Short Wave - War In Ukraine Sets Back Tuberculosis Treatment

Episode Date: April 8, 2022

According to the World Health Organization, Ukraine has the fourth highest incidence of tuberculosis in Europe — and one of the highest rates of multidrug resistant TB anywhere in the world. The country had been making progress but then came the pandemic, and now the war. Reporter Ari Daniel says doctors worry about increased spread of this contagious and deadly disease. See pcm.adswizz.com for information about our collection and use of personal data for sponsorship and to manage your podcast sponsorship preferences.NPR Privacy Policy

You're listening to Shortwave from NPR. Hey, shortwavers, Aaron Scott here. And today we've got Science Desk reporter Ari Daniel with us. Hello, Ari. Hey, Aaron. So you've been reporting on Ukraine, and in particular, how progress made from decades of fighting tuberculosis may be erased in a matter of weeks. Yeah. And just as a reminder, TB is a bacterium that mostly affects the lungs.

it was the most deadly infectious disease in the world until COVID. Exactly. And in my reporting, I found that there are all sorts of ways that the war in Ukraine is impacting public health. I've been talking with medical professionals there, including Olga Konstantinovska. She's a doctor who'd been living in Kharkiv in northeastern Ukraine. She worked at a couple different tuberculosis hospitals. And she said to me that before the war, people from all around, Harkiv, some two and a half million citizens, would go to a dispensary to be screened for the disease. She actually evacuated with her daughters several weeks back. Now, she tells me,

the doctors are having a hard time getting to the hospital in Harkiv. It's too dangerous to move about outside. Public transit is shuttered and the roads are ravaged, in her words, destroyed. One of the physicians, she knows, walks a total of three hours each day to get two and from work. The head of a local dispensary is living in her office because her apartment was destroyed. Well, today on the show, how the war in Ukraine is inhibiting the ability to fight tuberculosis. With the country's weakened infrastructure and a population on the move, many public health professionals fear TB and its multi-drug resistant form will spread within the country and beyond. You're listening to Shortwave, the Daily Science podcast from MPR.

So, Ari, we're going to be talking about how the war in Ukraine looks like it's going to affect the fight against TB. But tuberculosis is by no means a recent phenomenon in Ukraine, right? You're right, Aaron. For a lot of the 20th century, Ukraine was a republic of the former Soviet Union. And tuberculosis was actually managed rather well. But when the Soviet Union collapsed, the economies of its republics tanked. unemployment soared, crime escalated, and a lot of people went to prison. And I am guessing since TB spreads through the air that the close quarters that you find in jails and prisons probably made them easy breeding grounds.

Exactly. Then after folks served time, they would go back to their communities and introduce tuberculosis to their friends and families and neighbors and the rates skyrocketed. Wow. But between 2010 and 2020, Ukraine built back its infrastructure for treating TB. Rates for the disease were on the decline. Great. And then COVID hit. And in 2020, the percent of infected people receiving treatment fell dramatically. And now in many parts of the country, the war is only making things worse.

Right. And that treatment is a big deal that is now missing for people because taking antibiotics, it can take anywhere from six months to two years. years to treat TB. Right. And that's because tuberculosis bacteria divides slowly, so the treatment takes a long time. And interruptions can lead to drug resistance where the TB bacteria don't even respond to the drugs. In 2020, a third of Ukraine's new TB cases were drug-resistant, one of the highest rates in the world. And that number is likely to grow. All right, Ari. Let's listen to your story. And we begin with Dr. Konstantinovska, who you mentioned earlier.

In northeastern Ukraine, an extended family of eight is crammed into a living room where a few girls are playing the game Uno. The mother, Olga Konstantinovska, recorded this scene for me on her phone. She and her three daughters fled here to her father's place a few weeks ago once bombs began falling close to her home in Kharkiv. of houses will destroy it totally. So it's very high risk. Constantinovska also had to leave her practice as a tuberculosis doctor. TB, a bacterial infection of the lungs, is a problem in Ukraine. The country ranks among those with the greatest incidence of the disease in Europe,

and one of the highest rates of multi-drug-resistant TB anywhere in the world. Constantinovska used to work exclusively with these patients, but the war has upended that. In our region, the laboratory is working, but every hour we have attacks, we have bombs. For patients, it's impossible to come to hospital, to be inspected for TB. It became impossible for Konstantinovska as well, back in Kharkiv. Now, from her father's home, some 20 miles away, she remains in touch with her colleagues. I called to the hospital to speak with one doctor, and she said that hospital even has no potato and bread. We have drugs, but we have no food.

She's also on her phone trying to reach patients who haven't shown up for their treatments due to the war. We have 20 patients we can't find, so we don't know if they are alive or not. She worries about this kind of displacement since they're taking their TB with them, giving the disease more opportunities to spread. 11 patients right now are in other regions of Ukraine. They are trying to find the drugs because they stopped the treatment two weeks ago. Stopping treatment is worrying. It gives the bacteria an opportunity to evolve ways to outmaneuver the drugs,

which can lead to multi-drug-resistant TB. And once resistance emerges, Konstantinovska says it can pass from person to person, which is exactly what she and a small army of others in Ukraine have been fighting against for years. We're trying to fight TB with all our best knowledge and all the techniques. And it was working. TB rates fell by 48% over a decade. But then came the pandemic. Lockdowns early on shuttered hospitals to routine screening. Without proper treatment.

People are coming to hospital in very bad conditions. And dying more often from the day. disease. Now, the war is creating even more chaos. Salman Kashavji directs the Center for Global Health Delivery at Harvard Medical School. In these moments of deprivation as a result of war, as a result of being refugees, as a result of being crowded in, not having enough food, etc., your TB rates go up. One reason is interruptions in treatment cause people to become contagious again, and TB disproportionately affects people at the margins of society within Ukraine and be including Russia, where TB and drug-resistant TB have also been big problems.

Russia's under sanction. As funds and things get diverted to other efforts, you will see that the drug supply is going to drop. I've spent many years working with prison and other populations in Russia. I have grave concerns that many of them are going to be dying. Doctors have known how to defeat tuberculosis since the 1940s, and yet worldwide, according to the World Health Organization, more than 4,000 people will die from it today and tomorrow and the next day. Unless we are able to fight TB everywhere, this transmission will continue. Lucchika Dittu is executive director of the UN's Stop TB Partnership. She spoke with me from the airport in Bucharest, Romania.

Unfortunately, TB affects people in the lower income countries, and that's why we don't have the visibility, the traction and the resources that, for example, were mobilized for COVID. Within Ukraine, the longer the war lasts, the more cases will go undetected and the more treatments will lapse. Some TB experts told me they're angry that years of progress fighting the disease may be evaporating before their eyes. Thank you, Ari, for bringing this to us. And understand you have a follow-up story in the works. Indeed, Aaron, it's about an attack on a Ukrainian hospital in the city of Chernegev, and we tell it through the voices of three medical professionals who were on the ground. We will look forward to listening to that.

This story was edited for radio by Rebecca Davis and for shortwave by Giselle Grayson. The original broadcast was produced by Claudette Lindsay Haberman and Jonaki Meta. It was produced for shortwave by Rebecca Ramirez. Our audio engineer was Josh Newell. Andrea Kisick is the head of the science desk. Edith Chapin and Terran Aaron Samuel are the executive editors and vice presidents of news, and Nancy Barnes is our senior vice president of news. I'm Aaron Scott. And I'm Ari Daniel. Thank you so much for listening to Shortwave, The Daily Science Podcast from NPR.