COVID-19 vaccination in Ukraine.

Widespread vaccine hesitancy in Ukraine threatens the success of the country's COVID-19 vaccination programme. Edward Holt reports.

Ukraine has finally started its COVID-19 vaccination programme—months after other European countries—following what critics claim have been delays due to political infighting and allegations of corruption. But even as it begins, the government has admitted the country is facing a potentially serious obstacle to the programme's success: widespread vaccine hesitancy among both the general population and health-care workers. Speaking at a public event in Kiev at the start of February, President Volodymyr Zelensky said: “Having solved the issue of vaccine supplies, we face a new problem—mistrust of vaccinations and the refusal of a significant part of the population to get the [COVID-19] vaccine.”

Surveys from before the SARS-CoV-2 pandemic, during which more than 25 000 people in Ukraine have died from COVID-19, highlighted the depths of vaccine scepticism in the country. A Wellcome Trust survey in 2019 showed that only 29% of Ukrainians thought vaccines were safe, while 50% thought they were effective. “There is a long history of vaccine hesitancy in Ukraine”, Lotta Sylwander, Ukraine representative for UNICEF, which is helping manage vaccine deliveries to Ukraine, told The Lancet Infectious Diseases: “Some of it dates back to Soviet times when vaccine administration was not good, some of it is because of general mistrust of the health system, and some is down to a specific incident that left its mark on society.” That incident was a high-profile case in 2008, when a boy died following a measles and rubella vaccination. His death was unrelated to vaccination, but incorrect media reporting of the case, and a government response which many saw as confused, created a deep-seated mistrust of vaccinations among the public that continues today. Data from UNICEF showed that in the 5 years following the death, child vaccination coverage fell from around 80% to 50%. Vaccine hesitancy was identified as driving a huge measles outbreak in the country, which between 2017 and 2019 saw more than 100 000 infections and over 40 deaths. Surveys suggest a similar hesitancy towards COVID-19 vaccinations.

In February, Prime Minister Denys Shmyhal said only 50% of the population was willing to get vaccinated against COVID-19. A study by the EU-funded RECOVER research project released in the same month put this statistic slightly higher at 61%. WHO has said coverage needs to be 65–70% to reach population immunity. Igor Yakusheckin, an economist from Kiev, explained why he thought so many Ukrainians were reluctant to get vaccinated against COVID-19: “The Ukrainian authorities were not transparent about their vaccination policy. They would not say when the vaccinations would begin, then we found out from the media that 80% of available vaccines will be from AstraZeneca and far fewer from Pfizer-BioNTech, and then we discovered that the government is negotiating with Chinese producer Sinovac. People have no idea what vaccine they will be getting. It's all confusing and untransparent, which has made people suspicious and worried for their own safety.” He added: “I'm not going to get vaccinated. I know vaccination is necessary to end the pandemic, but not at any cost.”

There also appears to be widespread vaccine hesitancy among the country's health-care workers. Sylwander said UNICEF had information that up to 40% of Ukrainian health-care workers are vaccine hesitant. Svitlana Guk, head of the Centre for Respiratory Medicine at the Feofania Clinical Hospital in Kiev, told The Lancet Infectious Diseases: “There is quite serious vaccine hesitancy [among health-care workers]. This is due to a lack of reliable information on how vaccines are developed, work, and their production quality, as well as about guarantees that second doses will be administered on time. It is not that doctors see the vaccine itself as something bad, but that there is a lack of professional information [about the vaccines].” She added it was vital that as many people as possible, including health-care workers, get vaccinated to ensure population immunity and reduce the chances of new strains of the virus emerging. It is unclear to what extent this hesitancy could affect the rollout of the vaccine programme, under which health-care workers will be among the first to receive doses. Vaccination will be voluntary, but President Zelensky has said he thinks health-care workers have no right to refuse vaccination.

The Ukrainian Government is working with UNICEF on a public campaign to encourage people to get vaccinated, but even if authorities are able to win over a vaccine-hesitant population, it could be a long time before widespread vaccine coverage is achieved in the country. The government plans to have 50% of the population vaccinated in 2021–22. But a report by The Economist Intelligence Unit (London, UK) suggested it would be 2023 before widespread coverage was reached in the country.