SEATTLE, Washington — Measles is a highly contagious viral disease that can be easily transmitted from the mouth, nose or throat of an infected person. The virus can be deadly in severe cases. In fact, it remains a significant cause of death among young children worldwide. A safe and effective vaccine was developed in the 1960s and is still in use today. However, in Ukraine, there have been several cases of measles.
Around the world, measles cases increased by 30 percent in 2018. At least 53,000 of the measles cases in Europe occurred in Ukraine. There are a variety of factors that influenced the ongoing outbreak of measles in Ukraine. It is important to understand these factors as well as the global consequences of a measles spike in this region of the world.
Factors Behind Increased Measles Incidence
- Vaccine Hesitancy: Vaccine hesitancy can be defined as an unwillingness to get yourself or your child vaccinated despite having access to immunization methods. Much of Ukraine’s vaccine hesitancy can be drawn back to 2008 when a 17-year-old boy received a measles vaccine and died from unrelated causes the next day. Health officials assured citizens that the boy’s death was unrelated to his vaccination. However, rumors and skepticism spread throughout much of the country. In 2007, 97 percent of Ukrainian infants had been vaccinated. This number dropped to 56 percent by 2010. A study by Wellcome found that in 2018, Ukraine had one of the lowest immunization confidence rates in the world: only 30-40 percent of Ukrainian survey participants said they felt that vaccines were safe. This is a major obstacle in combatting measles.
- Fake Immunization Certificates: It is the law in Ukraine that children must have a certificate proving they have been inoculated before they can be enrolled in school. While this law has acted as a useful incentive in some areas, in others it has resulted in an increase in counterfeit certificates. Ulana Suprun, Ukraine’s health minister, estimates that as many as 50 percent of these certificates could be fake. Fortunately, a new computer database that requires specific serial numbers could help cut back on the number of fraudulent forms.
- Ineffective Vaccination: In some of the more remote, mountainous regions of Ukraine, power outages could have resulted in vaccines not being stored at the optimal temperature. An outbreak in one such region was attributed to ineffective vaccines as a result of less than adequate storing conditions. The Ministry of Health also has suspicions that the measles vaccine received in 2001 from Russia may have been faulty. More than 20,000 of those infected in the most recent outbreak were adults who had been vaccinated.
- Political Unrest: The past couple of years have not been easy for Ukraine politically. In 2014, protests to depose pro-Russian President Viktor Yanukovych were successful and a more Western European-leaning government was instated. Around the same time, Russia seized Crimea in the east and armed pro-Russian insurgents to fight the impending westernization. This conflict has occupied much of the Ukrainian government’s attention and makes it extremely difficult to track whether children born in the east are being vaccinated. If not, the virus could spread more easily to the main population.
- Cost of Consistency: In order for population immunity to be effective, at least 95 percent of the population needs to be vaccinated, and that number needs to be sustained. The cost of sustaining immunization programs can be expensive, especially during times of domestic conflict. The Ukrainian government also preferred the more expensive European vaccines over cheaper but still effective Indian and Korean vaccines. This has further increased immunization costs.
- Complacency: Some people avoid vaccinations simply because they feel there is not a strong enough incentive for them. This is especially true for adults who have lived vaccine-free and stayed healthy over the years. These recent outbreaks, however, are opening eyes all over the world to the necessity of vaccinations.
Global Health Risks
The outbreaks of measles in Ukraine are not confined to one country. In today’s world of globalization and travel, contagious diseases can spread easily without people realizing it. For example, Israel experienced a large measles outbreak in Fall 2018. Health officials later realized it was spurred by an Orthodox pilgrimage to the Ukrainian city of Uman around Rosh Hashanah. The journeyers likely picked up the virus and brought it back to Israel upon their return. That October, Israel recorded 949 cases of measles.
Ukraine is fortunate to have a relatively low measles fatality rate. When the country recorded about 53,000 cases in 2018, only 16 people died. However, measles outbreaks can be far more deadly in less developed countries. In Madagascar, at least 922 children died from a measles outbreak between October 2018 and February 2019. The virus is especially dangerous for small, malnourished children who do not receive proper treatment. The possibility of spreading measles to underprepared countries puts many lives at risk.
Improvements Moving Forward
The numbers can be discouraging. However, health officials are making improvements in vaccination systems so more people can be reached for immunization. In 2017, Ukraine’s vaccination coverage increased to include 93 percent of infants and 91 percent of 6-year-olds. WHO European Region reached an estimated 90 percent coverage for the second dose measles vaccine. This was the highest yet. Furthermore, in response to the outbreak earlier this year, an initiative vaccinated more than 280,000 children in the Lviv region of Ukraine, an area hit hard by the virus.
Measles-prone areas like Ukraine have a long way to go in stopping the outbreaks and making sure more of the population is vaccinated. They will need to develop a system that targets not only children but adults as well. This can be difficult and time-consuming. The results, however, are worth it.
– Morgan Johnson