INTRODUCTION

Vaccination is one of the effective preventive measures to protect the world's population from several bacterial and viral diseases, especially the vaccination of children from birth to adolescence. In Ukraine, since 2020, the Calendar of Preventive Vaccination of Children (CPVC) has been amended to fully harmonize it with the CPVC of the EU and the US [1-3].

However, full harmonization is not always appropriate, as the epidemiological situation for some diseases may significantly differ from country to country and in certain territories. For example, according to WHO statistics, about nine million people worldwide suffer from tuberculosis (TB) each year. Among them, only six million are undergoing treatment. Approximately 1.7 million TB patients die each year. The main goal of the National Health Programs of many countries around the world is the prevention of TB, which is n interrupting the transfer process of the activator from sick people to healthy [4]. In Ukraine, the incidence rates are higher than average, and the incidence of TB is growing from year to year [5].

However, CPVC revaccination with the BCG vaccine was removed from children aged seven years [2, 6]. According to the updated CPVC, children are vaccinated against TB for the first time on the third to fifth day after birth, and revaccination is no longer carried out at the age of seven. Also, some newborns, who have certain developmental abnormalities, in 1-2 days of life are transferred to specialized children's inpatient departments of health care facilities (HСF), in which vaccination is not carried out, as there is no BCG vaccine in these departments. This vaccine is also not available in the children's departments of the HСF clinics, as children at the age of 7 are no longer vaccinated. To address the above issue, we have launched a study on the vaccination of children in Ukraine. Note that the study began before the Covid-19 pandemic, however, even then we encountered a generally negative attitude toward vaccinated children in Ukraine.

This negative attitude, in our opinion, is because family medicine practitioners do not conduct information work with parents at the appropriate level. Also, pharmacies should be carried out educational work among the population of the country according to current legislation, however, this function, unfortunately, is also not performed by pharmacists [7].

The study aimed to investigate the dynamics of TB incidence in the country to conduct a study of the availability of anti-tuberculosis vaccines on the pharmaceutical market of Ukraine, identify existing problems with the negative attitude of citizens to the vaccination of children in Ukraine and outline ways to address them.

MATERIALS AND METHODS

The materials were data from official statistical databases on the incidence of TB population in Ukraine, the State Register of Medicines, and data from the survey of employees and students of higher education institutions (HEIs) on vaccination. The research methods were: a meta-analysis, statistical analysis, marketing office, field methods, and SWOT analysis.

RESULTS AND DISCUSSION

Every year, specialists of the Public Health Center of the Ministry of Health of Ukraine and the Center for Medical Statistics of the Ministry of Health of Ukraine are preparing an analytical and statistical reference book "Tuberculosis in Ukraine" and a package of documents on the incidence of TB in the regions of Ukraine [4]. We have worked out statistical data on the incidence of the TB population in the last four years (Table 1).

*1st quarter of 2018

According to statistics of disease dynamics among the adult population, TB tends to decrease in relapses, however, for new cases this trend is unstable. The reduction of morbidity and recovery of patients should be associated, first of all, with the appearance on the pharmaceutical market of new drugs that act on resistant forms of mycobacteria. It should be noted that the vast majority of the country's adult population is vaccinated in the first days of life and revaccinated at the age of seven. Sometimes, if necessary, revaccination was performed at the age of 14.

In terms of the reliability of data on diagnostic studies of TB incidence, there are data until 2019, as further attention was focused on the problems that arose with the Сovid-19 pandemic [8-10]. The coverage of the adult population with preventive and fluorographic examinations decreased to 45.9% in 2017, and the percentage of children aged 4–14 covered by tuberculin diagnosis decreased from 64.4% in 2012 to 49.7% in 2017 [3]. The percentage of detection of patients during preventive examinations to the total number of newly diagnosed patients decreased to 51.1% in 2017, a detection of patients with tuberculin diagnosis, although it increased to only 51.1%, but with insufficient preventive coverage of children aged 0-14 years (49.7% in 2017). The number of children under 1 year of age who received BCG prophylactic vaccination decreased to 83.6% in 2017, as did the number of children aged 7 and over to 46.0% in 2017. Significantly increased the number of deaths from TB, in particular, according to observations in 2017 to 25.0%, the number of deaths from TB patients out of inpatient treatment gradually increased to 32.8%, indicating a late diagnosis of TB and underdiagnosis of patients [4].

The incidence rate of children (from 0 to 17 years) with TB in 2014 compared to 2013 decreased by 15% (respectively 11.9 and 10.1 per 100 thousand population, or 948 and 770 in absolute numbers). However, the incidence of TB among children in 2018 increased by compared to 2014 by 2.9%. In 2014, the incidence was 10.1 per 100 thousand population, and in 2018 - 10.4 per 100 thousand, or 770 and 788 in absolute terms, respectively [11].

In 2021 (Table 1) the incidence of TB in all indicators had a positive trend, which we explain as an increase in the number of diagnostic studies conducted on the population associated with the Сovid-19 pandemic, and the detection of new cases and recurrences of the disease.

Thus, the question arises as to the expediency of abolishing BCG revaccination in Ukraine of children at the age of 7 and, if necessary, at the age of 14. Particular attention should be paid to solving the problem of supplying children's wards of polyclinics of HСF with the BCG vaccine.

In Ukraine, the CPVC in 2019 provides for vaccination against 10 diseases. All vaccinations before the age of 18 are free. People at risk, including doctors, students, the military, and educators, can get free vaccinations against measles, rubella, and mumps. However, in the absence of BCG vaccine supply to outpatient pediatric departments of HСF, there is a need to purchase them at their own expense. Marketing analysis of the BCG and tuberculin market in Ukraine, allowed them to establish their presence in the State Register of Medicines, as well as their availability and cost in pharmacies (Table 2) [12].

The cost of tuberculin in pharmacies in Ukraine ranged from 176 to 189 UAH or about € 6. The cost of the BCG vaccine has not been established, as it comes directly to maternity hospitals. Only the Uro-BCG vaccine, which costs UAH 3,000, can be purchased at pharmacies. or ~ € 95. Vaccination is offered in private HСF as a service with a pediatrician's examination and the cost is from one hundred to 1 thousand UAH. However, BCG vaccination is not offered.

Several publications on the negative attitude of some citizens to preventive vaccinations and vaccination, in general, prompted us to develop a specialized electronic questionnaire  [13-15] (Table 3).

The survey consisted of 16 questions, part of which was aimed at establishing the contingent of respondents, the second part of the questions concerned the respondent's own experience of vaccination, and a third part of the questions was asked to establish his attitude and desire for today and in the future regarding the vaccination of children.

The questionnaire was electronic, anonymous, and offered voluntarily to students, academics, employees of the administration, researchers, and other staff of two universities: Lviv Polytechnic National University (NU LP) and Danylo Halytsky Lviv National Medical University (LNMU).

As a result of the survey, the total contingent of respondents was: 173 people from OU LP and 73 people from LNMU, a total of 246 respondents. Our analysis of the passport part of the questionnaire in terms of age, level of education, and gender allow us to say that the sample of respondents is representative. The distribution of respondents in the two universities by age and level of education is presented in Figures 1 and 2.

The presented distribution in the percentage of respondents of NU LP and LNMU by the level of education (Figure 2) indicates a high activity of respondents from among students and associate professors in the two HEIs. It is these two categories of respondents are parents or future parents.

The analysis of the data obtained as a result of the questionnaire on all questions allowed us to conduct a SWOT analysis and identify strengths and weaknesses, advantages and disadvantages of the process of vaccination of children in the opinion of their parents or future parents. The matrix of the SWOT analysis is presented in Table 4.