Judyth Twigg Interview: Technical Roundtable on Immunization and Polio Eradication in Ukraine

This is an interview of Judyth Twigg, one of several conducted as part of the Technical Roundtable on Immunization and Polio Eradication in Ukraine, June 8 2016, Washington, DC, United States (US). Organised by the Washington-based US-Ukraine Foundation with technical and logistical support from The Communication Initiative, the purpose of the meeting was to provide a forum for Ukrainian diaspora experts/professionals to discuss the immunisation challenges facing Ukraine and to amplify their voices and ideas for positive change. A small number of outside technical experts also provided global context and lessons learned from other regions. The principal outcome of the roundtable was a concise statement outlining the issues clearly and offering strategic recommendations for improving the health situation in Ukraine, with a particular emphasis on immunisation, vaccination, and polio. Click here for a summary of, and access to, the statement.

In the interview, Professor Twigg is asked to discuss some of the key findings from her paper "Polio in Ukraine: Crisis, Challenge, and Opportunity" (see Related Summaries, below). Twigg is professor and former interim director at the L. Douglas Wilder School of Government and Public Affairs at Virginia Commonwealth University and is also senior associate (non-resident) with the Russia and Eurasia Program at the Centre for Strategic and International Studies (CSIS). Furthermore, she is senior adviser to the Eurasia Program of the Social Science Research Council and consultant to the World Bank and United States (US) federal government. She has also been an adjunct associate professor at the Center for Eurasian, Russian, and East European Studies at Georgetown University. Her work focuses on issues of health, demographic change, and health systems reform in Russia, as well as evaluations of health reform and communicable disease control projects across the former Soviet Union, sub-Saharan Africa, and other parts of the world. She has testified as an expert witness before the US Congress and has been a mem-ber of several congressional and other U.S. government advisory groups on Russian affairs. Twigg's most recent book is HIV/AIDS in Russia and Eurasia; she is currently working on a project comparing health systems reform in Russia, the Kyrgyz Republic, and Georgia.

Despite the decline of Ukraine's immunisation system (see Context, below), Professor Twigg notes with some optimism that Ukraine comes from the Soviet era legacy, which saw a very high immunisation level. There have also been positive factors such as the talented and dedicated teams - e.g., from Rotary International, the United Nations Children's Fund (UNICEF), and the US Agency for International Development (USAID) - whose integrity and cohesiveness are the building blocks for strong immunisation systems. However, progress is hampered by the "mess" that is the vaccine procurement debacle, representative of corruption that is endemic not just in the health system but throughout Ukraine), as well as vaccine refusal on the part of parents. There is domination in the media (and social media) by those who are profiting by the mess of procurement. There is also toxic information out there - not just in social media but also in the form of inconsistent messaging by health workers - that Twigg says can be traced back to a set of false rumours surrounding a measles outbreak in which a young man was falsely reported to have died due to the vaccine. If even just one source reports such misinformation, the rumors can take off like wildfile. Twigg states that consistent countermessaging is key - most importantly in social media.

The situation in the East is also worrisome. The movement of populations (e.g., there are approximately 2 million internally displaced persons (IDPs) in the country) makes coverage difficult. People are separated from their childhood health records, health workers have been displaced, and Eastern Ukraine, which is under Russian influence, is like a black box when it comes to immmunisation. There is so much we do not know. Even though authorities say the situation is well under control, it is paramount that we keep an eye out. There is, however, no capacity to track.

Twigg states that it would be difficult to imagine a more rapid and efficient on-the-ground response than there was to the 2015 polio outbreak in the Ukraine. Where there is room for improvement is the imposition of high-level political pressure. We need to take advantage of Ukraine's aspiration toward membership in Western institutions. A politician like the well-connected US Vice President Joe Biden would do well to be able to tell us that polio got a mention in one of his meetings (e.g., in December 2015) with Ukraine authorities. While the health of Ukrainian children is itself an end, we can place the situation in context: Ukraine is a gateway (and not just in the literal sense of population flows) in a lot of ways. The places where the polio outbreak took place are closer to many European capitals than they are to Kiev. There are, then, many reasons for imposing political pressure on Ukraine to address its immunisation weaknesses.

• Click here for an overview of the Washington DC Roundtable Discussion on Immunisation for Vaccine-Preventable Disease and Polio in Ukraine.
• Click here for a summary of and access to the Statement on the Roundtable on Immunization for Vaccine-Preventable Disease and Polio in Ukraine.
• Click here for an interview of David Salisbury from the same event.
• Click here for an interview of Patrick M. O'Connor from the same event.
• Click here for an interview of Boris Lushniak from the same event.
• Click here to access a video of an October 9 2015 press briefing on the Ukraine outbreak by Ellyn Ogden, Coordinator of the United States Agency for International Development (USAID) for polio eradication.