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 Deep mistrust of vaccines in Ukraine has allowed measles, a virus
which according to United Nations data kills 367 children a day
worldwide, to grow into an epidemic infecting more than 58,000
people in the country of 42 million this year alone.
That has brought one of the world's most contagious diseases to
Europe - there have been recent outbreaks in Poland, Romania and
Germany - and possibly beyond, to Israel and New York. International
health officials are investigating whether pilgrims to a rabbi's
grave in the Ukrainian city of Uman may have carried measles, via
Israel, to the United States.
Pockets of dissenters in many communities have long shunned
immunization. In Ukraine, more and more parents are questioning or
delaying their children's shots. Their doubts are rooted in a weak
healthcare system, corruption and mistrust of authority. Magnified
by rumors on social media, the doubts have transformed the country
into a weak spot in efforts to shore up global immunity against
infectious diseases, public health specialists say. The World Health
Organization (WHO) last year named "vaccine hesitancy" as a top 10
threat to global health.
Since 2017, measles has infected 115,000 people in Ukraine and
killed 41 - 25 of them children, according to the United Nations
Children's Fund (UNICEF). Survivors can suffer long-term
complications or disabilities such as blindness, deafness or brain
damage.
Even so, Khukharuk says parents visiting clinics like hers are
unsure whether to vaccinate: "Most of them have doubts. They are
hesitant, and they can be tilted one way or the other."
It's a fight on many fronts. Research shows vaccines save lives, but
only half of Ukraine's population believe they work, according to a
report published in June by Britain's Wellcome Trust, based on a
survey of attitudes among 140,000 people from 140 countries.
Globally, 84% of those surveyed said they believed vaccines are
effective, including more than 80% in the United States and the
United Kingdom.
Kukharuk and other clinicians say even their medical colleagues
argue vaccines weaken immunity. There is no evidence for such
beliefs; decades of science show the opposite.
Online, concerns about poor-quality ingredients and accounts of
children being forcibly vaccinated fuel notions that vaccines are a
ploy by Big Pharma and governments to make money and control
populations. In fact, most vaccines are low-margin products for drug
makers.
The shunning of vaccination weakens people's defences against
deadlier diseases, such as polio, which causes paralysis and was
eradicated in Europe in 2002. Two children in Ukraine were paralyzed
by polio in 2015 - Europe's first outbreak since 2010, according to
the WHO. An emergency vaccination campaign contained that flare-up.
"It's not only a concern for the children and the people of Ukraine,
it's actually a global issue," said Lotta Sylwander, head of UNICEF
in Ukraine. "Communication and the way we travel means that this
affects people and children worldwide."
AGENTS OF CHANGE
Children's artwork adorns the walls in the large, bright office of
Kukharuk's clinic, and cartoons about vaccination are shown to
children in the waiting room. But Kukharuk is mainly focused on
their parents.
The young doctor is part of a network of unpaid volunteers in a
Ukrainian pro-vaccination campaign sponsored by charity Rotary
International - many of them women, many also mothers - who put
themselves forward to persuade people to get vaccinated.
On a sunny Saturday morning in a park in the center of Kiev, another
doctor, Alla Pugach, enlisted the help of a team member dressed in a
bear costume to educate parents and children about vaccines. The
goal, Pugach said, "is to attract as many people as possible to
vaccination."
"We call these people 'change agents'," said Sergii Zavadskyi, the
charity's head in Ukraine. "We have a network of about 300 of them.
They are trying to help parents find the truth."
Rotary International has spent $200,000 in the country over the past
four years on public health activities including campaigns about
polio immunization. Its PolioPlus program is funded by donations and
events organized by members and supporters.
Volunteers organize meetings to tell unvaccinated adults, parents,
teachers, health workers and others about the risks of infectious
diseases. In her clinic, Kukharuk directs visitors to WHO data which
says vaccines save up to 3 million lives a year.
For its part, the government in Kiev says increasing vaccination
coverage is a matter of national security, and it has set up a
website to debunk myths about vaccination. It has long required
children to produce certificates showing they have had their shots
to go to school.
Earlier this month, Health Minister Zoryana Skaletska posted a
selfie on the ministry's Facebook page which showed her getting a
flu jab. "We remind you, vaccination is the most effective means of
prevention," the post said.
It's a tough sell. In 2016, only half the babies and children in
Ukraine who should have been immunized against diseases such as
measles, mumps, polio, tetanus and whooping cough had received these
routine inoculations, according to Ukraine's health authorities.
Immunization rates need generally be around 95% to achieve the 'herd
immunity' that can protect whole populations, the WHO says.
