Ukraine: The State of Infectious Disease, Public Health

We see the images every day. There are the bombed and burnt-out buildings, human remains in the streets, people picking up what is left of their belongs in their homes, and refugees fleeing to other countries.

The war in Ukraine is now in its sixth week, and with it, people are dealing with both the acute dangers associated with the war as well as the other long-term health care issues that are now coming into focus. 

“Beyond the direct effects of injuries, deaths, and destruction of health infrastructure, there are wider disruptions of routine care, maternal and child health, complex care for those with cancer or needing kidney dialysis, and unchecked spread of infectious diseases, including COVID-19, tuberculosis, and HIV/AIDS,” a recent JAMA editorial stated about the health situation in Ukraine.

Ukrainians are not only dealing with the dire crisis in their front yards, but they are dealing with the looming public health challenges associated with chronic health conditions, and acute or preventative care needs.

Infectious Diseases

COVID-19. According to One World Data, the current COVID-19 vaccination rate in the Ukraine is 34%. There are millions of Ukrainians who are displaced and are traveling to other parts of their own country and beyond.

The World Health Organization (WHO) has been developing weekly reports assessing the status of what is going on in Ukraine. It its latest report, the WHO offered some insights on the COVID-19 numbers they were able to collect.

“The incidence of COVID-19 continues to decrease, with 18814 new cases and 194 new deaths reported between 24 and 30 March,” the WHO report stated. “However, these numbers should be interpreted carefully, as from 23 February to 30 March, the seven-day average number of polymerase chain reaction tests and antigen-rapid diagnostic tests has dropped significantly, with a 96% (from 42 460 to 1577) and 88% (from 51,484 to 6100) decrease respectively, which suggests underreporting of COVID-19 cases and deaths.”

Although COVID-19 incidence rates are going down, Rachel Silverman, policy fellow at the Center for Global Development, cautions transmission is likely going on, especially as people are fleeing their homes and crowding into shelters.

“At this point there is a lot of infection-acquired immunity, so there is probably not that many people who are completely immunologically-naïve, but that said, Europe is in another surge. I’m sure it is transmitting quite easily in shelters, refuges,” Silverman stated.

Always in these situations, there are people who remain in war zones, and they are usually the sickest or those with the least resources or ability to leave. “In a lot of these places you have a population that is disproportionately elderly, vulnerable in other ways, and they could be particularly vulnerable to COVID-19 if they caught it,” Silverman said.

HIV. The Centers for Disease Control and Prevention (CDC) established a field office in Ukraine in 2010. According to the CDC, the country has been making strides in HIV including: antiretroviral therapy uptake increased by 24% from 2019-2021; more than 6,000 people living with HIV were enrolled in medication-assisted therapy; and more than 4,200 people have started pre-exposure prophylaxis (PrEP) since 2020. THE CDC was working with the country's public health officials on other initiatives and strategies to combat HIV.

Nonetheless, right now for people seeking ART and PrEP, the war has likely caused a disruption in these services.

Tuberculosis. Prior to the war, TB had been an ongoing health issue for the country. It has one of the highest incidence rates in Europe and an estimated 32,000 people develop active TB annually, with approximately 1/3 of all new TB cases being drug resistant.

There have been reports of people are missing their tuberculosis treatments, which could also lead to more multidrug resistant TB.

Although the physiological health challenges are most pressing, Silverman stresses the importance of addressing people’s psychological needs, especially with the mental trauma they are witnessing. “They are going to be in psychological distress, and they are going to need psychological care.”

What is Being Done

Although it remains a dire situation in Ukraine, the WHO and non-governmental organizations has been actively trying to address public health and infectious disease care needs.

In the WHO’s latest report, they covered HIV and TB. According to the organization, they have “developed tools to estimate the need for antiviral treatment and burden of tuberculosis (TB) among refugees from Ukraine to other countries. Both these tools are meant to support resource planning for the refugee-hosting countries. Based on the preliminary estimates, more than 30,000 people living with HIV may need HIV services in refugee-hosting countries,” the WHO report stated.

WHO is also assessing health services in neighboring countries such as Poland and Moldova. 

Contagion spoke to Silverman who offered some historical perspective on the Ukraine’s public health system prior to the war, the greatest infectious disease challenges right now, and what the country could be facing from a public health standpoint in the future.