Sep 01, 2018 Volume 392 Number 10149 p711-794
Measles, war, and health-care reforms in Ukraine
Russian-backed attempts to sabotage Ukraine’s economic, political, and health developments have left the country fighting a measles outbreak and continuing a bloody, undeclared war. The situation is emblematic of increasing tension between the ideologies of President Vladimir Putin and countries of the pro-democratic, neoliberal west.
The measles outbreak—affecting other countries including Serbia, Georgia, Greece, and Italy—has hit Ukraine hardest, with the country’s 23 000 cases accounting for more than half the European regional total. Kremlin-supported social media accounts spreading discredited theories about the measles, mumps, rubella (MMR) vaccine, combined with shortages and underfunding, have been blamed for the outbreak. Research published on Aug 23 concluded Russian trolls promoted discord and, masquerading as legitimate users, created a false impression that arguments for and against vaccination were equipoised. The result has been an erosion of public consensus on the value of vaccine programmes. The precipitous fall in vaccination level began after 2008, when 95% of eligible children in Ukraine received their second (and final) recommended dose of the MMR vaccine. By 2016, the rate was 31%, among the lowest in the world. Although now rising again, the latest 85% measles vaccination rate recorded by WHO remains below that needed for herd immunity. Records in 2016 show poor vaccination rates for other diseases: only 19% of children received the third recommended dose of the diphtheria-tetanus-pertussis vaccine and 56% received the third recommended dose of oral polio vaccine. Hepatitis B vaccination was low, with coverage with hepatitis B birth-dose and third-dose vaccines at 37% and 26%, respectively. WHO estimates between 3% and 5% of the Ukraine’s 45 million population has been infected with hepatitis C. Ukraine bears the second largest HIV epidemic in eastern Europe and central Asia…