Russia anti-vax campaign in Ukraine could cause COVID crisis for Europe

For years, long before Russia launched its military onslaught, Ukrainians were under attack by another Russian campaign – one aimed at undermining trust in Western vaccines and the governments that offer them to their citizens.

The anti-vaccine messages were actively promoted by President Vladimir Putin’s government, broadcast by Russian state television and reinforced by Russian computer bots on social media. The offensive was part of a larger effort to sow divisions within the fledgling democracies and increase distrust of the West throughout Eastern Europe and the former Soviet republics.

In Ukraine, the seeds of vaccine skepticism fell on particularly fertile soil. Just 35% of residents are fully vaccinated against COVID-19 and 1% are partially vaccinated – among the lowest rates in Europe, according to Oxford University data. Childhood immunizations against diseases like measles and polio are also among the lowest on the continent.

This is a concern for public health officials as more than 3.6 million Ukrainian refugees have poured into other countries and millions more have been displaced within Ukraine, often crammed into crowded, cold places without clean water or electricity.

“COVID doesn’t need overcrowded refugee camps to thrive,” said Dr. Chris Beyrer, director of the Center for Public Health and Human Rights at the Johns Hopkins Bloomberg School of Public Health. “Crowded gyms, crowded buses and crowded trains will do.”

The flight of refugees through history has prompted warnings that they carried disease and the plague – accusations more often prompted by xenophobic hysteria than fact. However, there has been virtually no hostility towards Ukrainian refugees across Europe, and public health experts have voiced their concerns cautiously so as not to compound the refugees’ trauma.

Many Ukrainian refugees have been resettled away from the congested borders, according to the European Center for Disease Prevention and Control in a recent bulletin. However, as more and more Ukrainians are being cared for in reception centers, “there is a higher risk of outbreaks of communicable diseases,” the agency said.

COVID-19 is high on the list of concerns.

The vaccination rate of Ukrainians could still overstate their level of protection, Beyrer said. That’s because the COVID-19 vaccines made available to them have varied in their effectiveness against the Omicron variant, and the minority of fully vaccinated individuals likely have not received a booster shot that offers the best protection against serious illness. And practically none of the children of Ukraine have been vaccinated against COVID-19.

But the coronavirus is far from the only concern. Sizable minorities have also gone without proven polio and measles vaccines, putting refugees — and to a lesser extent their new hosts — at increased risk of outbreaks when they huddle in confined spaces, said Dr. Gabriele Fontana, UNICEF Regional Health Advisor for Europe and Central Asia.

Having low vaccination rates against preventable diseases seems to be the least of Ukrainians’ concerns right now. Russia’s bombing of hospitals and civilian centers has killed at least 1,035 people, including more than 112 children, and disrupted care for people with life-threatening and chronic diseases.

Still, outbreaks of disease could worsen the misery of Ukrainians, pose challenges to the countries that host them and add to the war’s death toll.

This will “contribute to the litany of suffering,” said Beyrer.

In addition, the refugee crisis could fuel a new wave of COVID-19 in Europe, experts said.

Austria, Germany, the Czech Republic and Slovakia – four countries hosting hundreds of thousands of displaced Ukrainians – are already experiencing strong resurgences in new coronavirus infections, caused in large part by the hyper-contagious “stealth Omicron” variant. Hungary has also seen a significant increase in new cases in recent days.

In addition, many neighboring countries of Ukraine also have low vaccination rates. Slovakia, Romania, Moldova and Bulgaria have rates around 50% or below.

The European Center for Disease Prevention and Control has advised countries hosting Ukrainian refugees to offer eligible adults and children a COVID-19 vaccination if they have not been vaccinated, or a booster shot if they have. To reduce outbreaks in reception centers, the agency also suggests that displaced Ukrainians be tested upon arrival or, if testing is unavailable, that people with COVID-like symptoms “are screened and treated as possible cases with appropriate supportive care.”

There is little evidence of this happening at crowded border crossings, and Fontana expressed skepticism about the wisdom of offering vaccines while many families are in transit, given the possibility of the fever and pain that often follow a vaccination.

