Ukraine could be a month away from becoming the only country in the world without protection from polio because of delays in licensing a new vaccine, according to the World Health Organisation (WHO).
Health workers in Ukraine, which is currently battling a polio outbreak, will be unable to continue inoculating with an older type of vaccine from April, when batches of the older version must be discontinued and destroyed.
“It’s the only country out of 155 [still using the old vaccine] that hasn’t done that,” said Dennis King, WHO Ukraine’s polio outbreak manager. “The impact is that those unprotected children in Ukraine will allow the virus to continue to circulate. As long as the virus continues here, it’s a risk to Europe, it’s a risk to the neighbours.”
The global polio eradication initiative, led by the WHO, has planned a worldwide switch from trivalent oral polio vaccines to bivalent ones next month. The move is part of an effort to eliminate type 2 vaccine-derived polio now that its wild equivalent has been declared extinct. Trivalent vaccines will be destroyed to prevent any chance of transmission.
Ukraine is the only country still using trivalent vaccines not to have prepared for the switch. North Korea will receive vaccines despite its trade embargo, as will communities in Syria and Yemen. Even violent anti-vaccination campaigns in some countries will not derail the eradication initiative elsewhere, King said.
“In Afghanistan, Pakistan and Nigeria, the targeted assassination of health workers, besides the loss of life, has cost increased security and enormous resources and time – but it’s not going to stop eradication,” he said. “If this outbreak in Ukraine remains unresolved, the threat remains here.”
The French vaccine manufacturer Sanofi Pasteur applied for a licence to supply Ukraine with the new vaccine on 4 February but Joel Calmet, of the company’s communications department, said they had encountered an “extremely powerful” anti-vaccine movement. A healthcare lobby group is spearheading this resistance.
As Sanofi Pasteur’s polio vaccines are pre-qualified by Unicef, the registration process should have been routine, Calmet said. But Ukraine’s licensing officials say they need up to 210 days to decide whether to register the new vaccines.
On Monday ambassadors from France, Canada and the EU expressed concern that “corruption and baseless allegations against vaccines will lead to waste and abuse of donated funding for vaccines and leave children vulnerable”.
Ukraine is grappling with the first polio outbreak in Europe since 2010. Two children were paralysed in September by the debilitating sickness, and the WHO believes hundreds more could be infected.
The two cases were vaccine-derived polio. Children are given a weak oral dose of live polio virus when they are vaccinated, which stimulates the immune system and confers immunity. But the weakened virus replicates in the gut before being excreted. In rare instances, contaminated faeces can infect unvaccinated children.
Ukraine’s health ministry says the anti-vaccination campaign is the main reason Kiev has been unable to license the vaccine. While pledging to do everything in its power to push the registration through, the ministry warned that it faces an uphill struggle.
“We’re dealing not only with an outbreak but all the background speculations and manipulations about the quality of the vaccine, about the need for the vaccine in general, about the need to respond to the outbreak,” said the deputy health minister, Igor Perehinets.
“This is the second time we have an international donation of vaccines and the second time we are dealing with an information manipulation.”
When polio broke out, the influential healthcare lobby group, the Ukrainian council for patient’s rights and safety, denied the outbreak, claiming that an urgent international vaccination campaign was unnecessary.
The group’s president, Viktor Serdyuk, then demanded that 3.7 million Unicef polio vaccines be destroyed or “given to a poorer country” because of a disagreement over how they had been stored.
According to Ukraine’s parliamentary health commissioner, Dr Olha Bohomolets, the conflict over vaccines is only the latest symptom of deep-rooted corruption within the healthcare system.
“There are some specialists working in the ministry of health [responsible for licensing and clinical protocols]. For example, we have chief therapists, ophthalmologists, gynaecologists, psychiatrists,” said Bohomolets. “They are not paid by the ministry but they are making these decisions and they are paid illegally by pharmaceutical companies.”