Ukraine’s measles vaccine backlash illustrates the value of vaccine safety
A false attribution of bacterial meningitis to the measles vaccine in Ukraine in 2008 led to more than 130,000 cases of measles, 40 deaths and nearly US$ 140 million in economic damage worldwide. Gavi’s Dr Lee Hampton sets out the lessons we can take from Ukraine’s measles vaccine backlash
- 9 January 2023
- 5 min read
- by Lee Hampton
Our lives are peppered with unfortunate, and sometimes tragic, events. Occasionally, such events strike shortly after someone has received a vaccine – but that doesn't necessarily mean the vaccine caused it. For example, if someone receives a vaccine and is then struck by lightning, it is a tragic coincidence. Given this, it is important to carefully investigate serious medical problems that happen after vaccination before taking action on the assumption that the vaccine caused the problem.
The fallout from how the 2008 death following measles vaccination was handled had a total economic cost of a little over US$ 139 million.
In 2008, a teenager in Ukraine died of bacterial meningitis within a few hours of receiving an Indian-made measles vaccine as part of a mass vaccination campaign. Although there was no evidence that the death was due to the vaccine, the Ukrainian government suspended the vaccination campaign after 400,000 teenagers and young adults had been vaccinated out of the nearly 10 million planned, despite the protests of the World Health Organization.
A drop in public confidence in vaccination followed, resulting in a decrease in vaccination coverage. For example, the proportion of young children receiving a first dose of measles vaccine dropped from more than 90% in 2008–2010, to 40% by 2010.
In addition, the government decided to buy only European-made measles vaccine going forward. Since that vaccine was markedly more expensive and the government did not increase its vaccination budget to fully compensate for with the increased costs, shortages of vaccine persisted for years, contributing to decreases in vaccination coverage. Measles outbreaks followed, the first in 2012 and another in 2018–2019, with the 2018–2019 outbreak also triggering measles outbreaks in at least Israel and the US.
A group of researchers at Johns Hopkins and I recently looked into the health and economic impact of this episode. We found that Ukraine alone suffered more than 130,000 reported cases of measles and at least 40 reported measles deaths between 2009 and 2019. We estimated that the fallout from how the 2008 death following measles vaccination was handled had a total economic cost of a little over US$ 139 million.
Approximately $13 million was related to the costs of Ukraine switching to only buying European vaccines. Another $8 million was due to non-vaccine outbreak response costs in Ukraine and the US, while $37 million was related to the cost of treating measles in Ukraine and other affected countries. Then, $80 million was due to lost productivity, for example, from measles patients and family members caring for them having to deal with the illness instead of doing other things such as working. Ukraine absorbed almost $60 million of these costs while other European countries absorbed approximately $66 million, and the US and Israel collectively absorbed a little over $13 million.
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These measles cases, costs, and deaths were potentially avoidable, particularly since several pieces of information indicated in 2008 that the vaccine had not caused the teenager's tragic death. First, the vaccine used in the campaign had been safely in use worldwide for at least five years. Second, none of the other teenagers and young adults vaccinated in the campaign reported serious problems after vaccination, i.e. there were no other deaths among the 400,000 people vaccinated. Finally, a teenager's death from meningitis could be readily explained regardless of the measles vaccination campaign. Teenagers are unfortunately at relatively high risk for meningitis, particularly from meningococcal bacteria.
While many countries such as the US and UK have been vaccinating teenagers for years to prevent infections from a range of meningococcal strains, such vaccines were not in use in Ukraine in 2008. Since the teenager's death resembled ones that occurred in the absence of vaccination and no other similar illnesses occurred following vaccination in the Ukrainian campaign, as well as the fact that the vaccine used had a long safety record outside of Ukraine, the evidence pointed to the death being a tragic coincidence.
Fortunately, when problems follow vaccination, there are ways to avoid the kind of experience Ukraine had, as illustrated by an episode involving human papillomavirus (HPV) vaccine in Europe. In early 2008, the European Medicines Agency received reports of the sudden and unexpected deaths of two adolescent women following receipt of HPV vaccine, one in Germany and one in Austria. No cause of death was identified in either case.
The European Medicines Agency publicly stated that the vaccine had not been found to have caused the deaths and that the benefits of its use outweighed the risks. The German government publicly affirmed that conclusion, adding that 22 deaths with unidentified causes had occurred among German women aged 15 to 20 years in 2006. In other words, they found there was no increased risk from the vaccine. As a result, Germany and Europeans continued to receive the vaccine, which will prevent many deaths from cervical cancer.
Capable investigations into serious problems following immunisation, sound decision-making, and effective communications are capacities that require training, experience, and resources. My colleagues' and my study on the 2008 episode in Ukraine illustrates that having such capabilities in place are well worth the required effort and resources given the major negative consequences of such capabilities being absent when they are needed.
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