Last of the Line

Ali Maow Maalin in 1977*

October 26, 1977: Ali Maow Maalin gets sicker. He was born in 1954 in Merca, Somalia. He worked there at the regional hospital as a cook. He also was an occasional vaccinator for a WHO smallpox eradication team. He had not been successfully vaccinated even though it was a mandatory policy at his place of employment. According to CDC epidemiologists, he had been vaccinated, but the vaccine did not take effect and he was unprotected. Other sources state that he had never been vaccinated at all. Maalin himself denied having received the shot stating it looked like it hurt and he therefore avoided it.

In August 1977 there was an outbreak of smallpox in a Somalian group of about 20 families of nomads. Between August and October, eight children developed symptoms of the disease and on October 12, two children were discovered with the disease in a small settlement of Kurtunawarey – about 55 miles inland from Merca. Officials drove there to contain the outbreak and 23-year-old Maalin served as a guide. It is believed that it was during this trip that he became infected with the virus. On October 14, Habiba Nur Ali (6) died of smallpox, the last person to die naturally from the disease. By October 18, WHO workers successfully contained the outbreak among the nomadic group but they did not list Maalin as a contact.

On October 22, he began to feel bad and presented with a fever and headache. Malaria treatment was begun. On this day, the telltale rash appeared but yet it was ignored. Since he worked in the hospital, it was assumed he had been vaccinated against smallpox and so he was diagnosed with chickenpox and sent home. Over the next few days, his symptoms grew worse but he did not want to be isolated and so failed to report his distress to authorities. On October 30, a male nurse colleague reported him. It may not have been altruism, but rather the reward of 200 Somali shillings (about $35). Maalin was taken to isolation camp and diagnosed with smallpox, the last person to ever be diagnosed with naturally occurring smallpox. He did not suffer any complications and was discharged in November.

Donald Henderson had directed the WHO eradication program from 1967 to 1976. When he looked at the Maalin case, he was appalled. Maalin had been a popular young man and was visited by many relatives and friends before he was finally put in isolation. While he had been hospitalized with the initial fever, he had been permitted to walk freely throughout the hospital and interacted with many patients. There had been 91 people who had had face-to-face contact with Maalin and 12 of them were unvaccinated. All contacts were monitored for the following six weeks and face-to-face contacts were vaccinated. Merca Hospital was closed to new patients and all staff were vaccinated. No one was discharged. A total of 54,777 people were vaccinated in the two weeks following Maalin’s isolation. The program was effective and smallpox has been wiped out. Maalin died in 2013 at the age of 58.

I was scared of being vaccinated then. It looked like the shot hurt. – Ali Maow Maalin

Now when I meet parents who refuse to give their children the polio vaccine, I tell them my story. I tell them how important these vaccines are. I tell them not to do something foolish like me. – Ali Maow Maalin

Somalia was the last country with smallpox. I wanted to help ensure that we would not be the last place with polio too. – Ali Maow Maalin, explaining why he volunteered to help eradicate polio

A classic one in depicting omissions and mistakes in program operations. – Donald Henderson, describing this case

Also on this day: Tombstone, Arizona – In 1881, the gunfight at the OK Corral took place.
Whoa! – In 1861, Pony Express service officially ended.
Cloud of Death – In 1948, Donora, Pennsylvania was shrouded in a toxic fog.
Outnumbered – In 1597, the Battle of Myeongnyang was fought.
Baby Fae – In 1984, the baby was given a baboon’s heart.

* “Ali Maow Maalin (1977)en” by Source (WP:NFCC#4). Licensed under Fair use via Wikipedia – https://en.wikipedia.org/wiki/File:Ali_Maow_Maalin_(1977)en.jpeg#/media/File:Ali_Maow_Maalin_(1977)en.jpeg