Vaccination woes in Ukraine

Erica Richardson
European Observatory on Health Systems and Policies
5 April 2012

I’m recently back from a fruitful international meeting on crisis communication and pandemic preparedness in Kyiv, Ukraine.  One of the tools to be employed during an influenza pandemic is vaccination and while much emphasis is placed on obtaining vaccines of sufficient quality, stockpiling them and identifying the groups most at risk, less emphasis is often placed on ensuring those most at risk are willing to have the jab.  Consequently, in the meeting many of the discussions focused on ‘trust’ – who has it, who has lost it and how can public trust in state health interventions be rebuilt.  In the 2009 H1N1 pandemic, many at-risk Ukrainians resisted getting vaccinated despite a widespread ‘flu panic fuelled by alarmist media portrayals.  Vaccination coverage is something that we only touched upon in the recent HiT update for Ukraine (see page 12), but the immunization coverage data for 2010 are now available and warrant further explanation…

Currently, many Ukrainians are not getting vaccinated and there has been a crisis of trust in the government around public health interventions, the reasons are complex, but they are very much rooted in the country’s recent post-Soviet past.  Immunization rates in the Soviet Union were high and herd immunity was achieved for most vaccine preventable diseases.  However, there were significant gaps in the coverage through the 1990s.  The collapse of the Soviet Union led to the collapse of the supply chain for vaccinations and restricted access to care as underfunded health care providers started having to charge patients out of pocket – even for routine procedures such as vaccinations.  Poor access meant lower uptake, particularly for booster doses. The ruptured supply chain meant that vaccines were not always available and where they were they had often been stored incorrectly – this can significantly limit their efficacy.  Immunization rates subsequently recovered, but a cohort of older children were left unprotected.

graphSource: WHO Europe Health for All Database, January 2012 edition.

In 1994-6, there was a diphtheria outbreak across the CIS (see pretty graph).   There were 646 deaths from diphtheria between 1992 and 1997 in Ukraine, an overall case fatality rate of 3.7% (i.e. the odds of dying was 1:25, but for children it was higher).   It was a revaccination campaign targeting adults that brought it under control (Nekrassova et al 2000).

Fast forward to 2005 and measles starts making a comeback in Ukraine, in 2006 there are 42,724 new cases of measles registered nationwide (incidence = 91.7 per 100000 population, seven reported deaths) and with the support of WHO, UNICEF and CDC a revaccination campaign is launched.  In 2008, in Donetsk region, a 17 year old young man died soon after vaccination and this was reported locally, then nationally, then internationally as an adverse reaction.  In response, the revaccination campaign was suddenly halted by the government, although the young man’s tragic death was found to have been unrelated to the vaccine he received.   The revaccination campaign was not re-launched, and attention shifted to H1N1.

To recap, immunization coverage of 95% is required to achieve herd immunity in a population, and in Europe we are committed to the eradication of measles and maintaining polio-free status.  According to the latest HFA data, in 2010 only 56.1% of Ukrainian children were vaccinated against measles, 57.3% of infants were vaccinated against polio, 52.2% against diphtheria, tetanus and whooping cough (pertussis).  All of these are diseases which can kill or cause permanent disability.

Of course the problem with public confidence in vaccination is not confined to Ukraine, but the epidemiological constellation of large population cohorts with no resistance to measles, low current vaccination uptake and poor access to care creates the perfect environment for a fatal epidemic…

It is still too early and the data are still too fresh for me to provide you with a pretty graph, but fast forward to November 2011 and the Ukrainian State Sanitary Epidemiological Service reported a burgeoning measles epidemic in Ukraine – by the end of 2011 there were 1,382 notified cases of measles and one child had died.  For 2012, as of 4 April, 6,891 cases of measles had been recorded, mainly around Lviv.  The crisis of confidence in vaccines, complacency about very nasty diseases and subsequent epidemics across Europe clearly warrant further investigation.  Any volunteers?…

NB: Ukraine are co-hosting the Euro 2012 European Football Championship this year and on a personal note I would urge football fans not to avoid going to Ukraine to soak up the atmosphere and watch at least some of the matches – the host cities are wonderful places and the stadiums are stunning…
Just make sure your jabs are up-to-date before you travel!

One Response to Vaccination woes in Ukraine

  1. WHO “strongly recommends early treatment with the antiviral drugs, oseltamivir or zanamivir, for patients who meet treatment criteria, even in the absence of a positive laboratory test confirming H1N1 infection.” That means Tamiflu, the highly dangerous drug whose major shareholder includes former Pentagon head Don Rumsfeld. And it means GlaxoSmithKline, maker of the reportedly equally dangerous rival Relenza drug. The drugs produce precisely the symptoms of severe lung complications found in flu and in some cases have reportedly caused death.

Leave a Reply

Your email address will not be published. Required fields are marked *

* Copy This Password *

* Type Or Paste Password Here *

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>