Brazzaville/Amman/Geneva – For nearly a decade, the Horn of Africa has battled persistent outbreaks of variant poliovirus. Low immunity in children and unmonitored population movement have fuelled poliovirus spread. At a programmatic level, the lack of access to children living in insecure areas, variable levels of national ownership of polio eradication efforts across countries, limited cross-border coordination and delayed responses to outbreaks have allowed continued spread of poliovirus.