Polio makes a comeback in Ukraine as war halts vaccination campaign

In the fog of the war in Ukraine, it’s easy to forget a smaller, but still deeply poignant tragedy that happened months before the fighting started, on October 6, 2021. That day, a 17-month-old girl in the Rivne region of the western part of the country was stricken with paralytic polio — 19 years after the European region as a whole was declared polio-free. A second case of the disease appeared on December 24 in the Zakarpattya region of the south. And in those same months, 20 other children tested positive for the polio virus, albeit with subclinical, non-paralytic cases of the disease.
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In polio, 22 cases count as a crisis. The disease can spread explosively and exponentially, with an average of 200 silent carriers for each paralyzed case. That’s a lot of potential vectors that could potentially spread a lot of viruses to a lot of other people. And Ukraine – at least Ukraine as it was before the war started – did not stand still.

On October 9, the Ministry of Health declared a “regional-scale biological emergency” and implemented a plan in conjunction with the World Health Organization (WHO) to begin vaccinating 140,000 children in Rivne and Zakarpattya, ages six months to six. year. The vaccination campaign started on February 1, 2022; just over three weeks later, it ground to a halt as the Russian invasion scattered the population and made it impossible for health workers to safely enter the field to deliver the shots. Russian troops also damaged or destroyed 34 hospitals, the Ukrainian government said on Monday:

“We hoped to get this outbreak under control,” said Dr Gabriele Fontana, a regional health adviser at UNICEF, who worked with WHO to distribute the injections and provide the cold chain that keeps the vaccines from spoiling. “I think we’ve reached about 40,000 of the kids that we’d hoped for, but then we’re left with 100,000 that we haven’t reached.”

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Tragically, before the war, Ukraine was in the midst of a major transformation of its health care system, said Judyth Twigg, a professor at Virginia Commonwealth University who specializes in global health, especially in Russia, Ukraine and other parts of the former Soviet Union.

In 2016 — the last time polio cases were discovered in Ukraine — Twigg described Ukraine’s failure to modernize its health care system after the fall of the Soviet Union as a major cause of the polio resurgence. Widespread corruption drove up the price of medical care and the cost of vaccines, exacerbated by inadequate state funding for vaccine purchases and neglect of the health care system. “Ukraine still suffers so much from that Soviet legacy of a health system riddled with corruption,” Twigg says. “Money that should have gone straight to patient care has been diverted into the pockets of corrupt health administrators and politicians.” Meanwhile, disinformation about vaccines — some of which can be traced back to Russia — fueled widespread vaccine hesitancy.

That started to change from 2016 to 2019, during which time an American-born radiologist, Dr. Ulana Suprun, the acting health minister, says Twigg. She led the country through a series of reforms and created a new institution to transparently implement Ukrainian health contracts; relying on international agencies for drug procurement; and shifting patient care from hospitals to primary care offices. Suprun tells TIME that the changes in primary care were an important part of making parents more familiar with vaccination. “For the first time, Ukrainians could choose a GP they trust. It helped build a better understanding between doctors and patients, and doctors were able to convince more parents to vaccinate their children,” she says.

In the wake of the 2015 polio outbreak, Ukraine also took aggressive measures to control the disease, Twigg said. “Both the Ukrainian health authorities and the international community stepped up an intensive vaccination campaign that has come a long way in addressing the lack of knowledge. [and] vaccine hesitancy – dealing with a lot of misinformation about vaccines that prevented parents from vaccinating their children.” WHO data shows that these efforts have paid off: while only 59% of young children, the target population for the vaccine, were vaccinated against polio in 2015, that number had risen to 83% by 2019.

The war with Russia could potentially reverse many of these gains, already threatened by the rise of COVID-19. According to the National Center of Public Health of Ukraine, as of October 2021, only 53% of annuals had been vaccinated against polio in Ukraine, suggesting that the pandemic has slowed vaccination efforts against polio. Now, Suprun says, there are even more “setbacks to the health care system” [that] are directly related to the destruction of facilities, the lack of medical professionals as many have joined the territorial defense or military, and the difficulty in supplying pharmacies and hospitals due to constant rocket and other attacks by the Russian military. ” Furthermore, the displacement of civilians during the war, says Suprun, will make the delivery and administration of vaccines more difficult.

