Antananarivo - Madagascar has successfully halted the transmission of variant poliovirus type 1, following recommendations from a rigorous, independent Outbreak Response Assessment (OBRA) to declare the outbreak closed. This achievement marks a major milestone in the country’s ongoing efforts towards polio eradication.

The outbreak, which started in 2020, posed a serious public health threat, particularly to under 5 children but also to unvaccinated adults. In response, the government – through the Emergencies Operations Centre – in collaboration with the Global Polio Eradication Initiative (GPEI), swiftly launched a series of emergency vaccination campaigns. This effort, backed by strong political commitment from the highest levels, including the President and First Lady of Madagascar, successfully reached over 19 million people with life-saving polio vaccines.

As a result, no new detections have been reported since September 2023. 

Meeting the criteria for outbreak closure is a major achievement. For the certification to be met, a country must ensure high population immunity, strong surveillance performance (evidence that no transmission was missed), and at least 12 consecutive months without poliovirus detection (either in humans or environmental – sewage/wastewater).

“The progress made in recent years in the immunization and eradication of polio is a hopeful sign. Today, polio is finally eradicated. Together, we have proved that it is possible to overcome limits and build lasting change. Let's continue to act, raise awareness and join forces to give every child a healthy future”, said H.E. Mrs Mialy Rajoelina, The First Lady of Madagascar and immunization ambassador.

At the outbreak’s peak in September 2023, a total of 287 cases had been confirmed, including 45 cases of acute flaccid paralysis and 44 community cases, 198 positive environmental surveillance detections in wastewater.

Key to halting polio transmission in Madagascar was the country’s intensified surveillance system, which enabled swift detection of poliovirus in both human cases and environmental samples. Enhanced case investigation, community engagement, and innovative vaccination strategies, including house-to-house immunization efforts, were instrumental in stopping the spread.

Cases were spread across 30 districts in the country's 13 regions and two paralytic cases were reported in adults in January 2023, which placed the country in a unique position that required innovative responses. Four large-scale vaccination campaigns were carried out in 2023, enabling Madagascar to reach 95% vaccination coverage which was pivotal in stopping the transmission and closing the polio outbreak. 

“This success demonstrates that with political will, strong partnerships, and community involvement, polio outbreaks can be swiftly controlled. We must now sustain these efforts to prevent any future resurgence,” said Dr Chikwe Ihekweazu, Acting WHO Regional Director for Africa.

Health authorities, supported by GAVI, Rotary, UNICEF, WHO and the Gates Foundation, continue to strengthen routine immunization, enhance surveillance, and maintain high-quality outbreak preparedness measures to mitigate the risk of future polio re-emergence, and other vaccine-preventable diseases.

“This achievement is due to strong collaboration of the government, partners and the health workers who worked tirelessly in the frontlines,” said Etleva Kadilli, UNICEF Regional Director for Eastern and Southern Africa. “Madagascar offers a beacon of hope for polio eradication efforts across Africa, but we must remain vigilant to ensure no further outbreaks occur. Immunization is a child’s fundamental right, no matter where they are.” 

GPEI partners have reaffirmed their commitment to supporting Madagascar in sustaining polio-free status and boosting overall immunization coverage. 

“The end of this outbreak is a testament to what’s possible when we strengthen routine immunization and expand vaccination coverage" said Thabani Maphosa, Gavi's Chief Country Deliver Officer. "By reaching even the most marginalized communities, we ensure no child is left behind. Continued collaboration across all sectors—government, civil society, and international partners—is essential to maintain this progress and close the immunization gap for zero-dose and under-vaccinated children."

The dedication of Rotarians on the ground was also critical: "This is a proud moment for Madagascar. The closure of the outbreak represents the hard work of thousands of frontline workers, volunteers, and our national health teams who never gave up on protecting our children" said Haingo Ranoharisoa, Rotary National PolioPlus Committee Chair for Madagascar. 

The successful closure of this outbreak serves as a testament to the power of collective action in protecting children from preventable diseases.