The tangle of humanitarian consequences triggered by the war in Ukraine includes numerous impacts on the health sector – destroyed hospitals, hundreds of dead and injured, and precarious living conditions. The situation worsens if we take into account the fact that the coronavirus pandemic is not over, and the Eastern European country was one of the worst walking in the fight against Covid in all of Europe.
The war, of course, caused national health authorities to stop reporting health crisis figures. At least since February 25 – the day after the invasion of the country by Russia – there has been no more up-to-date data on the disease, confirms to sheet Oxford University’s Our World in Data platform, a world reference in collecting global data on the disease.
When the war broke out, Ukraine was experiencing the fifth wave of the pandemic, even though the average of cases and deaths began to fall. With a history of vaccine hesitancy, little access to immunizers and wide geopolitical dispute over the vaccine, it was one of the least vaccinated European countries: only 35% of the 44 million inhabitants had completed the first vaccination schedule.
Now, the country is experiencing two overlapping health crises, says Eliseu Alves Waldman, an epidemiologist and professor at USP. “On the one hand, the health infrastructure was shaken, a good part of the human resources became refugees and there are also mental health issues”, she explains. “On the other hand, there is a process of intense population movement, with precarious housing and no ventilation, environments favorable to the transmission of respiratory diseases. [como a Covid].”
The Ukrainian vaccination campaign started late – in the last week of February last year, almost two months after the official start of immunization in the European Union (EU) countries, a bloc that Kiev aims to integrate. The country was getting ready to authorize the vaccination of children aged 5 to 11 when the invasion came. In a belated attempt to boost rates, Volodymyr Zelensky’s government even rewarded those who chose to receive the vaccine.
Through the ePidtrymk program (epidemiological support), vaccinated persons over 14 years of age were entitled to 1,000 hryvnias (R$166), an amount that could be used to purchase books, movie and theater tickets, public transport and medication. The rate of vaccinated rose modestly, from 33.1% to 34.6%, one month after the implementation of the strategy, which would last until December this year.
As he does now to bargain for logistical, military and economic aid to confront Russian troops on his territory, Zelensky has repeatedly asked for European support to ensure access to vaccines — and has been frustrated on many occasions. The country entered into partnerships with Chinese pharmaceutical companies and also received doses through the Covax mechanism, led by the WHO (World Health Organization), but always in insufficient volume for vaccine coverage.
With tens of thousands of troops stationed on the border at that point, Russia has also entered the vaccine field. When Zelensky was struggling to get immunizations, pro-Moscow deputy and oligarch Viktor Medvedchuk, a longtime friend of Vladimir Putin, visited the Russian leader and wove a technology transfer deal for the Russian Sputnik vaccine to a Ukrainian drugmaker based in Kharkiv, today bombed by Russian troops.
Kiev then issued a decree that banned the registration of vaccines produced in Russia. Authorities in the country, including the president, said it was a hybrid weapon of Russia against Ukraine, to harm and demoralize the local government. Moscow, through aligned TV channels, retorted that Zelensky allowed Ukrainians to die for an insistent refusal to use enemy medicine.
The precarious scenario of combating Covid has meant that much of the population is not minimally protected against the serious conditions of the disease. And the wave of refugees from the conflict — 2.1 million, according to the most recent data from the United Nations — migrate mainly to neighboring countries that are not exemplary in the immunization issue.
Poland, where 1.3 million refugees have already gone, has 58.8% vaccinated. Hungary, destination of 203 thousand, vaccinated 64%. Russia, where 100,000 migrated, does not reach 50%. Already Moldova, destination of 82 thousand, has shy 26% with the first complete vaccination schedule.
This scenario adds another layer of concern to the health care that must be offered to refugees. Henry Rodriguez, head of the Doctors Without Borders (MSF) project in Roraima, targeting Venezuelan refugees, says governments will have to organize extensive triage systems, prioritizing pregnant women, children and those with chronic illnesses.
He, who has also worked on other missions with immigrants around the world, adds that the work of international organizations, such as the MSF itself or the Red Cross, will be essential to decongest local health systems, which tend to become overwhelmed again.
Waldman, from USP, says that it will be necessary to prioritize maternal and child health — women and children, after all, are the majority of refugees from this conflict. And he highlights the importance of monitoring the vaccination status of those arriving to prevent not only new outbreaks of Covid, but also other communicable diseases.
