Health

Polio Returns in Ukraine as War Pauses Vaccination Campaign


In the fog of the war in Ukraine, it’s easy to forget about a smaller, but still very profound, tragedy that occurred months before the fighting began, back on October 6, 2021. That date , a 17-month-old girl from the Rivne Region in the west of the country have polio—19 years after the whole of Europe was declared polio-free. The second case of the disease appeared in the southern Zakarpattya region on December 24. And in the same months, another 20 children tested positive for the polio virus, although there were other cases of poliovirus. subclinical, non-paralytic case of this disease.
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Where polio is linked, 22 cases are considered a crisis. This disease can spread explosively and exponentially, with an average of 200 silent carriers for all cases of paralysis. That’s a lot of potential vectors that can spread a lot of viruses to many other people. And Ukraine – at least before the war started – does not stand still.

On October 9, the Ministry of Health announced “Biological Emergency on a Regional Scale,” and launched a plan in collaboration with the World Health Organization (WHO) to start immunizing 140,000 children in Rivne and Zakarpattya, aged six months to six years. On February 1, 2022, the vaccination campaign was launched; Just over three weeks later, it stopped, as the Russian invasion scattered the population and prevented medical personnel from safely entering the scene to administer the injections. Russian forces also damaged or destroyed 34 hospitals, The Ukrainian government said on Monday.

“We were hoping to get this outbreak under control,” Dr. Gabriele Fontana, UNICEF Regional Health Advisor, worked with WHO to distribute the shots and provide cold chains to prevent vaccines from spoiling. “I think we reached about 40,000 children that we were expecting, but that number has 100,000 children that we are not reaching.”

Read more: Why Ukraine’s COVID-19 problem is everyone’s problem

Tragically, before the war, Ukraine was in the midst of a major transition in terms of its healthcare system, says Judyth Twigg, a professor at Virginia Commonwealth University who specializes in global health, particularly in Russia, Ukraine, and other parts of the former Soviet Union.

Back in 2016 – the last time polio cases were detected in Ukraine – Twigg describes Ukraine’s failure to modernize its health care system after the collapse of the Soviet Union as the main cause of the decline. resurgence of polio. Widespread corruption has increased the cost of health care and vaccines, combined with a lack of government funding to buy vaccines and the neglect of the health care system. “Ukraine still suffers a lot from that Soviet legacy with a corrupt healthcare system,” says Twigg. “Money that should have been used directly for patient care is being channeled into the pockets of corrupt health managers and politicians.” Meanwhile, vaccine misinformation — some of which has been from Russia—Provides for common hesitancy about vaccines.

That started to change between 2016 and 2019, during which time a US-born radiologist, Dr Ulana Suprun, served as acting health minister, Twigg said. She led the country through a series of reforms, creating a new institution to transparently conduct Ukrainian medical contracts; rely on international agencies to procure drugs; and transferring patient care from the hospital to the primary care unit. Suprun told TIME that changes to primary care are an important part of making parents more comfortable with vaccinations. “For the first time Ukrainians can choose a primary care doctor they trust. It has helped establish a better doctor-patient relationship, and doctors have been able to convince more parents to vaccinate their children,” she said.

Twigg said that after the 2015 polio outbreak, Ukraine also took active actions to control the disease. “Both Ukrainian health authorities and the international community have ramped up an intense vaccination campaign that has come a long way in dealing with a lack of knowledge [and] vaccine hesitancy — dealing with so much misinformation about vaccines has kept parents from getting their kids vaccinated. ” WHO data shows that these efforts have paid off: while only 59% of young children, the vaccine’s target population, were vaccinated against polio in 2015, by 2019 that number has risen. up to 83%.

The war with Russia has the potential to reverse many of the gains, already threatened by the rise of COVID-19. As of October 2021, only 53% of one-year-olds are vaccinated against polio in Ukraine, according to the National Center of Public Health of Ukraine – indicating that the pandemic has slowed efforts to vaccinate against polio. Now, the healthcare system faces “other obstacles,” says Suprun [that] was directly related to the destruction of facilities, the lack of medical professionals because many were involved in the defense of the territory or the army, and the difficulty in resupplying pharmacies and hospitals due to the constant missile and other attacks by the Russian military”. Furthermore, displacing citizens during war, Suprun said, would make vaccine distribution and administration difficult.

