20 years under Putin: a timeline

The problem of Russia’s slow vaccination rate is multilayered, with high vaccine hesitancy and insufficient production providing only partial explanations. Vaccine rollouts have varied widely across Russia’s regions, and local officials have struggled to maneuver the country’s centralized political system, a reluctant population, and regional specifics. Regional differences reflect the deeply rooted political issues of governance and public trust.

 

September 24, 2020: Moscow Mayor Sergei Sobyanin at a clinic offering vaccination for medical workers. By late August 2021, Moscow has been in the top-10 Russian regions in terms of vaccination rates, with 28.5 percent of general population receiving both doses of the COVID-19 vaccine. Photo: mos.ru

 

Russia has one of the longest-running COVID-19 vaccination campaigns in the world: its first vaccine, Sputnik V, was approved for use in August 2020; a large-scale vaccination prioritizing essential workers and military was launched in December; and mass vaccination for the general population started in mid-January. The country now has four approved vaccines, with a fifth on the way. Yet, as of August 25, less than 30 percent of Russian citizens had received at least one dose and less than 25 percent were fully vaccinated. The low vaccination rate is well behind the government’s original plan to vaccinate 60 percent of adults by September 2021, and, as a result, Russia failed to stop a deadly third wave of the pandemic driven by the Delta variant. Official mortality rates are unreliable: in August, the number of daily deaths hovered just under 800 for weeks (which is statistically highly unlikely), before rising slightly above that number. According to Alexei Raksha, an independent demography researcher, the real figure could be closer to 2,500

The third wave seems to have hit the regions especially hard, as overburdened healthcare systems struggle to keep up with the rate of infections. The country’s vaccine production capacities have also lagged significantly, although the situation has started to improve recently, albeit slowly. According to Deputy Prime Minister Tatiana Golikova, between July and September, a total of 67 million kits of vaccine doses will have been distributed across Russia, which, if accurate, would be impressive. This is also more than the number distributed in the previous three-month period (until mid-July)—43.8 million.

With the present pace, it is questionable whether Russia will manage to vaccinate 60 percent of its adult population before the end of the year. Perhaps this is why the government is moving the goalposts: Prime Minister Mikhail Mishustin is now speaking about achieving a herd immunity of 80-90 percent, which conveniently retires the government’s original plan.

 

Passing the buck

Vaccination rates vary widely among Russian regions. The frontrunners—the Republic of Chechnya, the Chukotka Autonomous District, and the Moscow and Belgorod Regions—have vaccinated more than 40 percent of their residents, while Dagestan, the worst performer, has so far managed to inoculate only 11 percent. While surveys show a high level of vaccine hesitancy in Russia—partly a symptom of the public’s low trust in state institutions, partly a product of anti-vaccination narratives amplified by Russian media—this factor does not fully explain the low vaccination rate. It does seem to inform policymaking, however.

Just as the federal government preferred avoiding lockdown measures, which were deeply unpopular in Russia, it also stopped short of mandating vaccination, even though the idea repeatedly surfaced. Instead, the responsibility was pushed onto governors—in the form of centrally set policy goals—who, in turn, deferred it to the management level of organizations and businesses, threatening them with fines should they fail to do their duty. The first region to float, in late May, the idea of mandatory vaccination was Yakutia, only to discard it days later. Moscow’s introduction of mandatory vaccination for 60 percent of the capital’s service sector employees in June, however, became an example adopted by other regions. By August, 43 of Russia’s 83 regions introduced some form of mandatory vaccination. 

There is some evidence that this solution has worked. In Khakassia, for example, once a form of mandatory vaccination was introduced, vaccination rates went up from 650-700 people per day to 2,000. In the Kemerovo Region, the pace increased from 4,000 to more than 11,000 per day. Overall, the vaccination rate across the country grew almost twofold from June to July—before plateauing in August.

 

Logistics and workarounds

Among the indispensable elements of any successful vaccination campaign is the widespread availability of vaccine doses and their efficient distribution. In Russia, both have been a challenge. Vaccines are distributed according to the Health Ministry’s plan. NatsImBio, a Rostec affiliate, handles the logistics. Once vaccine kits reach the regions, it is up to the regional and local authorities to bring doses to vaccination facilities, some of which might be located in remote villages and lack a cold chain infrastructure. Setting up a vast network of vaccination points and mobile teams is important, but it does only half the job, as is evident in the case of St. Petersburg, which has the country’s most extensive networks but quite average vaccination rates. Due to Russia’s size and its centralized transport infrastructure, it could take days for vaccine kits to reach certain areas even with an abundant supply of vaccines, which so far has not been the case. It is thus crucial for local authorities to know when and how many of the vaccine doses to order if they are to maintain a steady vaccination pace.

A steady pace has been lacking: since the beginning of Russia’s vaccine rollout, periodical shortages have slowed the campaign. In late June, the problem led to a halt in vaccinations in several regions—and this was widely suspected to be the result of Moscow’s hogging vaccine kits at the expense of the regions. This claim is difficult to confirm due to patchy data, but the incident coincided with the introduction of mandatory vaccination in several regions, boosting demand, for which the system was likely not prepared. As a result, some governors had to personally reach out to request more vaccine kits, leveraging their (varying) access to decision-makers in Moscow.

