In the border town of Waajale, Ethiopia, a
frayed, knotted rope marks the international boundary with Somalia. The
rope is ignored by just about everyone.
Global efforts to eradicate polio have made impressive progress
over the past decade. Last year there were only 223 cases anywhere in
But armed conflict and chaos are making it tough for the world to wipe out the virus completely.
Polio has re-emerged in war-torn Syria after more than a decade, the World Health Organization
Tuesday. "The original cluster of suspected cases was 22 cases," the
WHO's Oliver Rosenbauer says. "Out of those, 10 have now been confirmed
as polio. The others are still being processed in the laboratory."
Earlier this year, Ethiopia carried out five
mass immunization campaigns against polio along the Somali border. But
to be fully protected, kids need several doses of the oral vaccine.
Over in the Horn of Africa, an outbreak has ballooned into more than 190 cases. The outbreak's epicenter is , where fighting and violence have kept vaccinators from reaching hundreds of thousands of kids in the past few years.
officials are concerned that polio could become endemic in Syria and
the Horn of Africa. They have launched massive emergency vaccination
campaigns in both regions to try to protect millions of children against
the crippling virus.
But polio infections in Somalia have already spread to ,
South Sudan and Ethiopia. A recent visit to the Somali-Ethiopian border
highlights just how easily the virus can move silently around rural
areas — and eventually find kids who aren't vaccinated.
Ethiopia has reported only six cases of polio compared to 174 in
Somalia. But the landlocked country shares a thousand-mile border with
Somalia. Most of it's unmarked and uncontrolled. Goat, sheep and camel
herders move back and forth across the arid plains between the two
countries seeking fresh pastures for their animals.
At the border town of ,
a frayed, knotted rope strung across the road marks the international
boundary. The rope is ignored by just about everyone. Young men step
over it. Vendors with wheelbarrows full of vegetables scoot under it.
authorities acknowledge that it's impossible to completely control the
flow of people between the two countries. But in an effort to limit the
importation of polio, Ethiopia has set up 13 vaccination checkpoints at
major crossings. The Health Bureau has also deployed vaccinators to
nearly 40 informal points of crossing along the border.
Wajaale, the vaccination station is a small shack next to the rope on
the Ethiopian side. When I visited the station one morning in early
October, the vaccinator was absent. The sign announcing mandatory polio
vaccination for all children had been tied back so that it was
The town of Wajaale, Ethiopia, is located
along the Somali border. The region around the border here is peaceful.
But farther south, armed militants rule the area on the Somali side.
The goal of these border vaccination posts is to immunize every
child, under the age of 15, who crosses in either direction, says
Abdulahi Mohamed, who is with the government's regional health bureau.
"They have their vaccines there," he says pointing to a small ice chest.
"They check the children. Everyone under 15, they give one dose of
Abdulahi and other Ethiopian officials say
that each border vaccination post is immunizing hundreds of kids every
day. But during my visit, only 10 children had been vaccinated by noon.
vaccinators are poorly paid, Abdulahi says — the equivalent of about
$30 a month. He concedes that it's difficult to keep them motivated.
Ethiopia's health ministry says that containing this polio outbreak is a
top priority. "If you have a house that's caught fire, you need to
extinguish (the flames)," says the country's health minister, Dr. . "So we take this seriously."
Ethiopian health official Abdulahi Mohamed
says vaccinators along the Somali border are charged with immunizing all
kids crossing who are under age 15. But he concedes that extremely poor
pay may sap the workers' motivation.
Soon after polio was detected in Somalia this spring, Ethiopia
carried out five mass immunization campaigns against the virus along the
Somali border. Earlier this month they launched a national campaign to
try to reach every child in the country — some 13 million kids. The
World Health Organization and UNICEF have helped to fund the drives and
stock them with vaccine.
But the vaccination campaigns are
organized, run and largely paid for by Ethiopia's ministry of health,
and the operation has put huge new burdens on an already strained
national health system. The Ethiopian government even had to deploy
special security details to travel with the vaccination teams in some
parts of the country along the Somali border.
"The other side
of the border [in Somalia] is totally insecure," Kebede says. "Some of
the areas are governed by militants." These militants include, which claimed responsibility last month for the attack on a Nairobi shopping mall that left more than 60 people dead.
challenge of running a polio vaccination campaign in remote parts of
the Horn of Africa is that the vaccine needs to be kept cold. Most
Ethiopian health clinics in the province bordering Somalia don't have
electricity. The health ministry has to use ice packs and portable,
kerosene-fired refrigerators to keep the polio vaccine chilled.
mass immunization campaigns are also complex and expensive logistical
operations, Kebede says. They require hundreds of additional staff,
hundreds of thousands of vaccine doses, extra kerosene for the
refrigerators, and vehicles to deliver supplies to the targeted area.
Each immunization team needs tally sheets and maps.
infects some people without ever making them sick. These so-called
asymptomatic carriers appear healthy and can spread the virus to new
"With polio ... the vast majority of the people who are infected and spreading [virus] are not paralyzed," says Dr. , a vaccine specialist at Emory University in Atlanta. "So there's a lot of "silent transmission."
every case of paralytic polio, we can assume there are at least a 100
to 200 — maybe a thousand people," Orenstein says, "who are infected and
potentially spreading the virus."