Ukraine health officials fear big polio outbreak By David Stern

BBC News, Kiev Published duration 21 September 2015

image caption Many young Ukrainian children are not vaccinated

Health officials in Ukraine are gripped by fears of a major polio outbreak, after it was announced this month that the disease had paralysed two children in the south-western region of Trans-Carpathia.

Concerns that the virus could cut a deadly swathe through the country has mobilised officials to launch a national immunisation campaign that would embrace all children up to 10 years old.

The threat has also mobilised international organizations, as well as Bill Gates, whose foundation promotes increased vaccinations worldwide and who spoke to President Petro Poroshenko about the polio danger last week.

Olga and Anatoly Makarenko demonstrate the potential obstacles the campaign could face. They have decided not to vaccinate any of their children - Dima, seven, Ksenia, five, and Varvara, one.

image caption Mother-of-three Olga Makarenko has decided not to vaccinate her children (pictured)

And despite knowing something of polio's effects and reading reports that the virus may have already reached Kiev, they won't change their minds.

Dima, Olga points out, has already suffered a bout of whooping cough. But it was just a bit longer-lasting than a regular cough - showing, she claimed, there were no negative consequences.

"The vaccinations are much more dangerous than the illnesses that they treat," said Olga on a late summer day, as her children joyously romped in a nearby playground.

"Nobody knows how the vaccines were stored," she continued. "No-one knows if the expiration dates were changed. Vaccines are a serious thing. There are conditions for transporting, storing and producing them."

Forgotten disease

They are not alone in their views. Stories abound among the Ukrainian public that children have fallen ill or even died after being immunised.

The fact that some diseases have disappeared from public memory also means that a large number of people are unfamiliar with polio's lethal consequences.

media caption Olga Makarenko explains why she will not be vaccinating her children

As a result, Ukraine's vaccination rates are the lowest in Europe and the former Soviet Union, and are among the lowest in the world. Less than 14% of one-year-olds have been immunised against polio.

Health experts say that Olga, her husband and other anti-immunisation activists, some of whom include local doctors, are flat-out wrong. There is absolutely nothing wrong with the vaccines used in Ukraine, they say.

"In general, they depend on myths about vaccination," said Dr Tatyana Petrovskaya, head physician at the Our Doctor private health clinic. "These are based on the idea that a child should build up his or her immunities in a natural environment, that the immune system should work itself out by being exposed to illnesses.

"They don't understand how serious these diseases are."

Obstacles to vaccination

The possibility of a major polio outbreak, amid a largely unprotected population of children, has raised the alert among local and international health workers, who say they don't have a moment to lose.

"The situation is really alarming," said Dr Dorit Nitzan, the head of the World Health Organization's Ukrainian office. " We have an outbreak in the country . And every day that passes without vaccinating the children, the risk is getting higher that more and more children will get sick."

image caption Health officials say they don't know the true number of children who have been vaccinated

The campaign would be both massive and ambitious. Some five million children will be immunised, with those under six years receiving three doses of the oral polio vaccine. In all, more than 11 million vaccinations will need to be administered.

This would be a challenge for most countries under the best of conditions. Ukraine, in contrast, is currently fighting a war against Russian-backed insurgents in its eastern regions and suffering a severe economic depression.

media caption A child receives a vaccination at a private clinic in Ukraine

Adding to this is a health system riddled with corruption and decay, a government often hampered by political infighting and a weak, post-Soviet distribution structure.

Schools require all students to be immunised in order to be admitted, but many parents also pay bribes to falsify their children's documents. Officials say they don't know the true figures of how many children have in fact been vaccinated.

As a result, the vaccination campaign - which should start this week - could face difficulties and even fall short. And the virus could then spread beyond Ukraine's borders to regions in Europe where immunisation rates are also low.

"If you do it really timely - three to six months - the country, the children will be saved," said Dr Nitzan. "But this calls for real leadership, a real concentrated and focused effort. Everyone should join hands."

"Otherwise, Ukrainian children and many other European children will be at high risk."

What is polio?

image copyright SPL

An infectious disease caused by a virus which invades the nervous system and may cause irreversible paralysis

It can strike at any age but mainly affects children under five

Polio vaccine, given multiple times, can protect a child for life

'Situation is tragic'

The WHO and other international groups are calling for Ukrainian President Petro Poroshenko to draft a law declaring polio a public health emergency in order to boost the fight against the virus.

This would strengthen Ukrainian officials' hands in dealing with any resistance to the programme. It could also help speed up the purchase of vaccines since, at the moment, only around a third of the needed amount has been obtained.

Ultimately, more cases of polio are inevitable, experts say. The hope is that, with a rapid response, a full-blown crisis can be averted. But given Ukraine's catastrophically low immunisation rates, the chances of a major outbreak at some point are high - maybe inevitable.

"The situation is tragic, whichever way you look at it. If it's going to be now, tomorrow or next month, it's coming," said Dr Nitzan. "And it's coming big time, because children in Ukraine are not immunised against polio and against other diseases.

"We don't have time, so we are going to tell them the truth: 'You are risking your children'," she said, turning again to the specific danger presented by polio.