Ellyn Ogden in Ukraine. Polio Outbreak in Ukraine Media Briefing

"Ellyn Ogden, USAID coordinator for polio eradication initiative: vaccine is safe, we need to stop arguing and start vaccinating children."

In a press briefing held in Kyiv, Ukraine, on October 9 2015, Coordinator of the United States Agency for International Development (USAID) for polio eradication Ellyn Odgen expressed her deep concern about the state of vaccination coverage in Ukraine, which is one of the worst in the world. Whereas there was 90% coverage a decade ago, the coverage has plummeted to 14% today, and there have been no vaccines available for over a year - leaving millions vulnerable to vaccine-preventable diseases. Ukraine once set an example of putting children first; now, the government is showing a disregard for its obligation to protect children, Ogden claims. The provision of basic health services is a fundamental responsibility of government.

Ogden is on the committee that in 2002 certified Europe as polio free. This group is very concerned about Ukraine's inadequate response to the 2 cases of polio confirmed in the country on August 25 2015. (On September 1 2015, the Ministry of Health (MoH) notified the public about the 2 paralysed children. Ogden says that the committee is very pleased to hear that these children are recovering well, but stresses that this does not mean the problem has gone away. Most children who contract polio live with lifelong disabilities. There is no cure for polio; the only way to prevent it is to conduct large, well-planned campaigns. The virus cirrculates silently; asymptomatic children do not know they are spreading the virus. For this reason, the August 25 cases are tip of iceberg; the risk of outbreak is high.) Ukraine joins Madagascar, Mali, and South Sudan as countries at risk of polio re-emergence.

Specifically, Ogden explains that Ukraine is far behind schedule on the outbreak response. Ukraine, as a signatory to the 1988 World Health Assembly (WHA) resolution to eradicate polio and numerous other international agreements, should be not merely aspiring to European standards but, rather, seizing the opportunity to follow international guidelines. While these guidelines hold that vaccination should have begun within 14 days of the outbreak, 45 days have passed, and not a single child has been vaccinated. These guidelines also call for a presidential declaration of a public health emergency, but there has been none. Similarly, a plan of action has been drafted but has not yet received government endorsement. Identification of an emergency response officer has not begun. There is a lack of support for Ukraine's brave and highly competent frontline workers (FLWs) who are caught in the crossfire, with rumours, myths, and rhetoric undermining confidence in the health care system.

Per Ogden, the government has asked for and received confirmation that the vaccine is safe - there is consensus on its safety. It is time to get on with the job at hand. All parts of the government (not just the MoH) must work together, with decisive action taken at the highest levels. The international community is calling on Ukraine to implement international guidelines. The certification commission warns that Ukraine will have to prove that no virus is circulating; otherwise, the commission will be forced to revoke Ukraine's polio-free status - something that has never been done and that would constitute a "black eye" for the country and an indication that the country cannot provide even a minimum status of immunisation control. Surveillance needs to be doubled to make sure nothing slips through cracks. Travel advisories are in place for people considering traveling to the country; this could have implications for trade and commerce.

While transformational change is difficult, Ogden concludes that it is vital to that active intervention with the involvement of all relevant institutions be undertaken, including the pursuit of all urgent measures to vaccinate children to avoid an epidemic. While one never wishes for a polio outbreak, the upside of the situation is that it has exposed weaknesses in the Ukrainian system that need to be addressed. Now is the time to take hold of the opportunity to build a better health care scenario for Ukraine's future