Ukraine was struggling to control the COVID-19 pandemic even before Russian troops advanced on the country. It was slower to launch its COVID-19 vaccination campaigns than other European countries, and while the government encouraged citizens to get immunized, most people struggled to find a way to get the shot, didn’t feel the need to get vaccinated, or didn’t trust the safety and efficacy of the vaccine.
Just before the invasion on Feb. 24, only 35% of the Ukrainian population had been vaccinated. That puts it in line with most of its neighboring countries, although some, including Poland and Hungary, have achieved higher vaccination coverage. While different health systems and varying attitudes about vaccination in those countries are contributing to those contrasting rates, Ukraine’s relatively low vaccination rate could have implications for how large additional surges of cases, both in the country and in the region become as a result of the war. Like many other countries, Ukraine experienced a surge in cases due to the Omicron variant in November and another peak in the first week of February—most likely due to its low level of vaccination. By the middle of February, 60% of COVID-19 tests conducted in the country were positive.
Such low vaccine coverage isn’t enough to control a highly transmissible virus-like SARS-CoV-2, say public health experts. Add in a war—with the political and social upheaval it causes—and not only are spikes in infections inevitable but there is also the potential for new variants to emerge, which puts the whole world at risk.
Vaccination and mitigation measures such as mask-wearing, social distancing, and basic hygiene are critical for curbing the spread of SARS-CoV-2 but are impossible to maintain when a country is under siege. The humanitarian group Doctors Without Borders has been distributing trauma kits and training health care providers in Mariupol, Ukraine—a target of the Russian attack—as well as providing shelter and basic health needs for those crossing the border into other countries like Poland. But it’s not enough.
“War is an infectious disease’s best friend,” says Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “It challenges every public health program you can possibly have. It limits the medical care available for those who might be seriously ill, and often fosters transmission when so many people are crowded into bomb shelter locations and on trains. This is going to be the perfect storm of one serious challenge after another.”
A decade and a half ago, World Health Organization researchers found that 65% of major infectious disease outbreaks occurring in the 1990s were among refugee populations or in conflict zones. Les Roberts, professor emeritus of Columbia University’s Mailman School of Public Health who has spent time in war zones addressing outbreaks, notes that these populations are especially vulnerable to viral diseases like COVID-19. “It turns out when you are under stress, your immune system does not work as well. You are not eating as well, and you cannot fight disease as well,” he says. “And in times of conflict, you move around a lot, and end up in bomb shelters or basements or on trucks that are way more crowded than normal and have bad air circulation. I don’t think people fully understand how war is like the breeding ground of disease.”
