Ali Maow Maalin

Ali Maow Maalin was born in 1954 in Merca.

Maalin worked as a cook at the hospital in the port town of Merca in southern Somalia, as well as an occasional vaccinator for a WHO smallpox eradication team.

He had not been successfully vaccinated, even though smallpox vaccination was obligatory for hospital employees.

According to CDC epidemiologist Jason Weisfeld, one of the people who led the later containment effort in Merca, Maalin had received the smallpox vaccine but it had failed to take, and he had not been protected.

Other sources state that he had not been vaccinated.

Donald Henderson, who directed the WHO eradication programme from 1967 until 1976, describes Maalin's case as "a classic one in depicting omissions and mistakes in program operations."

Maalin, described by Henderson as "a popular man," had been visited by many relations and friends during his illness before he entered isolation.

While hospitalised with fever, he had walked freely around the hospital, interacting with multiple patients.

Multiple measures were used to contain the potential outbreak in the town of Merca.

The response was coordinated by Weisfeld and Karl Markvart.

Maalin's contacts were all traced by the WHO eradication team.

A total of 161 contacts were identified, 41 of whom had not been vaccinated.

There were 91 people who had been in face-to-face contact with Maalin, 12 of whom were unvaccinated.

Some of his contacts lived up to 120 km (75 miles) outside the town.

All contacts were kept under surveillance for six weeks.

His face-to-face contacts and their families were vaccinated, but none showed any sign of having been infected.

Merca Hospital was closed to new patients, all its medical staff were vaccinated and existing patients were quarantined in situ.

He was diagnosed with the disease in October 1977 and made a full recovery.

Although he had many contacts, none of them developed the disease, and an aggressive containment campaign was successful in preventing an outbreak.

Smallpox was declared to have been eradicated globally by the World Health Organization (WHO) two years later.

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, then aged 23, served as a guide to the party taking them in a closed Land Cruiser from the hospital where he worked either to the home of a surveillance supervisor or directly to the isolation camp.

He is believed to have been infected during the journey, which lasted no more than 5–15 minutes.

One of the children, a six-year-old girl named Habiba Nur Ali, died two days later.

She was the last person to die from naturally acquired smallpox.

The outbreak among the nomadic group was successfully contained by WHO workers by 18 October, but, critically, investigators failed to identify Maalin as a contact.

On 22 October, Maalin fell ill with fever and headache, and received malaria treatment in hospital.

After four days a rash appeared.

Perhaps working on the assumption that he had been successfully vaccinated against smallpox, Maalin was then believed to have chickenpox and was discharged from hospital.

Over the next few days, his symptoms developed to indicate smallpox as the cause.

Not wishing to be put into isolation, Maalin failed to report himself.

On 30 October, a nurse colleague reported him, possibly for the reward of 200 Somali shillings (around $35), and Maalin was transferred to the isolation camp.

He was diagnosed with an infection of the Variola minor strain of smallpox, based on his symptoms and later confirmed by laboratory tests.

The date of diagnosis is sometimes stated as 26 October 1977.

Maalin did not experience complications, and subsequently recovered fully and was discharged in late November.

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."

Ali Maow Maalin (Cali Macow Macallin; also Mao Moallim and Mao' Mo'allim; 1954 – 22 July 2013) was a Somali hospital cook and health worker from Merca who is the last person known to have been infected with naturally occurring Variola minor smallpox.

Maalin was subsequently involved in the successful poliomyelitis eradication campaign in Somalia, and he died of malaria while carrying out polio vaccinations after the re-emergence of the poliovirus in 2013.