Health

Measles resurgence haunts Ukraine campaign

KIEV — Ukraine has a measles problem — and its blaming the West.

The country recorded 54,000 measles infections in 2018, accounting for 65 percent of all European cases that year. While the country battled the outbreak, the minister in charge — tasked with carrying out Western-backed health care reforms — ended up in court.

Ostensibly, the charges against Acting Health Minister Ulana Suprun were unrelated to the measles crisis: She was accused of holding office illegally, as she has both U.S. and Ukrainian passports and has not been voted in by parliament, despite filling the post since 2016. Ukrainian law does not recognise dual citizenship.

Yet with Ukraines presidential election campaign in full swing ahead of Sundays ballot and incumbent Petro Poroshenko running for a second term, the governments pursuit of reforms and anti-corruption efforts backed by the West — which include Supruns health care overhaul — have become key campaign issues.

The court case against Suprun was part of “an overall [attempt] to destabilize and shake things,” said Viktoriia Tymoshevska, public health program director for the International Renaissance Foundation (IRF), a Ukrainian NGO advocating for health care reform. She said it was designed as a signal, “like, Everything is falling apart, this ruling group is losing it, everything is going in the wrong direction.”

A nurse prepares a measles vaccine to a boy in the school of Lapaivka village near the western Ukrainian city of Lviv on February 21, 2019 | Yuri Dyachyshyn/AFP via Getty Images

Suprun took over as acting health minister in 2016 as the country, under the watch of Poroshenkos pro-Western government, was trying to quash the re-emergence of highly contagious diseases such as tuberculosis and measles.

The ongoing medical reforms initiated by Suprun, which affect everything from how medications and vaccines are procured to where patients register for services, are supported by the European Union and the International Monetary Fund.

But they are hugely controversial in Ukraine. Suprun, a medical doctor born in the U.S., has been dubbed “Doctor Death” and been accused of committing “genocide” of Ukrainians with her attempts to shake up the health care system — and the measles outbreak has fanned the flames.

Supporters say the reforms are saving millions of euros by stopping corruption. Theoretically free of charge, the health system has been financed for years by bribes paid at every level, from patients to get surgery to surgeons to get access to operating theaters. Now procurement occurs through international agents in order to stop such illicit enrichment schemes, and medical institutions are funded based on patient numbers rather than available beds.

Suprun topped a recent poll of most hated politicians in Ukraine and has never been voted in by parliament.

That, however, means local hospitals and laboratories are closing — prompting accusations that the country now lacks an effective system to contain infections like measles. “Its a catastrophe; in my opinion we cant localize the outbreaks,” said Olga Golubovska, a head doctor at the infectious diseases department of Kievs Bogomolets National Medical University.

Such fears are compounded by wider uncertainty about the direction Ukraine is taking, five years after it threw out its pro-Russian government and turned toward Europe. Ukrainians are deeply unsatisfied with Poroshenko; in polls, he is trailing behind a comedian with a vague platform and no political experience.

The IRFs Tymoshevska said that opposition to the health reform is fueled by “general resistance to the unpredictability, and the fear that its only going to make it worse.”

Suprun is the only minister still in place from a raft of foreign-born “reformers” brought in after 2014s revolution to modernize institutions and tackle corruption. She topped a recent poll of most hated politicians in Ukraine and has never been voted in by parliament, leading her to be suspended by court order in February.

An artist puts the final touches on a depiction of Ukrainian President Petro Poroshenko in Kiev on 28 March 2019 | Sergey Dolzhenko via EPA/EFE

The court case was brought by Ihor Mosiychuk, an MP from the Radical Party whose leader Oleh Lyashko is running for president. In a Facebook post, Mosiychuk called for a new health minister who “can offer an adequate health care program that will be supported by parliament. Its time to end the chaos and anarchy which has led to Ukrainians mass suffering and death.” (Supruns health care reforms were approved by parliament — with numerous amendments — in late 2017.)

Suprun was reinstated in mid-February after Poroshenko publicly backed her.

But the attacks are likely to continue: Another leading presidential candidate, left-leaning Yulia Tymoshenko, claimed at a campaign rally that Suprun was sent by “foreigners” to “experiment on Ukrainians.”

Deaths, bots and trolls

The countrys vaccine coverage has been falling since the 2000s due to a combination of patient distrust and health system shortcomings. After the much-publicized death of a vaccinated teenager in 2008, outreach programs for children were discontinued.

Measles outbreaks can be prevented if 95 percent of people are vaccinated, creating herd immunity. Many countries are considered measles-free. Yet measles cases in Europe tripled from 2017 to 2018 as the disease reemerged worldwide.

“People dont believe vaccines are proper quality, or are administered properly” — Olga Golubovska, infectious diseases doctor at the Bogomolets National Medical University

With the World Health Organization declaring vaccine hesitancy among the top ten global health threats in 2019, Ukraines problems are not unique, but they are severe. After state vaccine procurement failed in 2012-14, delivery through international agencies was not approved until 2016. By then, the national coverage rate for the measles, mumps and rubella (MMR) shot stood at just 45 percent; rates for other vaccinations such as polio and diphtheria also dipped drastically.

Some doctors say they are disillusioned with the government reforms and the focus on corruption, even as they admit patients are losing faith in medical professionals, contributing to vaccine hesitancy and disease spread.

“The worst thing thats happening now is an attack on all professionals, who are a priori labeled as corrupt,” said Golubovska. “Trust in our institutions is not high enough. People dont believe vaccines are proper quality, or are administered properly.”

In comments to POLITICO, Suprun blamed “Russia, in one word” for vaccine hesitancy. SRead More – Source

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