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Polio Fear at Europe’s Door

KIEV, Jun 28 2013 (IPS) - The Ukraine is facing a “real threat” of a return of polio as well as outbreaks of other serious diseases such as mumps, rubella and measles because of a combination of state inefficiency and public mistrust of vaccinations, health experts have said.

The country has one of the lowest vaccine coverage rates in Europe, especially among children, and cases of some preventable diseases have soared in recent years.

International health officials say they are working with the Ukrainian authorities to improve immunisation rates, but fear that there could be major disease outbreaks in the future and lives endangered unless progress is made on raising vaccination rates.

“There is a very real risk that polio could return and that there could be outbreaks of other disease, such as mumps and rubella. Unless coverage, which is now at a 20-year low in the Ukraine, is improved we can only expect further outbreaks in the future,” Dr Dorit Nitzan, World Health Organisation representative in the Ukraine, told IPS.

Vaccination rates in the Ukraine have plunged since 2008 following an incident in which a teenage boy died after he received a jab for measles and rubella.

“There is a very real risk that polio could return and that there could be outbreaks of other disease, such as mumps and rubella."

The boy’s death was wrongly reported as being caused by the vaccine and an initial confused government response and the arrest of the country’s chief medical officer in what critics say was a purely political move left many people fearful over the safety of vaccinations.

This fear remains ingrained in many today. A recent survey by UNICEF showed that a third of Ukrainian parents are against immunisations.

Vaccination rates among children are particularly low. Although national health guidelines state that children should be vaccinated against 10 infectious diseases, including polio, rubella, whooping cough and measles, only 50 percent are fully immunised. This is down from 80 percent in 2008, according to UNICEF.

Olga Denisova, a 33-year-old sales assistant from Kiev, told IPS that she had had her adolescent daughter vaccinated, but was very worried about the safety of vaccinations.

“As a mother of course I am worried. I hear so many stories about vaccines not being safe that it is hard not to be concerned. People don’t have enough information about vaccination and the government should be telling them more about it,” she said.

“I know that because of the low vaccination rates there might be cases of polio here. That scares me. I think it is obvious that if myself and other mothers are worried about vaccines that there is something wrong with the whole vaccination process.”

Child vaccinations are not enforced by law but children are not allowed to start school without certificates showing that they have been vaccinated. Parents get round this by obtaining fake documents.

These fears are also, perhaps surprisingly, being reinforced by local healthcare workers.

Many of them take an at best apathetic, and at worst dismissive, approach to vaccines.

“We are working to try and get medical staff to actively promote vaccinations,” Dr Nitzan told IPS.

She said that many remained worried that, as happened to doctors in the case of the death of the immunised boy in 2008, they could find themselves punished or arrested if someone had an adverse reaction to a vaccine.

While the World Health Organisation (WHO) and the United Nations Children’s Fund (UNICEF) and some prominent Ukrainian physicians have been keen to make the public aware of the safety and importance of immunisation, it is not uncommon to find doctors claiming that vaccinations are harmful.

Even when people do want to be vaccinated, they are not always able to have it.

Immunisation is free under state health care but hospitals often run out of stocks for months at a time.

Some mothers have told local media of facing a ten-month wait at their local clinics for the vaccine their child needs. While some resolve the situation by paying out of their own pocket at a pharmacy, not all parents in a country where the average monthly wage is 300 euros can afford to do so.

The shortages at hospitals are put down to a mix of underfinancing, inefficient vaccine procurement procedures and corruption.

The state budget is under pressure, with the economy having struggled desperately since the 2008 financial crisis. The government says it has funding for around 65 percent of the nation’s vaccine needs.

Procurement processes for vaccines have also been widely criticised as inefficient with poor forecasting leading to problems with supplies.

Meanwhile, allegations of corruption in vaccine tender processes – leading to inflated prices being paid for vaccines by the health ministry and subsequently less vaccines available – are made frequently. UNDP officials have previously told Ukrainian media that “private interest in vaccine tenders” was behind vaccine shortages.

All these problems combined have left the Ukraine facing a serious health challenge, the WHO says.

An outbreak of polio – a disease almost completely eradicated from Europe – is of particular concern. Only 74 percent of the population is immunised against it compared to average rates in Europe and the U.S. of more than 90 percent. Because of the threat of an outbreak, the WHO last month led a polio simulation exercise in the Ukraine.

The WHO is hopeful that the situation can be improved.

“What’s needed is better procurement mechanisms, improved capacities, better reporting, for example proper investigations after adverse events, and of course an information campaign to build trust with the public,” Nitzan told IPS.

“We are hopeful though. The new Ukrainian health minister, Raisa Bogatyrova, is committed to not just public health in general but to vaccines specifically. We can only hope that there is cross-sector support from the other ministries involved in health in the Ukraine, such as the finance ministry, and progress (on improving vaccination coverage) can be made.”

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