Ukraine: Immediate steps needed to prevent a measles outbreak due to the ongoing war and low vaccination rates, warns WHO

According to the latest data available, 85% of eligible children in Ukraine received their first dose of measles vaccine in 2020. While this was a significant improvement compared to the low of 42% in 2016 and a major achievement for the country, WHO recommends vaccine coverage of 95% or higher each year to achieve and maintain herd immunity and protect the population. With the ongoing war leading to severe disruptions to the Ukrainian health system including routine immunizations, WHO is seriously concerned about a potential measles outbreak, which could have devastating health consequences.

There are immunization gaps among children, adolescents and adults in Ukraine. These gaps led to measles outbreaks in 2012 and then again from mid-2017 to the end of 2019, when Ukraine had the second largest measles outbreak reported globally. Thanks to the efforts of the health authorities, an aggressive immunization response helped to control the outbreak in 2019 and bring infection rates down, but overall population immunity remains low.

“Vaccination drives among school-age children initiated with WHO support to the Ministry of Health in 2019 were interrupted by the COVID-19 pandemic,” said Dr Jarno Habicht, WHO Representative and Head of the WHO Country Office in Ukraine. “Now the ongoing war is greatly increasing the risk of a measles outbreak, with so many families displaced and staying in crowded, temporary accommodation, and many others unable to access health-care services.”

“Despite the many challenges of the war, WHO is working closely with the Ministry of Health to provide COVID-19 vaccination as well as routine vaccinations of children for a range of vaccine-preventable diseases, including measles, rubella, diphtheria and polio,” continued Dr Habicht. “To protect children and prevent disease outbreaks, it is critical that every child who missed a scheduled vaccination is provided with easy access to catch up on needed doses. All possible efforts must be made to avoid a measles outbreak taking place amid the ongoing war. That’s why WHO is supporting the Ministry of Health to offer measles vaccines to internally displaced children, as part of European Immunization Week, in 10 oblasts across Ukraine.”

WHO is also concerned about and is closely monitoring an outbreak of vaccine-derived poliovirus type 2 in Ukraine. To date, two children with acute flaccid paralysis (AFP) have tested positive for polio, and the virus has also been detected in 19 asymptomatic contacts. A nationwide polio vaccination campaign to provide inactivated polio vaccine (IPV) to approximately 140 000 children aged 6 months to 6 years who had not received any previous doses was disrupted just weeks after its launch on 1 February this year. The campaign has since resumed where possible, with just 48% (approximately 69 000) of the targeted children vaccinated as of 24 April.

“Even one child with polio is a threat to every un- or under-vaccinated child in Ukraine. This is a highly infectious disease that can permanently affect or even take a child’s life,” noted Dr Habicht. “There is no cure for polio, only prevention. Vaccination is the only way to protect your child from this debilitating disease. At present, Ukraine has enough stocks of polio vaccine to meet routine immunization needs. The issue is not one of supply but access. Many children are displaced or on the move, the health system is severely disrupted, health facilities and hospitals have come under attack, and we have no way of knowing if polio is spreading among the population in several conflict-affected areas.”

WHO is doing everything possible to support the Ukrainian health authorities to reach high-risk groups, while bringing in additional vaccine supplies as required.

“The humanitarian crisis still unfolding in Ukraine has taken a tragic toll on health and well-being. Health services, already strained by COVID-19, have been stretched beyond capacity. Among the many serious and long-term impacts has been the disruption of immunization in the country,” said Dr Hans Henri P. Kluge, WHO Regional Director for Europe.

“Every day that passes without resumption of disrupted services or catch-up opportunities for displaced children increases the risk of polio circulation, outbreaks of other childhood diseases and further spread of COVID-19. The risk of these outbreaks is a stark reminder of the fragility that lies in our communities when we have un- and under-vaccinated populations,” concluded Dr Kluge.

The progress Ukraine has made over the years in protecting children and adults from life-threatening diseases deserves celebration and must not be taken for granted. Maintaining this progress requires a collective effort, especially now when the ongoing war is making it all the more challenging.