Malawi Launches Massive Polio Vaccination Campaign After New Outbreak

As a seven-year-old boy receives treatment for polio in a Malawian hospital, the country has mobilized an extraordinary vaccination effort to contain a concerning new outbreak of the disease.

In just four days, health authorities have vaccinated 1.3 million children across Malawi following emergency supplies airlifted by the World Health Organization (WHO) last week. The campaign represents a rapid response in one of the world’s poorest countries, which has been severely impacted by international aid reductions.

Malawi declared the outbreak after detecting the virus in sewage samples from two plants in Blantyre, the country’s second-largest city and home to the only known case. Health officials emphasize that even a single polio case presents significant danger, particularly in areas with low vaccination coverage, due to the virus’s highly infectious nature and often silent spread.

“Remember that eradication is all or nothing. You’re either done with it, or it comes back in full force,” warned Dr. Jamal Ahmed, the WHO’s polio chief, earlier this year.

The disease, which can cause permanent paralysis or death, particularly in children, has not been detected in Malawi since 2022. This latest outbreak represents a setback to global eradication efforts that once seemed within reach 28 years ago, when cases had dropped to just 2,880 across 20 countries.

The campaign in Malawi has faced challenges with vaccine hesitancy. In Ndirande township near Blantyre, some parents expressed reluctance or complete disinterest in the vaccination program.

“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,” said 21-year-old Frida Seva.

At Chisime primary school, approximately 10% of children remained unvaccinated because their parents had withheld consent. “There are some reasons including religion but to some parents it is just a choice,” explained teacher Georgina Donasi.

To combat hesitancy, Malawian health authorities have mobilized community leaders, religious figures, and local influencers to correct misinformation and reassure families. Their efforts have proven effective – in Ndirande alone, 45 of 84 initially hesitant households were eventually persuaded to accept vaccination.

The importance of community engagement echoes experiences in polio’s remaining strongholds in Afghanistan and Pakistan. Sheeba Afghani, a senior manager with UNICEF’s polio eradication program, has witnessed the power of local influencers firsthand.

“You can give a mother any argument,” Afghani explains. “It doesn’t matter. And then you have a local influencer walk in, and he says ‘vaccinate’, and she just hands you the child.”

Social media has complicated these efforts by accelerating the spread of misinformation. “Now, even before we’ve had the opportunity to arrive in the community, it’ll be on social media,” Afghani notes.

The outbreak in Malawi involves variant poliovirus, also known as circulating vaccine-derived poliovirus, which occurs when the weakened virus in the oral vaccine mutates after being excreted in areas with poor sanitation and low vaccination rates. There were 225 such cases reported globally last year.

Professor Heidi Larson, director of the Vaccine Confidence Project at the London School of Hygiene & Tropical Medicine, points out that the term “vaccine-derived” itself creates confusion. “It makes it sound like you get the vaccine and you can get polio, which is not the case.”

Larson also expressed concern about the impact of vaccine skepticism from influential American figures. “A lot of the misguided things coming out of the US now are really causing confusion. And when there’s uncertainty, it’s fertile ground for rumors.”

Funding constraints pose another significant challenge. The Global Polio Eradication Initiative faces a $1.7 billion shortfall in its 2022-29 strategy, following cuts in aid spending from major donors including the United States and Britain. This financial gap means the initiative can no longer respond “at scale” to all outbreaks.

Dr. Mike Chisema, Malawi’s immunization program manager, acknowledged these constraints while emphasizing the importance of continued vigilance. “Every time we have a case, we tend to mount a huge response because we don’t want to see it any more. So we want to control it from the source.”

The polio outbreak comes at a particularly difficult time for Malawi, which depends on external donors for 55% of its total health expenditure. Despite these challenges, many parents remain supportive of vaccination efforts.

At Malabada health center in Ndirande, Ruth Kutaombe brought her eight-month-old boy for 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.”

As Malawi continues its vaccination campaign, health officials remain hopeful about protecting the country’s children from a disease that once devastated communities worldwide. “It’s very important that we work very well with our stakeholders, the communities who are the beneficiaries of this important response,” says Chisema. “[Otherwise] people will die, because polio can get hold of the respiratory muscles. We have a huge history of polio in Malawi.”