Refugees from Ukraine walk after crossing the border by ferry at the Isaccaea-Orliwka border crossing in Romania.

Refugees fleeing the war in Ukraine walk after crossing the border by ferry at a border crossing point in Romania March 24.

(Andreea Alexandru/Associated Press)

Last fall, when Ukraine’s COVID-19 death toll was nearly 100,000 and less than 20% of his compatriots were vaccinated, President Volodymyr Zelenskyi spoke up. He blamed social media propaganda fueled by Russia and asked Ukrainians to choose vaccinations.

Ukrainians need to “turn off social networks and turn on their brains,” said Zelenskyy. Getting vaccinated “is the only solution,” he added.

His appeals have largely failed in Ukrainian towns and villages, said Kateryna Odarchenko, a political adviser who has conducted focus groups on vaccine hesitancy across the country.

“People totally believe misinformation and they don’t believe the government,” Odarchenko said.

Ukrainians’ reluctance to vaccinate is hardly limited to COVID-19.

In 2021, 53% of Ukrainian babies in their first year of life were vaccinated against polio, and outbreaks occurred in the country in 2015 and 2021. The resurgence of polio in a region declared polio-free in 2002 sparked an aggression that was still ongoing when Russia’s military attacked.

Today, 76% of children in Ukraine are fully vaccinated against polio, but that still leaves nearly 1 in 4 vulnerable to a disease that can debilitate children and lead to death or lifelong disability.

The virus that causes polio is spread through oral and fecal exposure, making it a potent threat to Ukrainian children hiding from the Russians in basements and subway stations without plumbing or proper sanitation.

Anastasia Vakulenko comforts Natalya Chikonova as they take shelter in an underground metro station in Kyiv, Ukraine.

Anastasia Vakulenko comforts Natalya Chikonova as they take shelter in an underground metro station in Kyiv, Ukraine.

(Marcus Yam/Los Angeles Times)

Measles is another problem. Ukraine’s low immunization coverage led to nearly 100,000 cases and 31 child deaths there between 2017 and early 2019, and led to a resurgence of measles that spread across Europe. Today, 87% of Ukrainian children are fully vaccinated against measles – far below the 98% needed to prevent outbreaks, according to public health experts.

Polio and measles are less likely than COVID-19 to follow refugees from Ukraine because many of their host countries have fairly high childhood immunization rates, Fontana said. But those who share Ukraine’s vaccine hesitancy – particularly Moldova, Romania and Bulgaria – could be in danger.

Unless kept in check by vaccines, measles outbreaks typically recur every three years, he added. With the last outbreak ending in 2019, this could be the year the disease returns.

UNICEF will address that risk by offering measles and polio vaccinations to Ukrainian refugees who request them, Fontana said.

“Without stigmatizing refugees … is it worth catching up with Ukrainians fleeing the fighting? Yes,” he said. “Is the influx of refugees increasing the risk of outbreaks in some of the countries they are fleeing to? Yes, marginally.”

However, there is a glimmer of hope that Ukrainian resistance to vaccination will ease as European governments open their doors to refugees.

The resistance to vaccination in Ukraine is deeply rooted in an “epic distrust” of the government in Kyiv, said anthropologist Kristen Ghodsee of the University of Pennsylvania. Years of corruption and mismanagement have had such a corrosive effect that only 14% of Ukrainians surveyed in December 2020 said they had confidence in their government.

“To get vaccinated you need trust,” she said. “You have to believe that the medical establishment … actually cares about you and will care about you.”

The benevolent reception Ukrainians are receiving from neighboring countries may inspire the confidence they have withheld from their own government.

“If they’re in a refugee camp, it’s a terrible public health risk and people will be worried about their children,” Ghodsee said. “Given that the European Union has bent over backwards to take care of them, I suspect many Ukrainians will eventually, perhaps reluctantly, say yes” to vaccines. Russia anti-vax campaign in Ukraine could cause COVID crisis for Europe

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