Another problem, often mentioned in press reports about Russians trying to get vaccinated, is a lack of organization. People were often unable to register for their shots via Gosuslugi.ru, Russia’s online government services portal, either because of vaccine shortages or because the system was overburdened. Registering by phone via a designated hotline proved to be cumbersome, as operators, when people managed to reach them, redirected callers from clinic to clinic, wearing out all but the most determined ones. Turning up for a dose at vaccination points set up in malls and other public places seems to have been a lesser evil, but these were less likely to offer the more popular, but much scarcer EpiVacCorona vaccine. They were even less likely to attract those Russians who distrusted Sputnik V or felt uneasy getting medical advice outside of a hospital.

City dwellers facing shortages were often able to change their address and get vaccinated in smaller residential areas where vaccines were more abundant; such stories were reported across the entire country, from the Northwest to the Urals and beyond. But this option does not always work. A Pskov Region vaccine seeker was turned away by the local authorities, who prioritized vaccinating public servants. It doesn’t help the vaccination campaign that stories about long queues and applicants being turned down spread far and wide on social media, discouraging potential vaccine-takers.

Still, some stories can also be encouraging. The fact that during the pandemic Moscow has often pioneered policies that other regions then adopted seems to have influenced perceptions and behavior outside the capital. According to a Novaya Gazeta report, Yekaterinburg residents rushed to get vaccinated after Moscow introduced a (short-lived) QR-code system to enter restaurants.  

 

Abundant sticks and scarce carrots

As controversial as Moscow’s QR passes were, they could be introduced and canceled with relatively little fuss. Employers’ coercion to make employees get vaccinated, however, is a more complex issue. In the Tula Region, which is a frontrunner of the vaccine rollout, reports of the Haval automotive plant threatening to “remove” unvaccinated employees from work have cast a shadow on the victory lap of governor Alexei Dyumin, Putin’s former bodyguard who faces a gubernatorial election in September. Employers across the country have also resorted to furloughing workers who refuse to get vaccinated, or mandating that they work from home. Still, regions where formal employment is comparatively low (e.g., the North Caucasus) and where the rollout has been especially slow, found it more difficult to put the onus of vaccination on employers. Dagestan’s numbers barely budged when the republic introduced mandatory vaccination for certain categories of employees and students in July. 

Convincing employees without coercion, however, takes time, and regional authorities often provide little help, as pointed out by the Omsk Region head of Oporа Rossii (“A Pillar of Russia”), an umbrella organization of small and medium enterprises. Large and state-owned companies with cash reserves—such as the energy enterprises in the fairly well-vaccinated Yamal-Nenets Autonomous District—are in a better position to offer goodies to employees. Accordingly, a July survey found that among employees of the industrial giants, the vaccination rates were above the national average(though with some notable outliers, such as Norilsk Nickel and Rostec). Some, though not all, offered various bonuses and days off to vaccinated employees. Several regions, including Moscow City and the Moscow Region, also organized raffles to incentivize residents to get vaccinated. Chukotka, one of the vaccination frontrunners, offered cash payouts of 2,000 rubles ($27) to senior residents age 60 and up, twice the amount offered in Moscow. In August, even the federal government adopted the initiative and announced a lottery with prizes amounting to 100,000 rubles ($1,350). But there isscarce proof to suggest that these efforts will result in a significant increase in vaccinations. Alas, they might even be counterproductive, if they strengthen people’s suspicions over being offered a reward for a vaccine they don’t completely trust.

On top of these issues, there is a problem with medical workers, among whom vaccine hesitancy has been depressingly high, but whom Russians trust more than they do the government. Addressing this problem could be more beneficial, but so far authorities have failed to do so efficiently. For instance, St. Petersburg officials suggested cutting payments to medical workers who refuse to get vaccinated, but to no desired effect. At the same time, in the Belgorod Region, which is among the top five in terms of vaccination rates, officials since May have been offering performance bonuses to medical workers as well as a day off for the general population and free rides on public transport for pensioners—all to boost vaccination. The latter efforts were deemed so successful that Putin himself mentioned them as a best practice in August and suggested that other governors should follow suit. 

Still, there are caveats. First, it is unclear how regions should finance these incentives. Moscow, Belgorod, and Chukotka—the vaccination frontrunners—are Russia’s wealthier regions, while most others have scarce funds for incentive payments without cutting other expenses. Second, COVID-19 bonuses promised to medical workers by the president last year were delayed and trimmed down by regional and local authorities. In short, even best practices are more likely to work in more “governable” regions—those with more money (Moscow), with well-oiled administrative machinery (Belgorod), or with an effective coercion apparatus (Chechnya).

In August, with wildfires raging in Yakutia and other regions and many people going away on vacation, the authorities struggled to further boost the vaccination rate. But, as in so many other cases, politics is a major part of the problem. As both the federal and regional governments are careful not to upset voters before the September Duma election, measures such as the mandatory vaccination of college and high school students before the start of the academic year remain off the table. Governors leading the so-called “protest regions” are focusing on keeping their regions calm rather than stirring public discontent with additional vaccination measures. Overcoming vaccine shortages and finding money to incentivize people to get their shots require connections in the capital. In Russia, as well as in other countries, the handling of the pandemic has brought to the surface deeply rooted political problems and associated risks.

 

Russia under Putin

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