Recap: The Immunization Context - Natural Social Spaces: How Do We Research Social Media and Development Trends, Dynamics, and Impact? Learning from a Polio and Routine Immunization and Social Media Research Initiative in Ukraine

Recap: The Immunization Context

In June and early July of 2015, Ukraine saw two cases of vaccine-derived poliovirus (VDPV) in Zakarpattia oblast5 in the westernmost region of Ukraine—a region that is closer to seven other European capitals than to its own, Kyiv (Figure 1). This outbreak was in the context of Ukraine having the largest pool of measles and rubella (MR) viruses in circulation in Europe (Martin, February 2009). MR supplementary immunization activity was to start in May 2008, but the bacterial meningitis death of a 17-year-old boy in Donetsk that same month was (misguidedly) blamed on his recent vaccination for MR. The anti-vaccine sentiment that emerged was stoked by sensational stories in the news and social media, leading to a health ministry moratorium on vaccine distribution and the firing of the country's chief sanitary inspector. During this time, there was widespread confusion within the medical community, exacerbated by a lack of information and general mistrust stemming from a concern about the quality of the vaccines and partial belief in and circulation of various ominous stories pertaining to negative side effects of vaccinations. Shortages ensued; at one point in 2015, there had been no vaccines available for over a year, leaving millions vulnerable to vaccine-preventable diseases (Ogden, October 2015). Health professionals grew increasingly nervous as they faced potential criminal prosecution in the case of adverse events following immunization. Furthermore, already-scarce government resources were stretched beyond their limits by payments far higher than was necessary for vaccines due to a corrupt system. Parents lost confidence in the entire system. Not surprisingly, vaccination rates plummeted, from near-full compliance in the early 2000s to below 50% in 2013. Polio vaccines reached only 14% of children under one year of age in the first half of 2014 (Twigg, June 2017).

In response, the United Nations Children's Fund (UNICEF), the World Health Organization (WHO), Rotary International, and other partners, working with allies in the Ministry of Health (MoH), launched a three-round polio vaccination campaign in late 2015 and early 2016 that eventually reached over 80% of Ukraine's children (Twigg, June 2017).

However, on August 26, 2016, a VDPV type 2 event was confirmed in the Odessa region of Southern Ukraine. The source was a healthy three-year-old girl who had been reported as fully vaccinated with two doses of inactivated polio vaccine and three doses of oral polio vaccine. News of this event renewed concerns and underlined how the success achieved during the outbreak response was (and remains) fragile. In December 2016, the MoH reported that 45.5% of children in Ukraine were fully immunized against measles; 29% against hepatitis B; 23% against diphtheria, pertussis, and tetanus; and 60% of children under one year of age against polio. Though there have been improvements over the last few years, it is still a very challenging situation. At the time of this research (2017), Ukraine still had some of the lowest routine immunization rates in the world.

As further background, Ukraine's formal nationwide vaccination rounds were conducted from October 19–November 9, 2015, November 30–December 19, 2015, and January 25–February 26, 2016. The three rounds encountered a number of roadblocks. For example, the government never declared a national public health emergency as required by the Global Polio Eradication Initiative (GPEI)’s standard operating procedures, and initiation of the first round was delayed due, for example, to lack of clear official information and vested political and business interests lobbying against international vaccine procurement. In addition, anti-vaccine rumors continued to circulate in the media, especially social media.

"When UNICEF initiated international procurement [of vaccines] in response to the summer 2015 outbreak, corrupt middlemen reacted in defense of their interests, goading fears about vaccine toxicity and side effects through an increasingly rabid media blitz that went as far as accusing the international development community of intentional harm to Ukrainian children. They tried to counter the threat to their lucrative schemes with waves of misinformation aimed at confusing parents, dividing Ukraine's own institutions of health governance, and keeping the international community at bay." (Twigg, June 2017).

The GPEI stresses that, "due to sub-national immunity gaps in Ukraine, the country is particularly vulnerable to either re-infection or re-emergence of poliovirus."⁶ The priority is to minimize that risk and associated consequences by maintaining high levels of immunity and strong disease surveillance.

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⁵ UNICEF report: Polio Outbreak in Ukraine, 2015-2016 Unique Challenges, Comprehensive Response December 2016 p 9. https://poliok.it/library/Polio%20Outbreak%20Ukraine%20Report%202015-2016
⁶ http://polioeradication.org/where-we-work/ukraine/

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Editor's note: Above is an excerpt of a study made possible by the generous support of the American people through USAID under the terms of the Cooperative Agreement AID-OAA-A-14-00028. The contents are the responsibility of the Maternal and Child Survival Program (MCSP) and do not necessarily reflect the views of USAID or the United States Government. The full table of Contents is here.

The previous section in this paper is Introduction.
The next section in this paper is Recap: The Social Media Context.