The Cutting Edge

Prime Minister Yuliya Timoshenko of Ukraine

Ukraine continues to be in a panic about a deadly outbreak of influenza still not confirmed as H1N1 swine flu.

The disease contagion may be showing signs of diminishing. But accounts of young and otherwise healthy victims succumbing continue to circulate, contributing to heightened political tensions in a country that will face a general election on January 17, 2010. The virus has become a pivotal issue. Sentiment within the Central European nation increasingly holds that the country’s medical systems and political leaders were slow to react or inadequate in their response to the outbreak. More than 95 victims have died this year.

Signaling the importance given to a show of concern, in the middle of the night on November 3, Prime Minister Yuliya Timoshenko, the Ukrainian foreign minister and the president’s chief of staff gathered at Kiev’s airport to share solemn words about the arrival of a shipment of Tamiflu, a drug effective against swine flu.

Near panic broke out on October 30 as deaths from flu and respiratory infections increased, leading to the announcement of a flu epidemic. Tymoshenko introduced travel restrictions, closed all schools and universities and banned mass gatherings for at least three weeks, and conducted a live TV session on October 31 with her cabinet, health officials and regional officials. Some officials have had to publicly denied rumors that a plague is afoot in the Central European homeland.

Tymoshenko’s opponents attacked her response to the outbreak and questioned the government’s readiness in the face of crisis. Party of Regions leader Victor Yanukovych demanded the head of the health minister and a criminal investigation into allegedly misspent budget funds.

Clearly, the flu--both its financial and health implications--has entered into the political fray as fevers rise. President Victor Yushchenko, for instance, signed a law hiking minimum wages and pensions, flouting demands from the International Monetary Fund. He defended his actions as support for poor people but some see it as a dig at Tymoshenko, who had staked her credibility with the IMF on defeating the budget-busting legislation, as she runs her presidential bid. Tymoshenko has pledged to buy millions of doses of vaccine and anti-flu drugs but pundits wonder from where will she obtain the needed funds from already cash-strapped public treasury. In recent days, she gave assurances that Ukraine’s gas bill with Russia had indeed been paid on time, perhaps placating those worried about a repeat of the January 2009 gas supply reduction by the giant neighbor.

On November 2, Ukraine deputy health minister Vasyl Lazoryshynets said that 67 have died from flu and respiratory problems and asserted that the toll did not vary much from previous years. He did not say at that time when the deaths occurred. Lazoryshynets added that there were 255,000 cases of flu and acute respitory illness in Ukraine’s population of 46 million and that there are 15,000 of these are hospitalized. 

Within 72 hours, the latter number had doubled to 30,000. President Victor Yushchenko called for unity but attacked Tymoshenko for a slow and inadequate response. In his address to the nation on November 4, he said some government officials’ negligence could be criminal. As for Tymoshenko, she said that what Ukrainians should fear is panic itself.

By November 6, more than 100 people had died of flu-related symptoms since late October, 14 from the particularly virulent H1N1 swine flu strain itself, said Health Ministry spokesman Oleskander Vilovol. Close to 34,000 Ukrainians nationwide were hospitalized because of severe flu symptoms, 32 of whom were confirmed cases of swine flu, Vilovol said, noting a moderate slowing of reported cases as compared with last week. However, flu remains a massive health problem, with 762,833 persons registered with the Health Ministry as currently "suffering from the flu," or roughly 1.6 per cent of Ukraine's entire population.

Amidst concerns voiced by neighboring countries such as Poland, the government in Kiev is calling for assistance from the international community to stem the death toll. For its part, Ukraine has ordered that all large public events, such as football matches and political gatherings, be cancelled and has also closed Ukraine’s colleges and universities. The World Health Organization is working on an assumption of 633,000 cases of flu or other respiratory ailments and trying to treat it appropriately. Ukraine had ceased inoculating for swine flu in September following a spate of deaths of children, blamed on the shots.

Several thousand people die from flu-related illnesses each year in Ukraine. While the total number of flu-related and acute respiratory illnesses is on par with previous years, the number of cases registered daily has since mid-October 2009 exceeded the epidemic threshold, leading experts to sound an alarm. For the first nine months of 2009, 3,822 people died from flu and complications. But the spike in deaths in the last month has raised fears that the number of victims during this flu season could grow much higher. Only on October 30, did the Ukrainian government announce the first confirmed death by swine flu.

Deputy Health Minister Bilovol referred to an early report of a flu outbreak being caused by “an unknown respiratory illness” in an October 23 press conference, while played down fears of an epidemic. Even as he spoke, reports were coming in from Ternopil Oblast, a city in the Ukraine, as the government there responded with school closings and other measures.

Bilovol asserted that all the necessary measures, including school closings, were being taken to contain the outbreak and restrict it to Ternopil Oblast. “We expect the start of the flu season in mid or late November," he said, "depending on the weather conditions.” He added that his ministry was ready “to handle any flu epidemic that might arise.” By November 3, Biloyol piqued his countrymen’s fears by saying that fully one quarter of the 45 million Ukrainians may contract the flu by this time next year. He said that Ukraine no needs 12.5 million doses of the swine flu vaccine.