And with Ukraine’s population now on the move — an estimated 1.3 million people have already fled across the border into neighboring Poland, Slovakia, Hungary, Romania and Moldova — polio is moving with them.

“Even if this is not a crisis [at first],” speak Dr. Siddhartha Datta, Program Director of the WHO Division of Immunization and Preventable Diseases, “any population movement leads to spread. That means if the polio virus finds unvaccinated children in an area, it will inevitably hit this population, both domestically and abroad.”

Read more: ‘It is our duty to help.’ Eastern Europe opens doors and hearts to those fleeing Ukraine

Oleksandr Matskov, deputy director-general of the organization, said: “There are a lot of people living in shelters, shelters of refugees at the border, where adequate sanitation and hygiene conditions cannot be provided. toilet”. Center for Public Health Ministry of Health. Such conditions make it easy for polio to spread, as it is transmitted through feces and can be transmitted to people through contaminated water or food.

In Ukraine, the war is making health care in general a growing crisis – and threatening the country’s ability to treat polio or immunize its children. Rivne Children’s Hospital — the first place The paralyzed child was treated for polio in the fall– so far not directly affected by the skirmish, but is poised for worse to come, especially as it sees hospitals in the east of the country suffer damage from Russian attack. Dr. Lilija Zoruk, head of the rehabilitation center, said the facility is preparing treat the woundedmake an evacuation plan, and watch colleagues go to fight for their country — while continuing to care for some of the country’s sickest children.

The type of polio that Ukrainian children get — along with the vaccines that WHO and UNICEF are using — are important to understanding the outbreak and controlling it. There are two types of polio vaccine: The oral polio vaccine (OPV) contains a live, weakened form of the virus. Inactivated polio vaccine (IPV)—given by injection—contains a killed virus. Both are effective and both have their advantages and disadvantages.

IPV is more difficult to administer and more expensive, and for that reason it is the most widely used OPV of the past three and a half decades – with incredible effectiveness. In 1988, Polio was endemic in 125 countries and crippled or killed 350,000 children each year. Since then, a global vaccination campaign, led by Rotary International, WHO, UNICEF, the Bill and Melinda Gates Foundation and others, has now reversed polio in just two endemic countries – Pakistan and Afghanistan, where cases are now counted in the dozens. .

But OPV has a problem. Sometimes, a live attenuated virus can mutate, become virulent, and actually cause the disease it was intended to prevent. These so-called vaccine-derived polio cases are rare – only three or four out of every million vaccines are administered, under the Global Polio Eradication Initiative—But allowed in free range, the virus can spread as easily as wild species. It was a vaccine-derived infection that hit 22 Ukrainian children — and that virus made some travel. Gene sequencing traced it to a vaccine-derived virus that was the first appeared in Pakistan in 2020 and then through Tajikistan, before reaching Ukraine. The 140,000 vaccines the WHO plans to deliver are all IPV, to ensure that a vaccine-derived polio outbreak is not replaced by another.

With war still raging, polio epidemics can spread — although UNICEF and Ukrainian health workers are working to get as many children vaccinated as possible, even as the vaccine campaign starts WHO head has been suspended. Across refugee routes, UNICEF is establishing so-called “blue dot hubs”—a reference to the organization’s blue, circular logo—to provide aid and assistance. people fleeing war. Immunization doctors, who administer both measles and polio shots, are joined by other health workers at the centres, in an effort to find and protect any children they may have. maybe.

But viruses will do what viruses do, which means they will take advantage of any opportunity to spread — especially in the crowded and unsanitary conditions of war. The Ukrainians did not ask to participate in a major land war — and neither did their children. War is cruel; polio is cruel. Together, they are a human tragedy.

 

Correction, March 9
The original version of this article misrepresented the coverage definition described in the WHO data. Vaccination coverage is for young children, not the entire population.





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