Ukraine: acceleration of the pandemic

On 26 October, following the decision by a special commission chaired by the prime minister, the Mykolaiv and Rivne oblasts were included in the red epidemic zone. This means that 8 out of Ukraine’s 25 regions are now under lockdown. On the same day, the average daily infection rate exceeded 20,000 and the number of deaths came to 734, the highest daily total since the pandemic began. In an effort to fight COVID-19, as well as to accelerate the vaccination campaign, the government has decided to introduce privileges for those vaccinated, who will be exempt from the restrictions. In addition, mandatory vaccinations for selected job groups have been announced. These actions have sparked a great deal of controversy among the public, and could lead to a flourishing market for illegal immunisation certificates.

Commentary

• The increase in the number of red-zone regions is linked to the next wave of the pandemic in Ukraine, which has accelerated sharply since the beginning of September. On 22 October, 16,300 new coronavirus infections and 409 deaths from coronavirus were registered, the worst such figures since the start of the pandemic (see Chart 1). On 26 October, the figures of 20,000 infections and 500 deaths were passed. Previous waves of the pandemic affected Ukraine less than some of its neighbours in terms of both infections and deaths. At present, however, only in Romania is the situation much worse, and similar numbers of new cases are being recorded in Moldova and Slovakia (see Chart 2); however it is worth noting that the latter country has approximately six times lower COVID-19-related mortality, most likely because the health service there is better, and many more people proportionally have been vaccinated.
• The main challenge in reducing the number of coronavirus victims will be the efficiency of the Ukrainian health service, which coped surprisingly well during the previous waves. Currently, COVID wards have been set up in 481 hospitals (totalling nearly 70,000 beds). The vast majority of them (65,000) have been equipped with oxygen concentrators. Currently, there are over 45,000 patients with confirmed or suspected COVID-19 in these institutions, which means that over the whole country, over 66% of all the beds are filled. As the infection rate rose, the government began to increase the number of hospitals receiving COVID-19 patients and the number of places (both regular and intensive care, see Chart 3) ready to take new patients. According to health ministry representatives, the maximum number of COVID beds may reach 90,000. However, the pandemic is not spreading evenly throughout the country, which means that the capacity of the hospital wards varies significantly depending on the region: from just 35% in Kirovohrad oblast to nearly 90% in the Kyiv-controlled part of Donetsk oblast. Currently, the north of the latter, near Kramatorsk, is in a particularly difficult situation; most hospitals there are full or are on the verge of exceeding capacity. Due to the greater number of health care facilities, regional centres are usually coping better than the smaller centres, although there are exceptions such as Zaporizhia, where the number of COVID-19 patients is approaching critical. Another challenge –apart from the infrastructure – is ensuring an adequate number of medical personnel, as many institutions are struggling with shortages of doctors and nurses.
• In accordance with the regulations currently in force in Ukraine, the country has been divided into four zones (green, yellow, orange and red) depending on the state of pandemic risk as determined by certain criteria (including increases in new cases, decreases in the number of tests performed, the occupancy rate of ventilator beds, and the number of people hospitalised due to the infection). The higher the degree of threat, the more restrictive the restrictions in a given region. Currently, 8 oblasts are in the red zone, 13 in the orange zone, and only 4 in the yellow zone (see Map). In the red zone, restaurants, shopping and entertainment centres, cinemas, theatres, educational establishments (except for grades 1–4), sports centres and non-food stores have been closed, and mass sports competitions have been halted, except for those held behind closed doors. The above restrictions do not apply to facilities and events where participants and organisers have tested negative for the last 72 hours or have received two doses of vaccine, and where masks are worn and a distance of at least 1½ metres between persons is maintained. In addition, as of 21 October, only persons who have a document confirming that the vaccine has been performed or a negative test have been allowed to travel between oblasts. According to media reports, however, this restriction has largely been disregarded by private carriers.
• The introduction of privileges for the vaccinated is intended to boost the drive to vaccinate the country. So far, only 18.8% of Ukrainians have been fully vaccinated, the lowest result in Europe. This is not due to a lack of preparations (more than 25 million doses have been delivered), but to the reluctance of the public, caused by various types of conspiracy theories and concerns about the possible side effects. Nevertheless, the growing number of districts in the red zone has recently accelerated the vaccinations: from 18 to 24 October, as many as one million people received the first dose (a record). As part of the government’s vaccination policy, it intends to vaccinate all employees at selected workplaces as of 8 November. Pursuant to an ordinance from the Ministry of Health, this obligation will apply to employees of central and local executive authorities, offices of state administration, universities, scientific and educational institutions. Those who do not comply with the new regulations will face dismissal. This has aroused a great deal of controversy in society, as evidenced by the petition (signed by over 25,000 persons) to President Volodymyr Zelensky’s office, in which they demand criminal liability for those introducing the compulsory vaccinations. The human rights ombudsman Ludmyla Denisova has also expressed her concern that the order may violate civil rights and freedoms by discriminating against people who decide not to vaccinate. At the same time, there are more and more reports of a booming market for false vaccination certificates. This applies not only to counterfeit paper documents, but also to entries in the official register through which QR codes can be generated on the state-owned Diia application. The existence of this practice is important because the vaccination certificates obtained via Diia are accepted by EU countries when crossing the Ukrainian border. It is difficult to assess the scale of this problem, but it is by no means a marginal phenomenon.
• It is difficult to predict when the current wave of infections will peak. Last autumn, this happened only at the turn of December, which may mean that Ukraine still has the biggest challenges ahead of it, especially as there are no signs so far that the infection rate is slowing down. Based on the experience of the last two waves, it can be concluded that the healthcare system should be able to survive at the national level, but the situation may become critical in individual regions. The economic costs related to the restrictions are another issue. On 21 October, the National Bank of Ukraine reduced its GDP growth forecasts in 2021 from 3.8% to 3.1%. However, if the red zones persist for a long time in many districts, even this forecast may prove to be overly optimistic.

APPENDIX

Chart 1. Daily infections and deaths in Ukraine

Source: author’s research based on data from the Ukrainian Health Ministry.

Chart 2. Infections and deaths per 100,000 inhabitants in Ukraine and neighbouring countries in 2021

Source: author’s research based on data from the Ukrainian Health Ministry, John Hopkins University CSSE.

Chart 3. Occupation of COVID beds in Ukraine

Source: author’s research based on data from the National Security and Defense Council of Ukraine.

Map. The division into epidemic zones as of 26 October 2021

Source: Ukrainian Health Ministry.