How war impacts the spread of infections

Two weeks into the war in Ukraine, we've seen heart rending footage of people fleeing the Russian attack with what little they can carry. Quite rightly, the reporting has focused heavily on what's happening to people and where they are going. But one issue that's not received much media attention is the question of infectious dieases. Conflicts always breed outbreaks, and packing people together in evacuation, refuge or shelter settings is the perfect opportunity for diseases to spread. Although it's fallen off the front page, Covid-19 has not gone away and rates of vaccination uptake are low in eastern Europe. The region is also a hotspot for drug resistant TB. Chris Smith spoke with Kate White, who's the head of the emergency unit at Médecins Sans Frontières...

Kate - In Ukraine, prior to this conflict, there were quite low vaccination coverage rates in terms of routine immunisation, and also in relation to COVID-19, which means that this population has a higher risk of contracting some of those diseases.

Chris - Do you know what the vaccination rate was for COVID?

Kate - It was roughly around 35% of the population. That's extremely low.

Chris - That means then that if we've got lots of people being corralled together in packed railway carriages, in underground shelters, and then in refugee centers, that there is the potential brewing for a big outbreak here.

Kate - Yeah, there is. But it is extremely difficult for people to deal with that in those really tight closed settings. They don't have the opportunity to take the measures that everybody talks about in relation to COVID. In many places, people are struggling to meet their day to day needs, let alone be able to reinforce those measures as well.

Chris - What measures are being put in place then? Or have people not realised they need to grasp this net and they need to do it quickly to make sure that we don't let these diseases, including COVID, escape?

Kate - It's more a case of the system has just been so incredibly overwhelmed right now. For example, in Poland, there is approximately 140,000 to 150,000 people crossing the border every day. That is 3x more than the peak that they experience in summertime holidays. If you can imagine just every day that shear stress on the system, it's not had time to put in place anything that's going to help prevent some of this. And then from an individual perspective, when you've had to leave your home and flee extremely fast with what little possessions you can, prevention of illnesses like COVID falls way, way, way down on your priority list. Trying to get a system in place that can encourage people to put that somewhere on their priority list and make sure that we're able to have that prevention for transmission is really important, but it's going to take a little while to be able put that in place.

Chris - One of the other big issues is that, previously, the World Health Organisation has earmarked Ukraine and the environs of Ukraine in Europe as one of the hotspots in the European region for TB. That spreads the same way; packed surroundings, lots of people in close proximity under extreme stress. That's a longer term challenge that we need to worry about as well.

Kate - There's two elements to that. I will start with the somewhat easier one, which is for those people who were already on treatment. In terms of Ukraine, one of the factors around TB was that there were many cases of drug-resistant TB. The regimen that people were previously on is really important to maintain. The good part about being on TB drugs is that even though you might not have finished your course and be cured, once you have been on the drugs for a certain period of time, about a week, you actually very significantly drop the ability to transmit TB to other people. Making sure that that group of people still has access to the specific drugs that they were on is really, really important.

Chris - Is someone worrying about that? Is that actually a priority? I haven't seen that documented in any newspaper, in any medical paper, any medical writings, someone saying, 'look, we've got a part of the world where there's a really high TB rate with drug resistant forms of this disease. There's going to be a lot of people who can't access their normal medicine. We need to sort that out.'

Kate - I think in terms of what's publicly out there, it's probably not a conversation that you see a lot; mostly because it's not the sexy news or the sexy response to this crisis. But amongst the health community that is engaged in this response, it is very much a conversation that is happening. They're just not getting the media coverage because most people are not interested.

Chris - Luckily we are.

Kate - The second element is obviously for those who have not yet received a diagnosis. For them what's really important is that we have good routine screening of people.