As polio in its wild form has not been found in Ukraine since 1996, this new strain received significant international attention. A spokesman for the WHO’s polio eradication department told BBC about the potential for an epidemic in Ukraine, as the polio cases were likely sewage-born.
In order to contain the spread of polio and other infectious diseases in Ukraine, President Petro Poroshenko and his health minister, Alexander Kvitashvili, need to launch an aggressive state-sponsored immunization campaign for Ukrainian nationals, with strict penalties for non-compliance.
A state-sponsored vaccination campaign with credible enforcement mechanisms is essential for two reasons.
First, these polio cases are not an isolated incident, and low immunization rates have caused other epidemics like the 5,000 cases of measles recorded in 2012.
Second, anti-vaccine activists in the Ukrainian media have been extremely vocal, and the Ukrainian government needs to take a proactive stance in countering their unproven theories for the benefit of public health in Ukraine.
Ukraine’s burgeoning infectious disease crisis and why it must be confronted
Even though medicine supply disruptions due to Russia’s war and the recent polio outbreaks have only recently put Ukraine’s infectious disease problem in the international spotlight, Ukraine’s infectious disease crisis has been festering for a long time.
A January 2010 World Bank report revealed that Ukraine had the highest infectious disease rate of any country in the WHO European region. In 2013, it was estimated that 300 to 350 children died every year due to infectious disease, a clear black mark on Ukraine’s post-1993 infant mortality reduction strategy.
The increasing number of cases in Ukraine from infectious diseases largely eradicated in the Western world highlight the need for a state-sponsored pro-vaccine campaign to strengthen public confidence in the immunization system.
The Associated Press reported in 2013 that Ukraine had the lowest vaccination rate of any ex-Soviet republic, despite being one of the more economically developed post-Soviet states. UNICEF estimates that 1.5 million Ukrainian children have not received polio vaccines. Measles vaccination rates are similarly low with just 56% of people receiving the first vaccine and 41% of people receiving the second vaccine at the time of the 2012 epidemic.
The rarity of polio and measles viruses in their wild form is not an adequate case against the need for a large-scale state-sponsored vaccination campaign.
Many of the recent infectious disease outbreaks in the region were not endemic, but were instead the product of diseases moving across national borders. Ukraine’s vulnerability to measles in 2012 was enhanced by the virus’s emergence in Romania. The 2010 polio outbreak, which was the most recently occurring incidence of the disease before the current cases in Ukraine, was also a product of virus migration from Tajikistan to Russia.
The Ukrainian government’s immunization policy is woefully inadequate in dealing with the spread of disease across countries, and it should emphasize this risk to show the public that vaccines are necessary and not obsolete.
Preventable infectious disease cases could also negatively impact EU travel to Ukraine. The 2012 measles epidemic occurred when Ukraine was in the international spotlight, as it co-hosted the 2012 European football Championship with Poland. WHO Europe at that time imposed health warnings and urged EU nationals to check their medical records, 4-6 weeks before traveling to Ukraine.
Fortunately, Ukraine has been able to gain substantial international support for its efforts to reduce infectious disease rates. Canada has spearheaded a UNICEF program that will give 1.2 million polio vaccines to Ukraine to combat the growing crisis. This aid is essential as the WHO discovered in late 2014 that many eastern Ukrainian hospitals did not have vaccines in storage. Storage shortages have existed fora long time, but have been exacerbated by the conflict. Donetsk’s ability togain new domestic supplies is hindered by the destruction of hospitals, and the emigration of up to 70 percent of health care personnel from the conflict-hit Donetsk and Luhansk regions since the start of the war in 2014. Therefore, the Ukrainian government needs to implement an extensive state-sponsored vaccination campaign to demonstrate its shared concern about this issue and ensure that these vital aid flows to continue to reach those in need.
Why the Ukrainian government needs to urgently combat myths about vaccines
One of the major obstacles to a successful state-sponsored pro-immunization campaign is the prevailing perception that Ukrainian vaccines, provided for free by the state health care system, are unsafe. The declining immunization rate in Ukraine became more drastic in 2008, when a large-scale media campaign against immunizations gained traction amongst the public. The death of a 17-year-old boy who received a combined measles and rubella shot provoked public outrage.
The Viktor Yushchenko administration’s response to this incident was disastrous for Ukraine’s public health. Even though the WHO determined that the boy had died from a bacterial infection unrelated to the vaccine, the Ukrainian government launched an investigation and proceeded to halt the campaign to revaccinate 9 millionUkrainians for measles.
Millions of vaccines that had been delivered to Ukraine were destroyed, a move unprecedented in modern European history. The Yushchenko administration’s extreme response reduced confidence in the immunization process further and the Associated Press reported an increase in the credibility of the bizarre theory that Ted Turner was fundingt he vaccine campaign to sterilize Ukrainian men.
The Ukrainian government needs to tackle myths about the risks associated vaccinations head-on, and educate the public on the necessity for immunizations.
The reestablishment of a state-sponsored vaccination campaign and the stiffening of penalties for those who refuse to comply will also benefit the struggle against pervasive corruption in Ukraine’s health sector. Parents concerned about the safety of vaccines in Ukraine frequently bribe doctors to produce medical records indicating that their children are properly immunized, when they actually have not received any vaccines at all.
Cracking down on these practices will be a small step towards improving a health care system, labeled by the Guardian earlier this year as the “most corrupt in Europe.”
Combatting the spread of infectious disease in Ukraine is a highly important health policy challenge and it should be given a much greater degree of prominence on the legislative agenda than it is now. However, the controversy associated with a state-sponsored vaccination campaign and the prospect for a temporary political backlash from anti-vaccine activists might delay action on this issue until the crisis spirals out of control.
Samuel Ramani is an master’s in philosophy student in Russian and East European Studies at St. Antony’s College, University of Oxford. He is also a regular contributor to Huffington Post Politics and World Post.