As tensions rose over school closings and cancelled football matches, Prime Minister Tymoshenko gave assurances that the $6 million initially spent earlier in the year on addressing the flu were well spent. Said the Tymoshenko on November 3, “The money was allocated for . . . drugs, laboratories, artificial respirators, test systems . . . everything necessary to get the patient out of the critical condition.” Perhaps embarrassing the premier, the General Prosecutor’s Office opened a criminal investigation into how the funds were allegedly misallocated.

“There are no test systems or antibiotics. Hospitals are not equipped with artificial respirators. All the drugs and equipment are either in transit or storage,” complained Tetyana Bakhteeva, chairwoman of parliament’s health committee. Victor Ovrachuk, deputy head of the Ternopil Oblast administration health directorate (the outbreak first emerged), agreed. “We have not received laboratories, artificial respirators or antibiotics. We have received a two-day supply of the antiviral medication Tamiflu. That’s about it,” said Ovrachuk. A spokesman for Dutch Humanitarian Aid said that the situation at the Lviv Oblast hospitals surveyed by his organization is “appalling,” saying on November 4 that there is a lack of basic medical supplies, barely any flu tests, vaccines or antiviral drugs, such as Tamiflu. “If children get ill, we can’t even establish whether they have the swine flu virus. We just have to go by the symptoms,” said the Dutch spokesman.

Prime Minister Tymshoshenko has appeared wearing the now iconic surgical mask now worn by people in areas all over the world experiencing an uptick in swine flu. Ukrainians are flocking to pharmacies to buy masks and Tamiflu and Relenza – the only antiviral medications known to be effective against the flu. By November 1, most of Kiev’s pharmacies had already sold all their stock of paracetamol (acetaminophen) ibuprofen, and flu-related medications. Vendors at outdoor markets also cashed in on the hysteria, hiking prices for onions, garlic and fresh fruits, as Ukrainians appeared to resort to folk remedies. Surgical masks are also in short supply even while Tymoshenko has given assurances that she can supply 100 million. Unconfirmed news reports flourished on Ukrainian TV that the government was using helicopters to disperse unknown chemical agents to prevent the spread of contagion.

Following pleas from Ukraine’s Health Ministry for aid from the EU, NATO, and the UN, experts from WHO dropped into Kiev to confer with their counterparts. “This is a serious matter,” said Glenn Thomas, WHO media officer. Earlier this year, the WHO provided Ukraine’s health ministry with comprehensive information on prevention and management of the swine flu virus, also donating 61, 000 packs of Tamiflu, 4, 000 flu test-kits and diagnostic equipment. Ihor Pokanevych, head of the WHO office in Kyiv, said on November 5 that health authorities are watching to see if the seasonal strains of the flu and the swine flu will mutate into more virulent form of virus. Ukraine is now a guinea pig in the global fight against the pandemic. “The outbreak in Ukraine may be indicative of how the virus can behave in the northern hemisphere during the winter season, particularly in health care settings typically found in Eastern Europe,” Pokanevych added.

On November 3, Ukraine’s parliament enacted legislation allocating an additional $131 million for flu response measures, in addition to another $12 million for funding other unspecified flu prevention measures. The armed forces and Emergency Ministry are preparing portable military hospitals, and the government has promised to provide all of the country’s regions with enough gauze to sew home-made own face masks. The Kirovohrad region has imposed a quarantine because cases of influenza and other acute respiratory viral infections have almost reached the epidemic threshold, according to the Kirovohrad regional administration website. Kirovohrad Governor Volodymyr Movchan signed the relevant directive on November 4. As of now 6, 914 people have been infected in Kirovohrad region (357 of them have been hospitalized) since October 29, according to the Health Ministry, which imposed quarantine in nine regions on October 30 because of the epidemic. "As the pandemic virus has rapidly become the dominant influenza strain worldwide, it can be assumed that most cases of influenza in Ukraine are caused by the H1N1 virus," the WHO said on November 2.

U.S. citizens now in the Ukraine cannot expect to receive inoculations or other medical assistance at the U.S. Embassy even while the U.S. has come to the assistance of Ukraine in general.  The United States is planning to donate 10 percent of US domestic H1N1 vaccine supply, as it becomes available, to a WHO-led H1N1 vaccine initiative. The U.S. donation to WHO, equivalent to 25 million doses of vaccine, is valued at approximately $10 million. Ukraine is scheduled to receive 930, 000 doses of H1N1 vaccine in early December.

The U.S. is to make available immunization materials such as syringes, needles, and vaccine safety disposal boxes, to provide technical support for immunization planning as well as for logistics and assistance to transport the vaccine, to train vaccinators and other professionals, and to prepare communications materials in support of the immunization campaign. The U.S. is also offering equipment and test supplies to Ukraine in order to bolster its diagnostic capabilities and ability to react to the current situation. For now, the world and the citizens of Ukraine wait and wonder whether the disease will recede or surge.