Ukraine is struggling to control the COVID-19 pandemic even before the Russian military advanced in the country. The rollout of its COVID-19 vaccination campaigns is slower than in other European countries, and while the government encourages people to get vaccinated, most people struggle to find a way to get vaccinated. felt the need to be vaccinated, or did not have confidence in the safety and effectiveness of the vaccine.
Just before the invasion on February 24th, just 35% of Ukraine’s population has been vaccinated. That is consistent with most of its neighbors, although some, including Poland and Hungary, have achieved higher vaccination rates. While different health systems and different attitudes about vaccinations in those countries are contributing to those contrasting rates, Ukraine’s relatively low vaccination rates are likely to have an impact on the extent of population growth. large increase in cases, both domestically and in the region, as a result of the war. . Like many other countries, Ukraine experienced an increase in cases due to the Omicron variation in November and another peak in the first week of February — most likely due to low vaccination levels. By mid-February, 60% of COVID-19 tests conducted in the country were positive.
Such low levels of vaccine coverage are not enough to control a highly transmissible virus like SARS-CoV-2, public health experts say. Add to a war – with the political and social upheavals it causes – and not only is the inevitable increase in infections, but also the potential for new variants to emerge, causing the whole world is in danger.
Vaccination and mitigation measures such as mask wearing, social distancing, and basic hygiene are important to limit the spread of SARS-CoV-2, but cannot be sustained when a country is in crisis. surround. The humanitarian group Doctors Without Borders has Distributing trauma kits and training healthcare providers in Mariupol, Ukraine – a target of a Russian attack – as well as providing shelter and basic health needs to people crossing the border to other countries such as Poland. But that’s not enough.
“War is infectious disease’s best friend,” said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “It challenges every public health program you could possibly have. It limits the medical care available to people who may be seriously ill, and often promotes transmission when too many people congregate in bomb shelters and on trains. This will be the perfect storm of one serious challenge after another.”
A decade and a half ago, World Health Organization researchers establish that 65% of the major infectious disease outbreaks that occurred in the 1990s were among refugee populations or in conflict zones. Les Roberts, professor emeritus of Columbia University’s Mailman School of Public Health who has spent time in war zones addressing outbreaks, notes that these populations are particularly vulnerable. by viral diseases such as COVID-19. “It turns out that when you’re stressed, your immune system doesn’t work as well. You neither eat nor fight disease,” he said. “And in times of conflict, you move around a lot, and end up in bomb shelters or basements or in trucks that are more crowded than usual and have bad airflow. I don’t think people fully understand how war is like a breeding ground for disease.”
More than 670,000 people have left Ukraine since the start of the war, and this increase in travel will almost certainly lead to a spike in the number of cases in the country and its borders — like Poland, Hungary, Slovakia. , Romania and Moldova — and strain their health care systems. Health experts are particularly concerned about the situation in Poland, where nearly half of all Ukrainians have fled, according to the United Nations High Commissioner for Refugees. “SARS-CoV-2 is spreading like lightning right now,” said Jeffrey Shaman, a professor of epidemiology at the Mailman School of Public Health at Columbia University. “For places like Poland and places in western Ukraine, where people are fleeing, there’s a lot of opportunity for this virus to cause damage that it wouldn’t have had a chance to do otherwise.” Before the wave came in, nearly 60% of Poland’s population was vaccinated, which should help protect the country against a surge, but new infections are likely to spike there as well, making increasing demand for health care services.
“We have been warning for years about the potential convergence of conflict and epidemiology — bad things to come,” said Dr. Eric Toner, senior scholar at the Johns Hopkins Center for Health Security. out when those things come together. “Certainly, under the dire circumstances that the present population, wearing a mask, remote control and isolation will not be possible. When people flee affected parts of the country, crowd on buses, trains and cars and end up in hotels or living with loved ones or in refugee settlements – it’s not conditions for good control of an infectious disease such as COVID-19. “
Public health experts say hospitals will likely be hardest hit by the influx of refugees during the pandemic. War-related injuries will take precedence over COVID-19 care, which will only make the virus more contagious. That disruption will lead to more healthcare workers becoming infected and unable to perform their duties.
“There will be treatment for hospitals, facilities and resources for conflict-related injuries,” Shaman said. “In the long run, I imagine it will lead to a decline in healthcare capacity to the level that Ukrainians are used to.” And if the increase occurs in neighboring countries as well, that will put additional pressure on healthcare services throughout the region. “The world community should provide the supplies and facilities to support the displaced Ukrainians and Poles from those consequences.”
Shaman and other public health experts are also concerned about the long-term impact of the conflict on COVID-19 control. Studies consistently show that vaccine-based immunity begins to wane after about 5 to 6 months. Repeat injections are essential to maintain protection against disease is so severe that it requires hospital care; if the conflict in Ukraine continues, it means that even vaccinated citizens will not be able to get health promotion as the care of trauma and war-related wounds will be prioritized. take precedence over vaccination efforts.
This situation highlights weaknesses in the global biodefense network against threats such as the highly infectious coronavirus. Even in the absence of military conflict, marked inequalities in health resources have led to profound differences in countries’ ability to control COVID-19; Developed countries have been able to purchase and distribute vaccines, while poorer countries, mainly in Africa and parts of Asia, are still struggling to contain the virus due to their lack of access. with injections. When such a conflict unfolds in the now-pandemic Ukraine, the lack of global coordination of public health resources becomes all the more tragic. “I can’t begin to tell you where the solution is,” Shaman said. “The World Health Organization does not have the authority or the financial resources to tackle this problem. This is a huge issue regarding development, national sovereignty, and the ability of nations to harmonize and support each other in a more believable way than in the ways we’ve seen the world develop. developed over the past 20 years. “
What is really needed, says Toner, is a global coordinating body for public health, which is unlikely, given the challenges posed by issues of national sovereignty. But the principles behind global coordination can still be implemented in more restrictive ways.
Global vaccine distribution program COVAX, through which developed countries purchase vaccines at a discount to developing countries, represents such an effort, but is falling short of its promise. They were unable to deliver the 2 billion doses they had secured by the end of 2021, and the team estimates that it will take until 2023 to provide enough vaccine to immunize the world. Toner said: “After the pandemic is over, I think we need to look at the reality of COVAX and why it’s not working as well as we had hoped, and what we can do to improve. it.
Some public health experts have suggested alternatives, like helping vaccine manufacturers set up production facilities in countries that have previously struggled to get new vaccines. as well as encouraging greater sharing of intellectual property to allow poorer countries access to the technology they need to produce vaccines. their own.
There are also ways to control and minimize the potential spread of the virus as Ukrainians gather in shelters and flee to other countries, Roberts pointed out. Immunization and health promotion of those entering these commons – especially those who are particularly vulnerable, such as the elderly or those with underlying health conditions – is a step in the right direction. important head.
However, that remains largely out of reach. The World Health Organization does not have the resources to quickly direct supplies of vaccines and personnel to crisis areas such as Ukraine, and lacks the political authority to address issues of national sovereignty. . Organizations like Doctors Without Borders and other humanitarian groups also play an important role, but are also limited in more local aid efforts. “If we continue to respond from crisis to crisis, then we will not solve the fundamental, systemic problems that need to be addressed,” Shaman said.