SCIENCE sciencemag.org 15 FEBRUARY 2019 • VOL 363 ISSUE 6428 677Measles epidemic in Ukraine
drove troubling European year
War and distrust of vaccines seeded ongoing outbreak
INFECTIOUS DISEASEa new policy for evaluating proposed stud-
ies involving “enhanced potential pandemic
pathogens.” NIH invited new GOF propos-
als, which would be reviewed by a panel
of experts from the Department of Health
and Human Services (HHS) in Washington,
D.C., and other federal agencies.
Kawaoka and Fouchier, the only scien-
tists so far to submit proposals, essentially
plan to continue studies interrupted by the
funding pause. The HHS panel reviewed
those proposals last summer, and a depart-
ment spokesperson said it approved them
late last year after the researchers accepted
recommendations to revise their risk-
benefit analyses, some safety measures,
and communications plans.
Kawaoka wants to identify mutations
in H5N 1 that could allow ferrets to infect
each other via respiratory droplets. His
grant includes requirements that he im-
mediately notify NIAID if he identifies an
H5N 1 strain that is both able to spread
via droplets in ferrets and is highly patho-
genic, or if he develops a dangerous strain
that is resistant to antiviral drugs.
Fouchier’s proposed projects include iden-
tifying molecular changes that make flu vi-
ruses more virulent. As with Kawaoka, the
panel did not ask him to remove any exper-
iments. But Fouchier says it suggested his
team clarify how it will monitor workers
for exposure and justify the flu strains it
wants to work with, which include another
bird virus, H7N 9.
HHS “is committed to being as trans-
parent as possible,” a spokesperson said,
and an advisory panel will be publicly
examining the review process “once a
sufficient number of reviews have been
conducted.” But the department cannot
release the specific reviews because they
contain confidential or proprietary infor-
mation. That lack of openness is “indefen-
sible,” says microbiologist Richard Ebright
of Rutgers University in Piscataway, New
Jersey. “Details regarding the decision
to approve and fund this work should be
made transparent,” adds Thomas Inglesby,
director of the Center for Health Security
of the Johns Hopkins Bloomberg School of
Public Health in Baltimore, Maryland. The
critics say the HHS panel should at least
explain why it thought the same questions
could not be answered using safer alter-
native methods.
One researcher who has sympathized
with both sides in the debate finds the
safety conditions imposed on Kawaoka
reassuring. “That list ... makes a lot of
sense,” says virologist Michael Imperiale
of the University of Michigan in Ann Ar-
bor. “At this point I’m willing to trust
the system.” jM
easles cases more than tripled
across Europe in 2018 , and one
country drove much of the surge:
Ukraine. Nearly 83 , 000 cases of
measles were reported in the World
Health Organization’s (WHO’s)
European Region in 2018 , compared with
some 25,500 in 2017 , WHO, headquartered
in Geneva, Switzerland, announced last
week. Ukraine had more than 54, 000 cases
in 2018 , its government says. Last year,
16 Ukrainians died of the extremely conta-
gious viral disease, which is easily prevented
with a vaccine.
“The current epidemic is the most mas-
sive in the entire postvaccine period,” says
Nataliya Vynnyk, a pediatric infectious dis-
ease specialist at Children’s Clinical Hospi-
tal in Kyiv. With more than 1 5, 000 cases and
seven deaths between 28 December 2018
and 1 February, according to the country’s
Ministry of Health (MOH), the epidemic
continues to worsen.
Ukraine’s government is taking action.
“It’s egregious to have people have measles
in the 21 st century in a European country,”
says Ulana Suprun, a physician who has been
Ukraine’s acting minister of health since Au-
gust 2016. She blames a decade of corrup-tion, war, a lack of political commitment to
vaccination, and antivaccine sentiment.
Measles is spread by respiratory drop-
lets. Most people recover, but the disease
can cause sometimes-fatal complications
including pneumonia and inflammation of
the brain. Typically, children are vaccinated
around their first birthday and again before
starting school. According to WHO, 95 % of
children need to be fully vaccinated to stop
the disease from spreading.
Elsewhere in Europe, vaccine skepticism
has given the virus an opening. Cases in
Greece doubled from 2017 to 2018 ; cases
in France grew nearly sixfold. Meanwhile,
the United States logged 372 cases last
year. An outbreak in Washington this year
has resulted in 53 confirmed cases as of
11 February, nearly all in unvaccinated chil-
dren, pushing the U.S. year-to-date tally
above 100.
In the past decade, vaccine refusal has
also played a big role in Ukraine. In 2008 ,
a day after receiving the measles vaccine, a
17 - year-old died—from an unrelated cause,
according to WHO and the United Nations
International Children’s Emergency Fund
(UNICEF). His death led to a huge loss of
confidence among parents: Vaccination
rates plunged from 97 % of 1 - year-olds in
2007 to 5 6 % in 201 0. Coverage then slowlyBy Meredith WadmanPH
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A nurse gives a child
a measles shot at City
Children’s Hospital
in Odessa, Ukraine,
in October 2018.Published by AAASon February 14, 2019^http://science.sciencemag.org/Downloaded from