And as the population of Ukraine is on the move – an estimated 1.3 million people have fled across the border to neighboring Poland, Slovakia, Hungary, Romania and Moldova – polio is moving with them.

“Even though this wasn’t a crisis [at first]says Dr. Siddhartha Datta, program manager in the WHO’s Vaccin-Preventable Diseases and Immunization Division, “Every population movement leads to spread. That means if the polio virus finds unvaccinated children in an area, it will definitely attack this population, both inside and outside the country.”

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“There are masses of people in shelters, temporary refuges at the borders, who cannot provide adequate sanitation and hygiene”, and the war has disrupted the supply of drinking water and food, added Oleksandr Matskov, deputy director general of the Public Health Center of the Ministry of Health. Such conditions make it easy for polio to spread, as it is transmitted through feces and can infect humans through contaminated water or food.

In Ukraine, the war is turning the health care system as a whole into a growing crisis — threatening the country’s ability to treat polio or vaccinate children. Rivne Children’s Hospital – where the first paralyzed toddler was treated for polio in the fall – has not been directly affected by the fighting so far, but is gearing up for worse, especially as it sees hospitals in the east of the country being damaged by the Russian attack. dr. Lilija Zoruk, head of the rehabilitation center, says the facility is preparing to treat the injured, preparing an evacuation plan and watching colleagues leave to fight for their country – all the while continuing to care for some of the sickest children in the country. country .

The type of polio the Ukrainian children contracted — along with the type of vaccine administered by the WHO and UNICEF — is critical to understanding and controlling the outbreak. There are two types of polio vaccine: Oral polio vaccine (OPV) contains a live, attenuated form of the virus. The inactivated polio vaccine (IPV) – administered by injection – contains a killed virus. Both are effective and both have their pros and cons.

The IPV is more difficult and expensive to administer, and for that reason it is the OPV that has been used the most over the past three and a half decades – with astonishing effect. In 1988, polio was endemic in 125 countries and caused the paralysis or death of as many as 350,000 children a year. A global vaccination campaign since then, led by Rotary International, WHO, UNICEF, the Bill and Melinda Gates Foundation and others, has now sent polio to the ground in only two endemic countries: Pakistan and Afghanistan, where cases are now numbering in the dozens. .

But the OPV has a problem. Sometimes the live attenuated virus can mutate, revert to virulence and cause the disease it’s supposed to prevent. These cases of so-called vaccine-derived polio are rare — just three or four out of a million vaccines, according to the Global Polio Eradication Initiative — but if the virus can spread freely, it can spread just as easily as the wild variant. It’s the vaccine-derived infection that hit the 22 Ukrainian children — and that virus had already traveled quite a bit. Thanks to genetic sequencing, it can be traced back to a form of a vaccine-derived virus that first showed up in Pakistan in 2020 and then made its way through Tajikistan before showing up in Ukraine. The 140,000 vaccines that the WHO planned to administer were all of the IPV variant, to ensure that one vaccine-derived polio outbreak would not just be replaced by another.

With the war still raging, the polio outbreak is destined to spread — though UNICEF and Ukrainian health workers are working to get as many children as possible vaccinated, even with the original WHO vaccine campaign on hold. All along the refugee routes, UNICEF is setting up so-called “blue dot centres” – a reference to the organization’s blue, circular logo – to provide aid and assistance to people fleeing the war. Vaccinations, which give injections against both measles and polio, are embedded with the other health workers at the centers in an effort to find and protect as many children as possible.

But viruses will do what viruses do, that is, take every opportunity to spread, especially in the crowded and unsanitary wartime conditions. Ukrainians have not asked to be part of a major land war – and certainly not his children. War is cruel; polio is cruel. Together they are a human tragedy.

 

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

This post Polio makes a comeback in Ukraine as war halts vaccination campaign

was original published at “https://time.com/6155963/polio-ukraine-war/”