## Polio: A Persistent Threat on the Brink of Eradication Polio, a highly infectious disease caused by the poliovirus, has long been a global health challenge, primarily affecting young children. While close to being eradicated worldwide, the virus continues to pose a threat in a few endemic countries and areas experiencing outbreaks. The poliovirus typically spreads through contaminated water or food, entering the body and multiplying in the intestines. In a small but significant percentage of cases, it invades the nervous system, leading to irreversible paralysis, often affecting the legs. This paralysis can be life-long, and in severe instances, the virus can attack the muscles involved in breathing, leading to death. The devastating impact of polio underscores the critical importance of widespread vaccination, the most effective tool to prevent its spread and protect vulnerable populations. ## Somalia's Continuous Battle Against Poliovirus Somalia has faced a persistent struggle against polio, with outbreaks resurfacing despite significant efforts. The nation has been grappling with an ongoing polio outbreak since 2017, highlighting the complex challenges inherent in achieving comprehensive immunization coverage. Factors such as internal displacement due to conflict and climate change, widespread insecurity in certain areas, and a fragile healthcare infrastructure create significant hurdles for routine vaccination programs. These challenges often result in immunity gaps, particularly among mobile and displaced populations living in informal settlements within urban centers, where traditional vaccination campaigns might struggle to penetrate effectively. Successfully reaching every child in these dynamic environments is crucial for Somalia to finally interrupt poliovirus transmission and join the global movement towards a polio-free world. ## A Fresh Strategy to Bolster Urban Immunization In a significant move to address these deeply entrenched challenges, Somalia's Federal Ministry of Health and Human Services, alongside the Banadir Regional Administration, recently concluded a five-day pilot polio vaccination campaign. Held from August 9th to 13th, 2026, in the Daynile, Garasbaley, and Kahda districts of the Banadir Region, this initiative marked a pivotal shift in strategy. The campaign was supported by key international partners including the World Health Organization (WHO) Somalia, the United Nations Children’s Fund (UNICEF), and the US Centers for Disease Control and Prevention (CDC). This concerted effort aimed to vaccinate 122,067 children, primarily those residing in hard-to-reach urban settings, particularly among displaced families who had often been missed in previous vaccination drives. ## Unpacking the Innovative Approach: Government, Data, and Community The pilot campaign introduced a groundbreaking "government-led, health-facility-anchored" approach designed to enhance ownership, sustainability, and reach. This strategy positions local government and existing health facilities at the heart of immunization efforts, fostering trust and ensuring better integration with broader health services. Rigorous planning, spanning three months, was a cornerstone of the campaign's success. This extensive preparation involved detailed field assessments and close collaboration between federal and regional health authorities, district teams, and all supporting partners. Senior government officials actively participated in the launch, publicly demonstrating their commitment to eradicating polio, a move that significantly boosts community confidence and engagement. As Dr. Mustafe Awil Jama, Director of the Family Health Department at the Federal Ministry of Health and Human Services, emphasized, this pilot exemplifies the power of collective action, where government, health workers, communities, and partners unite to ensure every child receives life-saving vaccines. ## Reaching Every Child: Overcoming Unique Urban Hurdles Urban areas present unique complexities for immunization campaigns due to high population density, rapid influxes of new residents, and the often transient nature of informal settlements. To overcome these hurdles, the campaign deployed a comprehensive strategy utilizing 178 vaccination teams. These teams employed a versatile combination of house-to-house visits, fixed vaccination sites, and mobile and transit point vaccination strategies. This multi-pronged approach ensured that children could be reached wherever they were found, whether at home, in markets, or along transport routes. The success of this broad coverage was underpinned by sophisticated microplanning. Teams meticulously used detailed population data, geographic information system (GIS) mapping, and field validation to accurately identify every settlement and prioritize locations, ensuring no child was overlooked. This data-driven precision is particularly vital in rapidly changing urban landscapes, where traditional census data might quickly become outdated. ## Ensuring Quality and Accountability A critical component of this pilot was its robust emphasis on quality assurance and accountability. Independent monitors from the Field Epidemiology Training Programme, backed by the CDC, provided real-time oversight, verifying vaccination procedures and data collection accuracy. This independent monitoring played a crucial role in identifying any children inadvertently missed during the initial rounds of vaccination. These identified children were then immediately referred for follow-up, ensuring that the campaign achieved its goal of closing immunity gaps. The rigorous verification process is a key differentiator of this new approach, moving beyond simply administering vaccines to ensuring that every dose counts and every child is protected. By strengthening the links between health facilities, vaccination teams, and communities, the campaign aimed to build a more resilient and responsive immunization system capable of adapting to the fluid nature of urban populations. ## The Road Ahead: Sustaining the Fight Against Polio The pilot polio vaccination campaign in Somalia's Banadir Region has yielded invaluable lessons that will inform and shape future immunization efforts across the nation and potentially in other complex urban settings globally. Achieving a 94% coverage rate for the initial target of 122,067 children under five is a testament to the effectiveness of the targeted and accountable approach. The insights gained from this experience will be instrumental in refining microplanning techniques, strengthening accountability mechanisms, and optimizing the use of data to identify missed children and improve overall vaccination coverage. As Dr. Mohamed Ali Kamil, WHO Representative in Somalia, highlighted, "Reaching every child requires strong government leadership, engaged communities and effective collaboration among all partners." This campaign provided an important opportunity to test a more strategic approach and gather lessons to guide the interruption of poliovirus transmission. WHO, UNICEF, CDC, and other partners remain committed to supporting the Federal Government of Somalia in replicating this successful model in other high-risk areas, reinforcing routine immunization services, and ultimately protecting every child from polio and other vaccine-preventable diseases. The ultimate goal remains a Somalia, and indeed a world, free from the shadow of polio, where no child ever has to suffer from this preventable disease. The continued collaboration and innovative strategies demonstrated in this pilot campaign bring that future a significant step closer.