Why polio is returning in parts of Somalia

Polio is moving through communities in parts of Somalia again, but the word “resurgence” can mislead if it suggests that every case comes from a continuously circulating wild virus. Somalia was recognised in 2020 as free of indigenous wild poliovirus. Later detections have included circulating vaccine-derived poliovirus, and a confirmed wild case in 2024 showed that imported virus can still start another outbreak.

Understanding the resurgence requires looking at several layers at once: a weakened routine immunisation system, dangerous gaps in access, distrust created by conflict and misleading information, and disease surveillance that can miss children when clinics and laboratories are strained. It also requires precision about the virus. A polio outbreak is a public-health failure of reach and trust as much as a biological event, and the response has to restore both.

A resurgence with several dimensions

Certification had a specific meaning. It showed that indigenous wild poliovirus had been interrupted, not that every district had reliable vaccination coverage or that borders were sealed against importations. WHO and African partners have repeatedly warned that polio survives wherever a large group of unimmunised people remains. Somalia’s geography, population movement and recurring insecurity make that warning especially consequential.

Vaccine-derived poliovirus adds another layer. Oral polio vaccine contains attenuated virus that can, in rare circumstances, regain the ability to cause paralysis after circulating for a long time among under-immunised communities. The resulting virus is not the same as the wild strain that circulated during earlier global campaigns. Maintaining protection therefore depends on high and equitable routine coverage, strong surveillance and rapid outbreak response with suitable vaccines.

The human stakes are severe because most infections produce no symptoms. A small proportion cause irreversible paralysis, and breathing muscles can be affected. Children under five are especially vulnerable, while adults can also carry and transmit the virus. A cluster of paralysis cases may represent many more infections than those detected by health workers.

Where immunisation coverage broke down

Somalia’s routine services have never reached every child consistently. Federal and member-state health systems operate amid shortages of trained staff, medicines, transport and reliable cold-chain equipment. Clinics may close, record systems may be incomplete, and families may move before a child receives the full schedule. The result is pockets of zero-dose and partially vaccinated children, particularly around displacement settlements, pastoral routes and districts where armed conflict limits government presence.

Conflict does more than block a single campaign. It can suspend door-to-door teams for months, force vaccinators to leave, and sever links between villages and health centres. Security restrictions can also mean that teams cannot enter communities associated with armed groups. When campaigns are repeatedly postponed, health workers lose access and families may not return when the next round begins.

A further complication is the practical difficulty of finding every child more than once. Pastoralist families travel with herds across administrative boundaries, displaced families relocate after drought or violence, and paper vaccination cards can be lost in transit. A child recorded as vaccinated in one district may appear unvaccinated in another. Cross-border coordination with Ethiopia, Kenya and Yemen is therefore important, especially where movement is routine rather than exceptional.

Conflict and the burden on public health

Militancy and state fragmentation feed the crisis, but they do not explain it alone. Health workers delivering oral drops have been attacked, their offices burned and their families threatened. The resulting fear affects ordinary staff as well as international teams. International monitors can be replaced, yet trust lost by communities cannot be rebuilt by changing contractors or distributing equipment alone.

Public institutions also face competing claims on limited resources. Health workers and vaccines must often share routes, vehicles and cold boxes with maternal care, nutrition programmes and outbreak responses for cholera, measles and other diseases. A system stretched by several emergencies has little slack when a highly contagious virus appears. This is a familiar pattern across Africa, where mining contracts and survival can tie commercial resources to political legitimacy, although the Guinea case is not a direct link to Somalia’s polio crisis.

Local officials, religious leaders, pastoral networks and community health workers can open doors that national messaging cannot. They also need reliable information, paid employment and protection from retaliation. Neglecting those relationships leaves campaigns dependent on short visits from outside, a model that struggles to sustain trust or reach children who are mobile, shy or excluded.

Trust and misinformation in local information markets

Misinformation is most damaging when it fills a vacuum. Some families interpret campaigns as a foreign political project or suspect that vaccine programmes hide surveillance activities. Others have been affected by claims that the drops cause infertility, paralysis or other harms. Such claims should not be dismissed as foolishness. They often reflect real historical experience with coercive medicine, broken promises and information controlled by armed actors.

