War in Ukraine as a challenge for epidemiological safety in the whole Europe

On February 24, 2022, the full-scale military invasion of the russian federation into Ukraine began. The armed conflict has resulted in deaths, injuries, severe destruction and damage to infrastructure and housing. The population is moving en masse from the epicenters of hostilities to the west of Ukraine and abroad.

In the two months since the war began, almost 13 million Ukrainians have left their homes. 7 million people moved to other regions of Ukraine, mostly to the west. Another 5.2 million people went abroad. The numbers continue to grow. At the same time, due to the large number of internally displaced persons, the workload of the healthcare system and staff in the hosting regions has significantly increased.

This war poses a threat of humanitarian catastrophe and also poses an epidemic threat both within the country and in the WHO European Region, especially in bordering countries.

Risk of disease outbreaks

Vaccination coverage in Ukraine before the war lagged behind the WHO recommended 90–95% for most vaccine-preventable diseases. Although in recent years we have had a fairly good trend of improvement, owing to changes in the national immunization program management, long-term planning and sustainable provision of vaccines to the country. The reasons that had led to this situation are a separate story, but russia’s full-scale war has exacerbated it.

According to the Ministry of Health of Ukraine, the analysis of vaccination coverage in the regions that provided information in February 2022 shows a low level of performed vaccinations among the target groups and for catch-up schedules.

I will dwell on a few figures. The first concerns polio vaccination among Ukrainian children. According to the Ministry of Health of Ukraine, the projected vaccination coverage by the end of 2022, provided the current rate is maintained, will be much lower than in previous years. Namely, by the end of 2022, with the current rates, the coverage will go down to 61.8% for children under 1 year, 52.8% for children of 6 years old, 53.4% ​​for 14-year-olds. Due to active hostilities in Ukraine, in some regions it is impossible to ensure vaccination — destroyed hospitals, warehouses, inability to provide logistics, etc., so the coverage is accordingly low. At the same time, in non-combat regions, polio vaccination coverage is still low. These are Ivano-Frankivsk, Rivne, Lviv Oblasts. This may be due to the fact that a significant number of children have moved from the eastern to the western regions, thus increasing the target group.

The situation is exacerbated by the fact that today Ukraine is experiencing an outbreak of circulating vaccine-derived poliovirus type 2. Circulation of the virus was confirmed in two Oblasts of Ukraine — Rivne and Zakarpattia.

Monitoring of the stepped-up IPV vaccination campaign (as an outbreak response) shows that it has been implemented at 42% overall, 35% for dose 1, and 57% for dose 2. It is currently not possible to estimate further levels of coverage by region, as a significant number of children had to be relocated.

Under martial law, there is a high risk of polio outbreak spreading not only in Ukraine but globally. Any population displacement increases this risk.

As in the situation with polio, in 2 months of 2022, compared to the same period in 2021, the levels of vaccination against measles, mumps and rubella are much lower, due to hostilities and the inability in some regions to provide vaccination. Projected coverage with the current rate, by the end of 2022 may reach 60.6% among 1-year-old children, and 44.4% for children of 6 years old.

Even in regions without active hostilities, where there are large numbers of internally displaced persons, the rates are not better: Ivano-Frankivsk, Lviv, Zakarpattia, Khmelnytsky Oblasts.

Given that measles is an endemic disease, vaccination is a priority not only within the national schedule, but also for catch-up. Missed doses should be received immediately once it is possible, regardless of the place of temporary residence.

Another important issue of epidemiological security is the COVID-19 pandemic, which continues in Ukraine and around the world. The war has put the pandemic issue onto the sideline, pushed it out of the TOP news, but the disease did not go away. It is also a problem for thousands of Ukrainians and the healthcare system. Vaccination remains the most effective response to the epidemic.

Vaccination is essential to the preservation of the Ukrainian nation

Given the above, one of the priority tasks for those who have moved to a safe place in Ukraine or abroad is protection from infectious diseases for themselves and their children via vaccination.

This applies to both routine vaccination and COVID-19 vaccination, emergency, supplementary and recommended vaccination. The state is now doing its utmost to provide the internally displaced persons (IDPs) with the opportunity to receive vaccinations for themselves and their children at the place of temporary residence. In particular, where possible in Ukraine, there are operating vaccination points in health care facilities. The Ministry, at the initiative of the Public Health Center and technical support by the NHSU, has developed recommendations on obtaining vaccination status of an internally displaced person within Ukraine or those evacuated abroad due to the russian armed aggression against Ukraine, which have already been sent to each provider of immunization services.

It is clear that most displaced people are in a state of stress. Common reactions that may accompany vaccination (slight fever, injection site pain, weakness) often prompt people to give up vaccination. In order to preserve the Ukrainian nation, it is important that children and their mothers are safe. But it is equally important to protect yourself and your children from infectious diseases that are an invisible enemy and cannot be stopped by borders. Vaccination remains the only reliable weapon against it. Once you have reached a safe place of temporary residence, take care of the vaccination for yourself and your children. Find the nearest vaccination point to where you currently are. Come for vaccination, protect yourself and the people around you. This will not only take care of your own health, but also help doctors not to be distracted by saving patients from vaccine-preventable diseases.

At the same time, at the local level, it is important to provide measures to improve the state of immunoprophylaxis, both among those who have found temporary shelter there and permanent residents. We suggest the following:

- active surveillance, detection of cases of acute flaccid paralysis among children and polioviruses in the environment;

- strict infection control and prevention activities in places of temporary stay for the IDP;

- interaction of places of temporary stay with health care institutions for the provision of medical care, detection of diseases and vaccination.

In turn, the Public Association “Coalition for Vaccination”, together with its partners, is advocating for vaccination among local authorities and involving all parties to cross-sectoral cooperation. The Public Association also provides organizational and expert support and works as a bridge to encourage people to get both their scheduled and COVID-19 vaccinations, providing information on how to get the vaccines.