Stopping a polio outbreak in war-torn Ukraine

After 6 years without polio in Europe, a vaccine-derived polio virus outbreak hit Zakarpattya, in Ukraine’s western region in September of 2015.

The site of outbreak is right in the heart of Europe. Bordering four countries – Poland, Slovakia, Hungary and Romania, Zakarpattya, is geographically closer to eight European capitals than to Kyiv, Ukraine’s capital. How did this come about and does this outbreak at the heart of Europe mean that the virus can spread further through the continent?

It’s no coincidence that polio has cropped up in Ukraine. For one, the country’s immunisation rates have been plummeting since 2009. By 2015, immunisation rates reached a mere 15% of coverage. Ukraine also has some of the strictest and most complicated rules for vaccination in the world, making it more difficult to keep children up to date on their immunizations.

A line of children sit on a bench in a hallway.
UNICEF/BershadskiyIn January, two girls wait in a queue for getting vaccination against polio in a health facility of the village of Gvardiyske, Odesa region.

To complicate things further, the country had no vaccines for more than a year. For UNICEF, bringing polio vaccines during 2015 was simply a nightmare. You needed to get through a huge number of customs policies and regulatory authorities in Ukraine. On top of all these challenges, armed conflict is seriously affecting the wellbeing of over 215,000 internally displaced children as well as those living in the east of the country.

Rumours and misconceptions about vaccination make matters worse. Social media platforms have at times helped to spread damaging rumours about the alleged “toxicity of vaccines,” the “non-existence of the polio outbreak,” and that the outbreak is an “international plot.” As a result, parents are unnecessarily scared of vaccination in general, and of polio vaccinations in particular.

So, is a polio campaign impossible given these circumstances? Definitely not.

Four months after the outbreak, in the midst of the third round of vaccinations, I feel we are inching closer to closing the polio chapter in Ukraine. Despite all of these challenges, UNICEF managed to bring nearly 15 million doses of oral polio vaccines to over 24,000 immunisation posts in the country – enough to protect 4.7 million children from the disease. UNICEF communication teams raised a massive campaign to help win the trust of parents, teachers, doctors and politicians and get them to bring their children for immunisation.

Another source of hope is the health workers. I asked Dr. Olena Mykolaevych, the paediatrician at Kyiv polyclinic number 13, how she deals with parental refusals, thinking that she must spend hours persuading hesitant parents. She replied that she always keeps her own two children’s’ immunization records on her desk, to show parents and encourage them to accept vaccination.

“If you do not trust me now, how could you trust me when you need my advice in the future?” she tells them.

Seeing her response gives me hope for ending the polio outbreak in Ukraine. With the help of committed doctors going the extra step, polio can be defeated. Closing the immunization gap in Ukraine is not going to be easy, but it is not impossible.

Dragoslav Popovic, MD, MPH, has over 25 years of experience in public health, having worked for organisations such as World Bank, International Rescue Committee, and the Government of Bosnia and Herzegovina. He spent 20 years as UNICEF Health Officer and is currently the Health Consultant at UNICEF Ukraine.

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