“War is tuberculosis’s best friend. Unfortunately, this is no different in Ukraine,” says Andriy Klepikov, his tone friendly but sober. A fact that he has to deal with. Klepikov heads the Ukrainian foundation Alliance for Public Health, which, together with partners, supports programs against major infectious diseases, especially HIV and tuberculosis (TB).
TB is a disease that particularly thrives during war. Their risk factors include cramped conditions in barely ventilated rooms, as experienced by many Ukrainians in air raid shelters. A poor nutritional state that is not uncommon in war. And the cold that comes into the apartments in the Ukrainian winters when the power goes out again because the infrastructure was bombed.
This increases the risk of infections, while the chaos of war makes diagnostics and the months-long drug treatments more difficult. “Patients experience more immediate threats to their lives from war than from tuberculosis. They then forget to take their medication,” says Klepikow.
Many also lose contact with the treatment facilities. Because they are among the 3.5 million people who have had to leave their homes and are on the run in their own country. Or because their treatment center is one of the 1,500 medical facilities that were damaged or completely destroyed in the Russian attacks. Or because there is a lack of personnel and equipment. The list of how war disrupts TB programs is long. Delayed diagnosis and inadequate therapy can in turn increase the risk of infection.
So how is the situation developing? The World Health Organization (WHO) estimates for 2022, the year the war began, suggest that the disease is currently spreading more rapidly. According to statistics, 90 new cases occurred per 100,000 inhabitants. In 2020 it was 73 per 100,000 inhabitants. That was also a lot. In the WHO European region there are only 25 cases per 100,000 inhabitants. About 18,000 Ukrainians received a TB diagnosis in 2022. The WHO estimates that as many more are likely to carry the bacteria around undetected.
“We resist”
Askar Yedilbayev, who is responsible for the disease at WHO Europe, warns that the numbers should be interpreted with caution. The aftermath of the corona pandemic can be felt in the statistics of most member states. At that time, TB programs were interrupted, in some cases fewer cases were recorded, and perhaps fewer occurred because of restricted mobility. This means that many countries are now experiencing an increase in the number of cases.
Nevertheless, according to the WHO expert: “It is likely that the increase in the incidence of tuberculosis in Ukraine is partly due to the effects of war.” His assessment: The war threatens the progress against TB that the country has previously worked hard to achieve.
Andriy Klepikov’s assessment is – and it also sounds friendly and sober: “Tuberculosis is like war. The situation is worrying, but we are resisting.” There is simply no alternative.
For the foundation, this meant adapting its strategies. “We had to become mobile,” says Klepikow. Aid organizations are now driving converted delivery vans to emergency shelters to find infected people and ensure treatment. They work more closely with social institutions, because that’s where people who have lost their homes often go first. And aid organizations are now also providing humanitarian aid.
They distribute food, hygiene products, blankets, flashlights, power banks and set up emergency shelters. They have long been active across borders and support TB patients who have fled abroad. They also stayed in touch with some patients who came to Germany, says Klepikow. The alliance helped translate medical documents and establish contacts between doctors from both countries.
And yet large gaps are noticeable. Due to capacity reasons, emergency shelters can often only offer a bed for a few weeks, it is said in an Allianz publication. Mobile clinics cannot reach everyone. A doctor was there only once in seven months, a villager from the Kharkiv region complained in the publication. “Medicines are the big problem. People have nowhere to turn.”
In Germany, fewer cases were seen than feared
They are already working so much harder than ever before, says Klepikow. How do you endure that? “It’s difficult,” replies the Ukrainian: “I think each of us comes to the point where we need mental support.” Klepikov chooses his words carefully. He knows that he has to continue to appeal for help from abroad. But also the idea that the Ukrainians are spreading TB to the rest of the continent on a large scale is not helpful.
In fact, this fear does not seem to be confirmed, at least in Germany. After a study in the journal Eurosurveillance Around 4,000 TB cases were registered across Germany in 2022. 262 of those affected came from Ukraine. This is less than expected; Initial estimates were based on 450 new cases for the year, write the authors from the Robert Koch Institute (RKI). It is possible that some cases were overlooked, the article says. But perhaps those who go on the run are also above average in health.
The According to the latest data from the RKI New TB cases in Germany rose from around 3,900 in 2021 to almost 4,500 last year. The incidence recently rose slightly to 5.3 per 100,000 inhabitants. This increase could be partly explained by effects of the pandemic, it said.
All in all, the situation doesn’t seem too dramatic at the moment. This impression is also shared by Dumitru Laticevschi, regional manager for Eastern Europe at the Global Fund to Fight AIDS, Tuberculosis and Malaria. He is currently confident that the situation is currently under control. According to Laticevschi, the complete picture also includes: Without the perseverance of people like Andrij Klepikov, tuberculosis would be “a ticking time bomb.”