Ali Maow Maalin

Hospital worker, last naturally acquired case of smallpox (1954–2013)

Ali Maow Maalin (; also Mao Moallim Other sources state that he had not been vaccinated. It was later revealed in an interview in 2007, Maalin said that he had not been vaccinated, explaining: "I was scared of being vaccinated then. It looked like the shot hurt."

In August 1977, an outbreak developed in a Somalian nomadic group of twenty families; eight children developed symptoms in August to October. On 12 October 1977, two children with smallpox symptoms were discovered at an encampment near the small inland settlement of Kurtunawarey, around 90 km (60 miles) from Merca. Local officials drove the children to Merca, where there was a nearby isolation camp. Maalin did not experience complications, and subsequently recovered fully and was discharged in late November.

Multiple measures were used to contain the potential outbreak in the town of Merca. The response was coordinated by Weisfeld and Karl Markvart.

Maalin remained in the Merca area, where he was employed in a range of roles. Maalin worked for WHO as a local coordinator with responsibility for social mobilisation, and spent several years travelling across Somalia, vaccinating children and educating communities. The Boston Globe described him as one of the "most valuable" local coordinators for WHO. A younger sister of Maalin died due to measles, inspiring Maalin to train as a health worker and assist in providing measles measles immunisations to children. After the 2013 reintroduction of poliovirus into Somalia, Maalin was again carrying out vaccinations in the Merca district when he developed a fever, and died days later, on 22 July 2013, of malaria.

Smallpox was an infectious disease caused by two strains of virus, Variola major and V. minor. V. minor was the rarer of the two strains, and causes a much less severe disease (sometimes called alastrim), with a fatality rate of around 1%. No treatment is available, and the only protection is vaccination. The virus is usually transmitted by prolonged face to face contact with a person showing symptoms. The incubation period averages 12–14 days. One of the most feared diseases of human history, smallpox was still causing an estimated 2 million deaths every year as late as 1967. The global effort to eradicate smallpox from endemic areas such as Africa began in 1959 with a mass vaccination campaign. This approach met with little success, and a more effective targeted approach was developed in the late 1960s. This involved active surveillance by case hunting, combined with rapid containment of infection in areas reporting outbreaks by intensive vaccination. The majority of African countries were free from smallpox by 1972. By the end of 1975, the virus had been eradicated worldwide except in Ethiopia and Somalia in the Horn of Africa, and their neighbour Kenya. The nomadic people of the Ogaden Desert retained endemic smallpox with an unusually mild form of the disease, which facilitated persistence in the population. From 1975, WHO efforts were concentrated on this region. Ethiopia saw its last case in August 1976 and Kenya in February 1977. Elimination efforts relied on an intensive reporting system. A severe drought in 1975 exacerbated the difficulties by increasing movement across the border with Ethiopia, and frequent outbreaks continued. In March 1977, surveillance efforts found over 3000 cases in the south of the country. The Somali government declared a state of emergency and successfully appealed to the United Nations for assistance. By June, when the outbreak peaked, 3,000 Somali health workers supervised by 23 international advisers were involved in the eradication efforts. Eradication work was hampered in July when the Ogaden War broke out, limiting access to the desert.

Barrett, Scott. Why Cooperate? : The Incentive to Supply Global Public Goods (Oxford University Press; 2007)

Fenner, Frank, Henderson, Donald A., Arita, Isao et al. Smallpox and Its Eradication. (World Health Organization; 1988) Porter, Roy, ed. The Cambridge Illustrated History of Medicine (Cambridge University Press; 1996)
Tucker, Jonathan B. Scourge: The Once and Future Threat of Smallpox (Grove Press; 2002)