Kyrgyzstan is witnessing a growing complacency towards measles, with some people believing that the vaccine is more dangerous than the disease itself. This misconception has led to a significant decrease in immunisation coverage in the Central Asian state in recent years, especially among children under 12 months. And this growing number of unvaccinated children is translating into an overall decrease in collective immunity - as well as an increase in measles cases.
In December 2017, Kyrgyzstan’s Ministry of Health reported two measles cases from migrant workers returning to the country from Moscow, where they had contracted the virus. In January 2018, 13 more cases were registered in Bishkek, the capital, and the northern Chui region. The fact that measles - a disease which has a free and effective vaccine - is experiencing such an uptick in Kyrgyzstan hints at the country’s changing attitudes towards immunisation.
Both in Europe and globally in the last few years, measles has been making a comeback. In 2015, Kyrgyzstan saw its largest measles outbreak in recent memory when more than 17,000 people contracted the disease. These mostly younger people between the ages of 10 and 19 had not been vaccinated in connection with their parents’ religious views. In response, the country implemented a nationwide vaccination campaign - with young people in Bishkek and Chui region as the principal target group.
Prior to 2018, this campaign seems to have been effective - the number of registered measles cases dropped dramatically. However, this trend appears to have now been reversed once again.
Approaching the limit
Despite Kyrgyzstan’s relatively high overall immunisation rate, coverage has fallen over the past five years, dropping from 97.4% in 2013 to 95.5% in 2017 as a consequence of more parents refusing to vaccinate their children.
According to the World Health Organisation, the elimination of diseases such as measles requires “sustained immunisation coverage of at least 95% each year”, and Kyrgyzstan is dangerously approaching this bottom line.
The total number of vaccine refusals in Kyrgyzstan has almost doubled in two years, from 4,611 in 2016 to 7,905 in 2017
According to a UNICEF report for 2016-2017, the total number of vaccine refusals in the country has almost doubled in two years, from 4,611 in 2016 to 7,905 in 2017. This reveals a lack of public awareness about the composition of vaccines and the purpose of immunisation, as well as the dissemination of false and unverified data regarding Islam and its attitude to vaccination.
Since 2018, over 100,000 measles cases and 90 measles-related deaths were reported in the WHO’s European region, which covers 53 countries in Europe and Central Asia, including Kyrgyzstan. The WHO reports a 300% increase in measles cases “in the first three months of 2019, compared to the same period in 2018” across the world. Further, many countries are “in the midst of sizeable measles outbreaks”, including Kyrgyzstan and Kazakhstan.
According to the WHO, between 2000 and 2016 period, the measles vaccine prevented an estimated 20.4 million deaths.
Why the decreasing coverage?
Gulnara Jumagulova, deputy director of Kyrgyzstan’s Republican Centre for Immunoprophylaxis at the Ministry of Health, told openDemocracy that there were more than 1,000 new cases of measles registered in the country in 2018, 80% of which were children under five. Not only was this the highest number of new cases among Central Asian states, but it is due to rise: 1,900 more cases were recorded in the first quarter of 2019.
“Measles outbreaks occur when the unvaccinated population group increases, so collective immunity against this infection decreases,” explains Jumagulova. “The reason for this is the high number of refusals of preventive vaccinations, as well as the high level of internal and external migration.”
The Republican Centre for Immunoprophylaxis has identified other reasons contributing to the decrease in coverage for measles and other vaccines. These include a lack of access to healthcare in Kyrgyzstan’s remote areas, as well as low levels of awareness among Kyrgyz society - especially among people who have migrated inside the country - about the need to vaccinate children.
However, according to the centre, the main reason for refusal is connected to unsubstantiated beliefs about “non-halal” vaccines containing pig blood, as well as a widespread misbelief that Islam prohibits Muslims from vaccinating. Between 2017 and 2018, the number of vaccine refusals in Kyrgyzstan due to purportedly religious views increased from 68.3% to 83.3%.
This is why, according to Jumagulova, Kyrgyzstan’s Ministry of Health is now planning a campaign to combat misconceptions among the country’s Muslims on vaccine safety and Islam’s position on vaccination. It’s going ahead with this in collaboration with the country’s State Commission for Religious Affairs and Muslim Spiritual Board. The former is the main state body in charge of forming, implementing, and coordinating policy in the field of religion, while the latter is a quasi-government agency that regulates Muslim affairs in the country.
In 2014, WHO European Region Member States adopted the European Vaccine Action Plan 2015-2020 (EVAP), which includes immunisation goals for the region such as sustaining polio free status, eliminating measles and rubella, and meeting regional vaccination coverage targets.
In order to achieve national, regional and global targets for immunisation, Kyrgyzstan has to fulfil its commitments within this action plan. The Ministry of Health is currently preparing draft legislation on compulsory vaccination.
As Jumagulova explains, “this bill is at the stage of public discussion, and is necessary primarily for public safety and protection against dangerous infectious diseases, for which there are safe and effective vaccines.”
With vaccination coverage for the disease in Kyrgyzstan fast approaching the WHO-mandated 95% limit, the recent uptick in measles cases - in particular, the 2015 boom and the increase since 2018 - indicates that vaccine refusals may reduce collective immunity in the short and medium term.