Fear of vaccines exacerbates polio outbreak in Ukraine

This week, the World Health Organization (WHO) did not mince words with Ukraine: Declare a state of emergency. WHO sounded the alarm after the first polio cases the country has seen in five years paralyzed two children, a 4-year-old and 10-month-old.

“These cases have arisen as a result of a very low level of immunization in the country,” Igor Pereginets, deputy minister of health in Ukraine, said in a statement.

Ironically, health officials believe the polio vaccine, coupled with low immunization rates and poor sanitation, is behind the latest outbreak.

The polio vaccines used in Ukraine contain a live but weakened virus. When a child is immunized, the virus replicates in the intestine and is excreted. Typically, the weakened virus can confer immunity to an unvaccinated child. But in rare cases, the weakened virus can mutate, grow stronger, and infect an unvaccinated child. In a population like Ukraine’s, in which the vaccination rate is only 50 percent, the virus can circulate for a long time and mutate into a form that can paralyze and kill.

In response to the recent cases, the Ukrainian government launched a polio vaccine campaign with a goal to vaccinate 90 percent of children 5 years old and younger. But a longstanding distrust of vaccines is hindering efforts to stop the disease’s spread. As of early November, only 60 percent of children 5 years old and younger have been vaccinated, which led the WHO to call for the state of emergency.

While the vaccination rate in Ukraine remains low, distrust of vaccines remains high. In 2008, a teenager who recently received the measles and rubella vaccines died of sepsis. Though the WHO and UNICEF both insisted the death was unrelated to the vaccine, suspicion prevailed. UNICEF estimates show rates of measles vaccination fell from 70 to 80 percent in 2008 to about 50 percent in 2012. The number of measles cases swelled from 40 in 2010 to 13,000 in 2012.

Ukrainian medical policies also reflect a distrust of vaccines. If a child in Ukraine dies within 30 days of receiving a vaccine, the vaccine is listed as a cause of death until the investigation is completed. During that time, the licenses of health professionals who administered the vaccine are suspended and they can face prison, Dorit Nitzan, the WHO representative in Ukraine, told NPR.

Compounding the polio problem, a Ukrainian healthcare lobby group claims the vaccines are unsafe and wants every one of them destroyed. If the Ukrainian government heeds its call, Nitzan insisted, it will be making a grave mistake: “This is a real threat. It is an outbreak. The more time children are not immunized, the more children will get sick.”

While many in Ukraine fear vaccinations, a 2014 UNICEF/WHO survey found few Ukrainian mothers fear polio. The survey noted only18 percent of Ukrainian mothers thought polio was a dangerous disease and only 27 percent knew it could cause paralysis.

Other regions also have seen vaccine-sourced polio deaths. In September, an 8-year-old boy in Laos became paralyzed from the poliovirus and died five days later. WHO officials identified the virus as being derived from an oral vaccine. They believe it may have been circulating in Laos’ Bolikhamxay Province for more than two years.

But the WHO has emphasized the risk of vaccine-derived polio infection “pales in significance” to the health benefits associated with oral poliovirus.

Globally, the polio picture appears to be improving. So far this year, 60 wild poliovirus cases have been reported from two countries (Pakistan and Afghanistan), compared to 316 cases from nine countries during the same period in 2014, according to the Global Polio Eradication Initiative.

Rahima Ahmadi, a polio vaccination coordinator in Mazar-e-Sharif, has dedicated much of her life to seeing Afghanistan polio-free.

“As a mother, I never want to see a child paralyzed in her mother’s arms,” she said. “We can prevent this disease with just two drops of polio vaccine.”