As the war in Ukraine continues, health experts worry the conflict will spark new epidemics of infectious diseases, including Covid-19, and hinder necessary treatments for chronic conditions—potentially leading to a "public health disaster" that will have consequences for years to come.

Ukraine's brewing public health crisis

Currently, health organizations in Ukraine are working to prevent a "public health disaster" as residents lose access to necessary medications and treatments, the New York Times reports.

According to the Times, more than 250,000 Ukrainians have HIV, and a large number have multi-drug-resistant tuberculosis (TB), a form of the disease that cannot be treated by most medications. In addition, vaccination rates for many diseases, including polio, measles, and Covid-19, remain low.

In recent years, health officials have made progress against these infectious diseases, including a 21% drop in new HIV infections and a 36% drop in TB diagnoses. However, the current war has led to diagnosis and treatment delays, particularly as Ukrainians flee the country and health facilities are caught in the crossfire, and officials are worried that these challenges will lead to new epidemics.

"Last year, we were working to differentiate between different TB mutations," said Iana Terleeva, head of tuberculosis programs for Ukraine's Ministry of Health. "Now instead, we are trying to differentiate between aerial shelling, raids and other military hardware."

In addition, people with chronic conditions, such as diabetes and cancer, are unlikely to be able to continue their care. In Ukraine, almost 1,000 health care facilities are close to conflict zones, and of the hospitals that are still operational, many are facing shortages of necessary medical supplies and equipment.

Currently, the World Health Organization and others have deployed medical teams and sent supplies, vaccines, and medications to Ukraine, as well as neighboring countries where more than 3 million refugees have fled—but this aid may not reach areas of active conflict where it is needed most.

"Everything is at very high risk, as it is always in the battlefield," said Michel Kazatchkine, a former United Nations secretary general envoy for Eastern Europe. "We should anticipate major health crises with regard to infectious diseases and chronic diseases across the region that I expect to be severe and durable."

How will the war in Ukraine affect the pandemic?

As millions of Ukrainian refugees enter neighboring countries, and millions more are internally displaced within Ukraine, often in crowded and unsanitary areas, health experts have voiced concerns about increased coronavirus transmission in the region that could potentially lead to new surges.

According to data from Oxford University, only 35% of Ukrainians are fully vaccinated against Covid-19, and just 1% are partially vaccinated. Furthermore, Chris Beyrer, director of the Center for Public Health and Human Rights at the Johns Hopkins Bloomberg School of Public Health, said the vaccines made available in Ukraine may be less effective against the omicron variant, meaning that many vaccinated people will still be at higher risk of infection and severe illness.

"COVID doesn't need crowded refugee camps to thrive," Beyrer said. "Crowded gyms, crowded buses and crowded trains will be enough."

Many countries accepting Ukrainian refugees, including Austria, Germany, the Czech Republic, and Slovakia, are already experiencing surges in new Covid-19 cases, largely driven by the highly transmissible omicron subvariant BA.2, or "stealth omicron." Although many refugees have been settled away from crowded borders, the European Center for Disease Prevention and Control said the growing number of Ukrainians at receiving centers may lead to "a higher risk of communicable disease outbreaks."

To reduce the risk of Covid-19 outbreaks among refugees, the European Center for Disease Prevention and Control has recommended countries offer eligible adults and children Covid-19 vaccines as an initial dose or as a booster, depending on their vaccination status. The agency also suggested that refugees be tested as they arrive, or if testing is not available, to triage and provide appropriate care to those with Covid-like symptoms.

Overall, it is likely too soon to tell how the crisis in Ukraine will impact the trajectory of the pandemic, but health experts continue to keep an eye on the situation.

"It's hard to tell what happens next, but there's probably no positive side you could see," said Paul Spiegal, director of the Center for Humanitarian Health at Johns Hopkins University. (Mandavilli, New York Times, 3/26; Healy/Baumgaertner, Los Angeles Times, 3/26; Stern, The Atlantic, 3/25)