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Could Russian Aggression Solve Ukraine’s Vaccine Crisis?

Ever since Edward Jenner’s smallpox vaccine gained traction in the early 19th century, vaccination has formed the bedrock of public health. Vaccination for diseases like diphtheria, measles, and hepatitis B has become commonplace throughout much of the world as a relatively efficient means of reducing child mortality and improving overall wellbeing. With high basic vaccine coverage considered a UN Sustainable Development Goal, governments and NGOs have vigorously worked to improve access to vaccines globally. Ukraine, however, is an exception. While most of the world has expanded vaccine coverage in the last decade, Ukraine’s vaccine coverage for common vaccines like BCG (Bacillus Calmette Guerin) and DTP (diphtheria, tetanus, pertussis) has plummeted to become the lowest in Europe. But with increasing Russian aggression and reactionary NATO interest, Ukraine’s precarious geopolitical situation provides a surprising opportunity to improve the country’s vaccine coverage.

Multiple factors suppress Ukraine’s immunization efforts. With insufficient public health funding, Ukraine lacks medical clinics that could provide healthcare access for many people. But capital cannot entirely explain Ukraine’s vaccination failures, as nations like Zimbabwe and Eritrea are among the world’s best in vaccination rates despite low healthcare funding. While Ukraine is certainly not a wealthy nation, it still underperforms in vaccination coverage compared to nations of similar economic standing. Education, particularly education attainment of women, correlates with vaccination coverage, likely by increasing understanding of vaccination and health information-seeking behavior. But Ukraine, with relatively high education attainment rates among both men and women, still lags behind.

Rather, vaccine hesitancy — not a lack of access or education — more significantly accounts for Ukraine’s poor vaccination rates. Many Ukrainians incorrectly believe that vaccines have dangerous side effects that outweigh their benefits, a notion spread by high profile events such as Andrew Wakefield’s paper claiming that vaccines cause autism. In 2008, Ukrainian media blamed the measles vaccine for the death of a teenager, triggering a precipitous decline in overall vaccination rates within Ukraine, a trend that still persists. Since 2008, vaccine skepticism has pervaded the Ukrainian populace, reducing the willingness of parents to vaccinate their children.

Most importantly, this trend exists not solely among the general population, but among Ukraine’s medical professionals as well. While subject to the wills of their patients to a degree, Ukrainian doctors still largely hold vaccine skeptic views themselves, doubting their safety or efficacy. Various factors could contribute to this view within Ukraine’s medical community. Poor training and a tendency to rely on media for information, rather than scientific publications or other medical professionals, could explain the ill-informed views of many clinicians in Ukraine. Political views could also play a role, with vaccine skepticism a rejection of Soviet-style state control after Ukrainian independence. Ukraine’s economic situation shortly after becoming a sovereign state synergizes with this effect. Corruption and economic contraction persisted throughout the 1990’s, souring the public’s view of the state’s capacity and intentions. With vaccines historically viewed as a method of state control, willingness to vaccinate among both healthcare workers and patients would tend to fall in such a political climate.

The Ukrainian medical community’s resistance to vaccination significantly hinders any campaigns to address vaccine hesitancy domestically. Research into effective vaccination campaign strategies is ongoing, with few conclusions. The importance and effectiveness of primary care physicians, however, is clear. Because of their repeated interface with patients, primary care physicians most significantly impact patients’ decision to vaccinate. Tragically, the vaccine skepticism harbored by many Ukrainian doctors counteracts any larger public health efforts to combat vaccine skepticism.

The Ukrainian government is left with few domestic options to address its vaccination crisis. Circumventing doctors would likely fail due to the ineffectiveness of most outreach campaigns, even if funding for public health increased. Changing the mentality of physicians would require extensive training and money; moreover, distrust of the state mutes any messages from the state’s health officials.

Instead, Ukraine should look to the outside to boost its vaccination coverage. The views of its medical community present the greatest obstacle to improving vaccination; while resolving this problem internally is substantially difficult, turning to international actors could be more productive. Effective science and medicine relies on the communication and exchange of ideas; isolation allows an unsubstantiated belief or unprofessional practice to establish itself within a medical community. In Ukraine’s case, the collapse of the Soviet Union severed direct ties between the Ukrainian medical and scientific community and its counterparts in other Soviet states. With a detachment from broader medical communities, vaccine skepticism could more easily ingrain itself in Ukraine.

As Russia looks to expand influence across Eastern Europe, Ukraine has become a central figure in the foreign policy objectives of NATO nations. While Ukraine has leaned towards NATO for over a decade, recent Russian aggression has further spurred international attention towards the country. As a result, Ukraine now has a long list of potential suitors seeking to strengthen diplomatic relations. While much of this interest will have a military objective, science diplomacy is still an attractive avenue for NATO countries looking to cultivate influence within Ukraine. This provides Ukraine with an opportunity to accelerate ties with the international medical community. Ukraine has made some moves to strengthen bonds with NATO nations, including a training program for military medics. While a primarily military-related partnership, this alliance could also serve as an important first step in further connecting Ukraine’s medical professionals. Ukraine will be able to organize more joint training programs, attract more international research collaborations, or participate more actively in biomedical conferences, for example. With NATO countries likely financing the bulk of expenses, Ukraine should find these opportunities an inexpensive opportunity to expose its doctors to foreign medical professionals.

Such a strategy is not entirely novel. China, for example, suffers from systematic academic fraud within its research institutions. By increasing international research collaborations with other nations, China is exposing scientists to a broader range of research practices, thereby increasing the diffusion of internationally-acceptable research protocols back into China. Many Chinese scientists educated or researching abroad similarly bring professional practices to China if they chose to return, reducing corruption as a result.

The same principle applies to Ukraine, as exposing doctors to foreign counterparts that support vaccination increases the likelihood of pro-vaccination beliefs trickling back into the country. This bypasses the problem of low trust in Ukrainian government, as Ukrainian doctors would be interacting with foreigners. Additionally, Ukraine can pursue more direct aid from interested European nations. Perceived lack of quality in vaccines manufactured in Ukraine or India, where the bulk of Ukraine’s vaccines come from, is a contributing factor in vaccine hesitancy among Ukrainian doctors. Vaccine donations from wealthier European nations seeking diplomatic influence could eliminate this issue.

On the borderland between two major geopolitical forces in Russia and NATO, Ukraine exists in a perilous position. As Ukraine slowly gravitates towards Western Europe for the economic opportunities and potential military protection from Russia, it should not neglect the potential for public health gains in the process. Few domestic policy tools can effectively eliminate or reduce systematic vaccine skepticism, while international integration of medical communities is low-cost, and, in Ukraine’s case, avoids the political pitfalls hindering domestic health reform.

Photo: “Polio Champions”

About the Author

Sean Joyce '19 is the Section Manager for the World Section of the Brown Political Review. Sean can be reached at sean_joyce@brown.edu

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