Trust is rebuilt by answering the concern directly and consistently, disclosing side effects, explaining why oral drops are used in some outbreak settings, and explaining that vaccine-derived strains arise only where immunisation has collapsed. Local radio, health centres and trusted religious or pastoral figures can carry a clearer message than a distant ministry. Communities should also be able to report adverse events without fear that a health worker will be punished.

Digital tools have their own limits. A WhatsApp warning can cross a district quickly, while a correction from a distant ministry may never reach the sender. Regional publishers and information services, including regional public information, can help readers find local notices and compare accounts. Official data should still be checked against dated WHO or UNICEF updates, and shared graphics should retain their source because old maps and old case totals circulate with alarming effect.

Climate, displacement and weak early warning

Climate shocks intensify the health response. Repeated droughts have displaced rural households and damaged water systems, while floods have cut roads and contaminated wells. Malnourished children are more vulnerable to infection and severe disease. The same events increase crowding in settlements where sanitation is poor, open defecation is common and routine vaccination has become difficult.

Flooding can also alter familiar routes just as teams are trying to complete a campaign. People may cross a newly cut road or border, and a missed settlement can reconnect to transmission after health authorities believe an area has been covered. Seasonal movement means coverage maps need regular revision rather than being treated as fixed administrative snapshots.

Early warning depends on acute flaccid paralysis surveillance: clinicians must recognise sudden weakness in a child, report it, investigate stool samples and trace contacts. Where clinics are inaccessible, families may travel far or remain afraid of hospitals, so the absence of reports can reflect poor access rather than low transmission. International funding for laboratories, transport and community reporting is therefore part of outbreak control, not an optional extra.

Recommendations for an Australian response

Australia offers useful experience because it eliminated local transmission of wild poliovirus through high coverage, a strong surveillance system and an inactivated polio vaccine in its routine schedule. On the National Immunisation Schedule, IPV is included in childhood combination vaccines at 2, 4 and 6 months, with a booster around age four. Families should check the current schedule and their child’s official record rather than rely on memory or informal household books.

The legal environment is different from Somalia but also depends on public cooperation. Federal Child Care Subsidy rules can withhold support from families whose children lack required vaccinations or a medically accepted exemption, and jurisdictions such as New South Wales and Victoria use additional no-jab, no-pay or outbreak-exclusion measures. Under Australia’s biosecurity framework, travellers arriving from places with polio risk may need proof of vaccination. These rules work best when clinics, schools, childcare centres and public health nurses explain them early.

Political arrangements matter at home too. The experience of South Africa’s coalition pressures shows how formal agreement can preserve institutional stability while leaving frontline service delivery contested; health campaigns can fade when authority, funding and accountability are split.

Australian readers also encounter the issue through travel and family networks. Travel-health services and community pharmacies in Melbourne, Sydney and Brisbane form part of the country’s mature travel-health market, although a stand-alone polio product may need to be ordered through a general practitioner. Australian Somali communities, including families in Melbourne, Sydney and Adelaide, maintain connections and travel routes through the Horn of Africa. Practical advice and current outbreak information can protect travellers without stigmatising an entire community.

• Check the official immunisation record for every child in the household and arrange catch-up doses through a general practitioner or authorised clinic if any are missing.
• Before travelling to a country with ongoing transmission, seek individual health advice early and carry any certificate required for entry into Australia.
• Keep routine programmes strong, including school and childcare checks, because outbreak campaigns work best when they reinforce an established system.
• Communicate through trusted community voices and use plain language to answer safety concerns, with translation, respectful dialogue and rapid correction of false claims.
• Channel support towards locally led health work, cold-chain equipment, accessible clinics and rapid laboratory transport, prioritising stable multi-year funding.
• Follow dated WHO, UNICEF, Smartraveller and state or territory health guidance, report suspected paralytic illness promptly and avoid sharing maps or case totals with unclear dates.

Turn concern into practical support

For an Australian reader, the most useful response begins close to home: confirm that children and vulnerable adults are protected, seek travel advice when visiting affected areas, and use pharmacies, schools, childcare services and general practitioners as trusted health touchpoints. Community meetings in Melbourne, Sydney and Adelaide can connect families with current advice without turning a public-health problem into blame.

The larger campaign needs the same discipline. Support vaccination teams, locally led reporting, safe water and sanitation, and cross-border coordination that follows mobile families. Protect health workers, publish timely evidence and keep financing stable through drought, flood and conflict. Check records, fund community health workers and demand evidence-based responses: each action can narrow the gap between a missed child and an outbreak.