification of acute flaccid paralysis cases
  • More than 2.5 million children under 5 years reached with oral polio vaccines during nationwide campaigns
  • Circulation of cVDPV2 detected in Somaliland and Puntland after years of no cases in these states. Cross-notified 17 acute flaccid paralysis cases with Ethiopia
  • Polio and acute flaccid paralysis surveillance and response maintained across the country
  • Somali women empowered through employment as 65% of polio field staff are women

What we have achieved

  • Enhanced quality of immunization campaigns by improving planning and monitoring of immunization campaigns and improving quality of training offered to health workers. Campaign quality is monitored by independent third-party monitors.
  • Negotiated and gained access to insecure districts, which led to an estimated 50 000 children being vaccinated against polio in these areas for the first time. These areas have been inaccessible for many years.
  • Prioritized health facilities and liaised with health focal points to develop schedules for active visits and passive reporting, both of which search for children with acute flaccid paralysis, to detect the spread of any polioviruses.
  • Improved reporting and field supervision by using real-time, electronic means of reporting, including the Open Data Kit.
  • Developed the capacity of more than 200 national staff through training on surveillance and microplanning led by international experts. Training is done directly, hence eliminating the need for cascading.
  • Developed information, education and communication materials on acute flaccid paralysis surveillance to help health workers, Somali parents and caregivers and our partners understand how polio is spread, what acute flaccid paralysis is and what actions need to be taken when it is detected, and the benefits of vaccination.

What is next

  • The Polio Eradication Programme will intensify efforts to promote population immunity and strengthen surveillance to end the ongoing cVDPV outbreaks and to eventually certify the country free of polio through the following activities.
  • Target high-risk populations (nomadic people, internally displaced people, populations living in border districts inside the country and along shared international borders) with fractional doses of inactivated polio vaccine. Campaigns will be conducted in phases, using bOPV and fractional inactivated polio vaccine.
  • Expand environmental surveillance to other major cities, including Hargeisa, and three sites in Kismayo and Baidoa to monitor viruses in the environment in these cities.
  • Continue community-based surveillance through the use of village polio volunteers mainly in inaccessible areas and areas with no health infrastructure, including international borders.
  • Deploy transit point vaccinators to vaccinate children at ports of entry across the country.
  • Continue to implement the polio transition and integration plan. This plan aims to use polio assets (human resources, physical assets and infrastructure) and systems to strengthen disease surveillance, response to health emergencies and routine immunization, and the overall health system, while at the same time working to maintain the country's polio-free status.
  • Continue to strengthen capacity of health workers and conduct regular programme reviews in different areas to maintain high standards of health care delivery.
  • Continue polio containment activities and the implementation of the International Health Regulations (IHR) recommendations to work towards the certification of a polio-free country.
  • Continue to negotiate access to reach 537 000 children under 5 years in difficult-to-reach areas.

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