A seven-year-old boy is currently receiving treatment for polio at a hospital in Malawi, prompting a major vaccination campaign to curb a recent outbreak of the disease. The effort, launched in one of the world’s poorest nations and significantly impacted by aid cuts, has already vaccinated an astonishing 1.3 million children within just four days, following the emergency delivery of supplies by the World Health Organization (WHO) just over a week ago.
Malawi declared the outbreak after detecting the virus in two “environmental samples” collected from sewage plants in Blantyre, the country’s second-largest city and the location of the single confirmed case. The presence of even a single case is considered a serious concern, particularly in areas with low vaccination rates, due to the virus’s highly infectious nature and its ability to spread silently, often with mild or no symptoms. Polio can lead to permanent, irreversible paralysis or even death in a small but significant percentage of cases, especially among children. Malawi had not reported a case of wild poliovirus since 2022.
This outbreak represents a setback to global efforts to eradicate polio, a goal that appeared tantalizingly close in 2022, when only 2,880 cases remained in 20 countries thanks to the widespread use of a vaccine administered as drops into a child’s mouth. However, the virus has proven stubbornly persistent in some of the most remote regions of the world.
Dr. Jamal Ahmed, the WHO’s polio chief, issued a stark warning earlier this year: “Remember that eradication is all or nothing. You’re either done with it, or it comes back in full force.” This underscores the critical importance of maintaining high vaccination coverage to prevent the resurgence of this debilitating disease.
The fight against polio extends beyond simply combating the virus itself; it also requires building trust within the communities where it continues to circulate. In Malawi, community health workers have been visiting nurseries, primary schools, and homes in areas like Ndirande township, Blantyre, to address concerns and promote vaccination. Conversations with young mothers revealed a range of perspectives. Half of the six mothers interviewed between the ages of 21 and 31 expressed a lack of knowledge about the disease, while the other three voiced hesitancy about vaccinating their children.
“My child is four years old but I don’t know much about the vaccine. I am also not interested in getting the child vaccinated. I feel my child has had enough vaccines in her life,” stated 21-year-old Frida Seva, reflecting a sentiment of vaccine fatigue and uncertainty.
At Chisime primary school, dozens of children lined up to receive the vaccine after health workers secured parental consent in advance. Approximately one in ten children remained seated at their desks, as their parents had not granted permission. One teacher, Georgina Donasi, explained that reasons for refusal ranged from religious beliefs to personal choice.
Malawi’s communities have demonstrated a strong commitment to the vaccination campaign, with social mobilizers, health workers, religious leaders, and traditional authorities working together to address misinformation and reassure families. These efforts have yielded positive results, with 45 out of 84 initially reluctant households in Ndirande ultimately accepting vaccination thanks to targeted engagement.
This collaborative approach mirrors successful strategies employed in other polio-endemic regions, such as the border areas of Afghanistan and Pakistan, where the wild poliovirus remains endemic. Local communities are often essential in building the trust needed for effective vaccination drives.
Unicef teams working in these areas have found that acceptance of vaccination can sometimes be conditional, dependent on approval from local leaders or the provision of additional support, such as food or other healthcare services. Sheeba Afghani, a senior manager with Unicef’s polio eradication program, described a scenario where a mother, initially resistant to vaccination, readily agreed after a local influencer advocated for it. “You can give her any argument,” Afghani explained, “and then you have a local influencer walk in, he says ‘vaccinate’ and she just hands you the child.”
Misinformation circulating on social media also poses a significant challenge. Afghani noted that false claims can spread rapidly, even before health officials have an opportunity to address them directly in affected communities.
The current outbreak in Malawi is classified as a sporadic outbreak of variant poliovirus, also known as circulating vaccine-derived poliovirus. This occurs when the weakened virus used in the oral polio vaccine is excreted and, in areas with poor sanitation, begins to spread. While initially providing some protection, the virus can mutate in areas with low vaccination rates, potentially causing paralysis. There were 225 reported cases of this type of poliovirus globally in 2023.
Misinformation and disinformation are increasingly recognized as global threats, and vaccination campaigns are particularly vulnerable. Prof. Heidi Larson, director of the Vaccine Confidence Project at the London School of Hygiene & Tropical Medicine, emphasized that misinformation can have varying impacts depending on the context. She also highlighted the potential for confusion caused by the term “vaccine-derived,” which can be misinterpreted to suggest that the vaccine itself causes polio.
Statements from US leaders, including Robert F. Kennedy Jr., casting doubt on vaccinations, have the potential to fuel vaccine hesitancy globally. Prof. Larson noted that suggestions that polio was no longer a significant threat contributed to this confusion.
The polio outbreak in Malawi coincides with a period of significant aid funding cuts, impacting the country’s healthcare system, which relies on donor funding for 55% of its total health expenditure. The Global Polio Eradication Initiative is currently facing a $1.7 billion funding shortfall, which may limit its ability to respond to outbreaks at the same scale as in the past.
Dr. Mike Chisema, Malawi’s Ministry of Health immunization program manager, acknowledged the funding challenges but emphasized the country’s commitment to protecting its children. “We would like to mount a coordinated and organised response to make sure that we protect our children and not have a disability cohort of children in future, which can also affect productivity of the country,” he said. “Every time we have a case, we tend to mount a huge response because we don’t want to see it any more.”
As Malawi continues its vaccination efforts, Ruth Kutaombe, a mother holding her eight-month-old son at Malabada health centre, expressed her firm belief in the importance of vaccination. “It will protect him from contracting the disease,” she said. “I visited the hospital for the routine under-five clinic but after hearing they are giving the vaccine, I made a choice to have him vaccinated.”
