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Wars can cause infectious disease outbreaks, posing potential threat to Northeast Ohio

Hundreds of thousands of people have been killed in the Russia-Ukraine War and now thousands more are dead in the Israel-Hamas War. But war doesn’t just spread death by conflict — it can also kill by allowing diseases to spread with consequences that can reach beyond the battlefield, perhaps even to Northeast Ohio.

Ideastream Public Media’s Glenn Forbes and Stephen Langel discussed how wars thousands of miles away can threaten public health locally and what can be done to prevent this.

FORBES: Stephen, what kind of threats are we talking about?

LANGEL: An outbreak of infectious diseases like measles and tuberculosis. Dr. Amy Edwards specializes in infectious diseases at University Hospitals Rainbow Babies & Children's Hospital. Wars destroy public health infrastructures, making it difficult to keep infectious diseases at bay, she said.

“I don't think most people understand how much work it takes to keep the communicable illnesses under control," Edwards said. "When you take away that infrastructure … via war, you start to see the communicable illnesses coming out.”

Additionally, war zones create environments that are good for spreading diseases.

This is what the past president of the American Public Health Association Dr. Barry Levy told me.

“With people being crowded together, people being often malnourished or at least inadequately nourished, people not having access to both medical care and public health services, these diseases can spread very rapidly and easily.”

He added when countries like Russia target health care facilities and health workers the situation becomes more dire by limiting access to care.

FORBES: What kind of risk are we talking about?

It presents a serious risk not only for millions of Ukrainian children who lack vaccinations but for anyone else who’s exposed.

According to an infectious disease doctor with the University of Pittsburgh diseases such as measles and tuberculosis can be deadly.

Here’s Dr. Lawrence Kingsley:

“Globally, the leading cause of death is infectious diseases. In the United States, it ranks something like three or four behind … heart disease, cancer. … Measles can cause an encephalitis [inflammation of the brain] and cause death. … Due to the prevalence and the communicability of measles … it poses a substantial risk to the community.”

Levy agrees.

“If children are not immunized or have not been fully immunized against measles, they're at great risk not only of getting the disease itself but having severe infections and possibly even dying as a result," he said.

FORBES: Why would this be a particular concern for Northeast Ohio when these war zones are thousands of miles away?

LANGEL: Edwards says growing vaccine hesitancy in the U.S. is the reason, especially when combined with war refugees arriving from countries like Ukraine with lower vaccination rates.

“There are unvaccinated people in Northeast Ohio. And that's the key. It takes an unvaccinated population to spread these illnesses. So, for instance, if you know, if a person with incubating measles were to fly here from wherever and happen to be housed near other unvaccinated people, then yes, we could see an outbreak,” she said.

LANGEL: Global Cleveland says 5,500 Ukrainian refugees have emigrated to Northeast Ohio since the war began early last year. It’s too early to know whether we’ll see an influx of people coming here as a result of the Israel-Hamas War.

FORBES: What can be done to address this?

LANGEL: According to public health expert Dr. William Pewen, what's needed is a combination of vaccinations to protect millions of under-vaccinated Ukrainian children combined with diagnostics to detect and therapeutics to treat the diseases in the war zones.

FORBES: The Biden administration announced a joint funding proposal for Ukraine and Israel late last month that includes more than $9 billion for humanitarian aid. Will this address the problem?

LANGEL: Ohio Democrat Sen. Sherrod Brown has told me he believes it will.

“I just know that if we're going to do humanitarian aid, there will be aid for children and part of that will be vaccines,” Brown said.

However, there are potential issues.

First, many Republicans are opposing Ukraine funding, including Ohio Sen. J.D. Vance and the new House Speaker, Louisiana’s Mike Johnson.

And, even if the White House has the votes for the funding, those working in public health on the ground say that still may not ensure the infectious disease issue is addressed.

FORBES: And why is that?

LANGEL: Pewen, who’s been working on the problem since early last year, said the current proposal does not include language requiring funds to be allocated to address this problem. Without such specific language, nothing is likely to get done, he said.

“After 18 months and multiple supplementals, that maxim about repeating the same action and expecting a different result comes to mind," he said. "Unfortunately, expressions of intent aren't sufficient. Specific and substantive resources are going to be needed. That's the only way we're going to get assistance directly and expeditiously that are needed, where they're needed.”

FORBES: And what does Brown say about this?

LANGEL: He believes specific language may not be needed.

“I don't know if it needs to be specific in the law. … all the people that are doing this know this is a major component of humanitarian aid because you got to take care of children,” Brown said.

FORBES: When will we know for sure?

LANGEL: I have been told something should be decided within two weeks.

Stephen Langel is a health reporter with Ideastream Public Media's engaged journalism team.