The Horn of Africa still remains vulnerable to a polio outbreak despite most nations inching closer to eradicating the disease from the face of the earth.

According to Unicef, the countries that need close monitoring are Kenya, Uganda, South Sudan and Somalia, due to the high numbers of children who miss vaccination every year.

The UN has set a target of stopping all forms of polio transmission by the end of 2018, but concedes the target will not be easy to meet given instability in parts of the world such as Somalia, South Sudan, parts of Central and West Africa, the Middle East, Pakistan and Afghanistan, which has disrupted vaccination services.

“There is therefore risk of a spread of polio virus from Pakistan and Afghanistan to the rest of the world. The Horn of Africa remains vulnerable due to the high numbers of children who continue to be missed by the routine immunisation system and frequent population movement,” said Dr Peter Okoth, a health specialist at Unicef.

Polio is a highly infectious viral disease, that mainly affects young children. The virus is transmitted mainly through contact with contaminated faeces.

The virus normally multiplies in the intestine, from where it can invade the nervous system and cause paralysis.

The good news

Polio cases have decreased by over 99 per cent since 1988, from an estimated 350, 000 cases then, to 359 reported cases in 2014. As at 2014, only three countries (Afghanistan, Nigeria and Pakistan) remained polio-endemic, down from more than 125 in 1988.

The good news is that no case of the virus has been reported from Africa since July 24, 2014 when the last one was recorded in Nigeria.

While governments in East Africa have invested significant human and financial resources in immunisation, especially procurement of childhood vaccines, Unicef said the programme remained under-resourced, raising concerns about the preparedness of the respective countries in case of an outbreak in future.

“A significant population does not have access to functional health facilities and have to walk long distances to access services. Outreach services are not adequately funded, immunisation equipment [cold chain] in most health facilities is old, frequently breakdown and need replacement and limited funding is earmarked for training of healthcare providers, leading to delivery of low quality services in some health facilities,” said Dr Okoth.

Another major concern, the health specialist added, is the lack of effective strategies to deliver services to nomadic and highly mobile population in some of the countries.

Despite the challenges, Dr Okoth said, East Africans value vaccination and understand the benefits of having their children vaccinated.

The Director of Medical Services in Kenya, Dr Nicholas Muraguri, concurred with Dr Okoth’s sentiments, saying East African countries are not out of the woods yet and must continue holding regular nationwide vaccination exercises to augment the routine programmes.

“In Kenya, for example, the immunisation coverage is 80 per cent, which means we reach about 1.2 million children of the 1.5 million born annually. As a result, around 300,000 children miss out due to various challenges, one of them being inaccessibility of some areas and mobility of nomadic populations. However, we are working hard to meet the 100 per cent coverage target,” said Dr Muraguri.

Kenya, Dr Muraguri said, was in the process of revamping its cold chain system, adding that 1000 fridges had already been bought and will be distributed to various counties.

The cold chain system is important for preserving the vaccines and preventing them from becoming ineffective.

The Horn of Africa continues to be polio free after successfully containing the 2013 polio outbreak that started in Somalia and spread to Kenya and Ethiopia. The last case of wild polio virus from the Horn of Africa was in January last year in Ethiopia.