Ukraine was struggling to control the COVID-19 pandemic even before Russian troops advanced on the country. It has been slower to launch its COVID-19 vaccination campaigns than other European countries, and although the government has encouraged citizens to get vaccinated, most people have struggled to find a way to get vaccinated, haven’t felt the need to get vaccinated, or don’t have confidence in the safety and effectiveness of the vaccine.
Just before the February 24 invasion, only 35% of the Ukrainian population had been vaccinated. This puts it in line with most of its neighboring countries, although some, including Poland and Hungary, have achieved higher vaccination coverage. While differing health systems and varying attitudes towards vaccination in these countries contribute to these contrasting rates, Ukraine’s relatively low vaccination rate could have implications for the magnitude of further increases in cases. , both in the country and in the region, as a result of the war. . Like many other countries, Ukraine saw an increase in cases due to the Omicron variant in November and another spike in the first week of February, likely due to its low level of vaccination. As of mid-February, 60% of COVID-19 tests carried out in the country were positive.
Such low vaccination coverage is not enough to control a highly transmissible virus like SARS-CoV-2, according to public health experts. Add to that a war – with the political and social upheaval it causes – and not only are spikes in infections inevitable, but there is also the possibility of new variants emerging, putting the whole world at risk.
Vaccination and mitigation measures such as mask-wearing, social distancing and basic hygiene are key to curbing the spread of SARS-CoV-2, but are impossible to sustain when a country is under siege. Humanitarian group Doctors Without Borders is distributing trauma kits and training healthcare providers in Mariupol, Ukraine, a target of the Russian attack, and providing shelter and basic healthcare to those crossing the border to other countries like Poland. But it’s not enough.
“War is infectious disease’s best friend,” says Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “It calls into question all the public health programs you can have. This limits the medical care available for those who could be seriously ill and often promotes transmission when so many people are crammed into bomb shelters and on trains. It will be the perfect storm of one serious challenge after another.
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A decade and a half ago, World Health Organization researchers found that 65% of major infectious disease outbreaks in the 1990s were in refugee populations or conflict zones. Les Roberts, a professor emeritus at Columbia University’s Mailman School of Public Health who has spent time in war zones dealing with outbreaks, notes that these populations are particularly vulnerable to viral diseases like COVID-19. . “It turns out that when you’re stressed, your immune system doesn’t work as well. You don’t eat as well and you can’t fight off illness as well,” he says. “And in times of conflict, you you move around a lot and end up in bomb shelters or basements or in trucks that are much more crowded than normal and have poor air circulation. I don’t think people fully understand how war is like the 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 an increase in cases in the country and those bordering it – such as Poland, Hungary, Slovakia, Romania and Moldova – all straining their health systems. Health experts are particularly concerned about the situation in Poland, where almost half of Ukrainians have fled, according to the United Nations High Commissioner for Refugees. “SARS-CoV-2 is spreading like lightning right now,” says Jeffrey Shaman, professor of epidemiology at Columbia University Mailman School of Public Health. “For places like Poland and places in western Ukraine where people are fleeing, there’s a huge opportunity for this virus to do damage it wouldn’t have had the opportunity to do otherwise. .” Prior to the influx, nearly 60% of Poland’s population was vaccinated, which will help protect against a surge, but new infections are likely to rise there as well, increasing demand for health services.
“We’ve been warning for years about the potential convergence of conflict and epidemiology — bad things happen when these things converge,” says Dr. Eric Toner, senior fellow at the Johns Hopkins Center for Health Security. “Certainly, in the dire circumstances in which the population finds itself at the moment, wearing a mask, distancing and quarantine will not be possible. As people flee affected parts of the country, crowding into buses, trains and cars and ending up in hotels or living with relatives or in refugee camps, these are not the conditions for a good control of a communicable disease like COVID-19.
Hospitals will likely be the hardest hit by the influx of refugees during the pandemic, public health experts say. War-related injuries will take precedence over COVID-19 care, which will only facilitate the spread of the virus. This disruption will in turn result in more healthcare workers becoming infected and unable to perform their duties.
“There will be leaks in hospitals, facilities and resources because of the injuries associated with the conflict,” says Shaman. “In the longer term, I imagine this will lead to a deterioration in the ability to provide health care at the level that Ukrainians are used to.” And if surges also occur in neighboring countries, this puts additional pressure on health services across the region. “The global community would be advised to provide supplies and facilities to protect the displaced Ukrainian and Polish populations from these consequences.”
Shaman and other public health experts are also concerned about the longer-term effects of the conflict on controlling COVID-19. Studies consistently show that vaccine-based immunity begins to wane after about five to six months. Booster shots are essential to maintain protection against an illness so severe that it requires hospital care; if the conflict in Ukraine continues, it would mean that even vaccinated citizens cannot be strengthened, as trauma care and war-related injuries will take priority over vaccination efforts.
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The situation exposes weaknesses in the global biodefense network against threats such as highly infectious coronaviruses. Even without military conflict, stark 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 because they lack access to vaccines. When a conflict like the one currently unfolding in Ukraine strikes during a pandemic, the lack of global coordination of public health resources becomes more tragically evident. “I can’t begin to tell you where the solution is,” Shaman says. “The World Health Organization has neither the authority nor the resources in terms of money to deal with this. This is a very broad issue that involves development, national sovereignty and the ability of nation states to get along and support each other in trust rather than in a way in which we have seen the world change over the past 20 years.
What is really needed is a global coordinating body for public health, Toner says, which is unlikely, given the challenges posed by issues of national sovereignty. But the principles that underpin global coordination could still be implemented in a more limited way.
The COVAX Global Vaccine Distribution Program, through which developed countries purchase vaccines to lower prices for developing countries, was such an effort, but falls short of its promise. It has failed to deliver the 2 billion doses it had guaranteed by the end of 2021, and the group estimates it will take until 2023 to deliver enough vaccine to immunize the world. “After the pandemic is over, I think we need to take a hard look at COVAX and why it didn’t work as well as we had hoped, and what we could have done to improve it,” Toner says.
Some public health experts have offered alternatives, such as helping vaccine makers set up manufacturing facilities in countries that have historically struggled to get the latest vaccines, as well as encouraging more shared intellectual property to enable the poorest countries to access the technology they need to produce vaccines. by them selves.
Roberts points out that there are also ways to control and reduce the likelihood of viral spread as Ukrainians gather in shelters and flee to other countries. Immunizing and strengthening people who enter these community settings, especially those who are particularly vulnerable, such as the elderly or people with underlying health conditions, is an important start.
However, this remains mostly out of reach. The World Health Organization lacks the resources to quickly direct vaccine supplies and personnel to crisis areas such as Ukraine, and lacks the political authority to address sovereignty issues national. Organizations such as Doctors Without Borders and other humanitarian groups also play a vital role, but are also limited to more localized aid efforts. “If we continue to be reactive crisis after crisis, we will not be addressing the underlying systemic issues that need to be addressed,” Shaman says.