POWER FAILURES
Measles is more contagious than flu, tuberculosis or Ebola. The
virus that causes it lingers in the air and on surfaces for more
than an hour after an infected person has moved on; so in an
unprotected population, each infected person, on average, would pass
it to 12 to 18 others, virologists say.
In Ukraine – a state still locked in conflict with pro-Russian
separatists after decades of Soviet domination – rumor and mistrust
are also highly contagious.
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Some parents' worries stem from the health system. Ukraine has no
universal healthcare and is perceived to be more corrupt than most
of its neighbors, according to Transparency International.
Many hospitals have long been poorly equipped with unreliable power,
which has at times put vaccine cold-chains at risk and meant some
shots may have been unrefrigerated and rendered ineffective, said
Ulana Suprun, a Ukrainian-American medical doctor who was acting
health minister in Kiev until the government changed in August.
In 2008, a 17-year-old boy died shortly after being given a
measles-rubella vaccine. The government suspended the immunization
program to investigate. It found no link to the boy's death. But by
then, health officials say, the damage to public confidence was
done.
In the past, vaccine provision was also disrupted by an opaque
medicines procurement system which allowed oligarchs to broker
backroom deals with little external oversight. Patients who believe
they are being fed sub-standard medicines say they often pay to go
private, or bribe a doctor to get what they need.
The medics themselves can be part of the problem. Parents whose
children have not had their shots can, for a small bribe, find a
doctor to write them a fake certificate. Websites seen by Reuters
offer false documents saying a child has all the school-required
immunizations for about $9 to $12 a time.
During her three-year tenure as acting health minister, Suprun says,
she visited scores of medical schools and universities where
students said their professors mistrusted vaccines.
On one visit, she recalled a student telling her, "My professor said
... the complications from vaccines are worse than the diseases."
She said one of her staff visited a doctor - she would not name them
- who advised against using a certain vaccine, because it was "made
from the placentas of Indian women."
RUMORS AND TROLLS
Social media fan the flames. As in many countries, sites targeting
Ukrainians carry false claims - that vaccines cause autism, for
example.
These intermingle with more blatant untruths and conspiracy
theories.
"Unvaccinated children's immunity is stronger than in your
vaccinated ones," asserted a post on Facebook in September in the
name of Svetik Lamakhova in Oleksandriya, central Ukraine, who
confirmed to Reuters she had expressed that view.
Another Facebook poster, named Elisaveta Shchepova, said that
doctors and officials encouraging vaccination in Ukraine "do not
need our health – they need our money, grief in family, illness and
death." She did not respond to requests for comment.
Online advocates of vaccination are attacked. Olena Kudryashova, a
31-year-old fitness trainer, said she came down with measles when
her daughter was just over 1, just as she had decided to go ahead
and give her the shots. The baby caught measles too. The mother went
on to ensure her baby was immunized, which she posted on Facebook
along with pictures of herself and her child.
Her post, in December 2018, was shared 14,000 times and prompted
more than 4,000 comments, many of them negative. "I seriously think
you were bribed," said one. Another: "We have been vaccinated since
the days of the USSR, and even now 95% of our children are
vaccinated mercilessly - so why have we got a measles epidemic ???
Maybe because vaccination is a profitable fiction with many
unexplored side effects ???"
Jan Sciegenny, a spokesman for Facebook, said the company takes
misinformation regarding vaccines on its platform very seriously and
is working on ways to connect people with authoritative information
on both Facebook and Instagram.
MOMENTUM
The risks of leaving children without shots may be higher than
previously thought. Two scientific studies published in October
found measles actually damages children's immune systems, by
eliminating antibodies they built up to diseases they had before
they were infected. That makes vaccination even more important.
UNICEF says that on the request of the health ministry, it now
procures vaccines for Ukraine's immunization campaigns against
infectious diseases including measles, diphtheria, tetanus and
polio.
But the doubters have momentum. This year, from March to August, the
group "Vaccination. Free choice" held demonstrations to protest the
requirement that children be inoculated.
Veronica Sidorenko, its head, said she doesn't trust data cited by
the government and UNICEF, and believes a powerful pharmaceutical
lobby is behind "mass hysteria" about the current measles outbreak.
She said the outbreak of measles itself sparked an "intensified
vaccine policy" which included what she described in an email to
Reuters as "psychological pressure on parents and manipulation of
statistics and information."
The city of Kiev, which has 3 million residents, had just 87 cases
of measles in 2017.
Between January and June this year, it recorded 5,000.
(Reporting by Kate Kelland and Pavel Polityuk; Additional reporting
by Sergei Karazy in Kiev; Edited by Sara Ledwith)
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