COVID-19 in Russia: Should we expect a novel response to the novel coronavirus?

ABSTRACT

Russia provides an important case study in its COVID-19 response by a country that has one of the largest epidemics, increasingly authoritarian government policies, and important domestic and international political influence. In this article, we describe and explain Russia’s public health and social policy responses to COVID-19 – earlier in the pandemic when the concern was the border with China, to later when there were confirmed cases in all regions in the country. In the past, Russia has served as an interesting case for exploring global health politics and infectious diseases. Thus, we position our analysis of the COVID-19 response through a reflection on infectious disease control in the Soviet Union and contemporary Russia. We explore the following: government control, contention with official statistics, (dis-)information, (mis-)trust, and vulnerabilities of medical care workers. We also discuss how Russia is reinforcing its role in global health during the pandemic, for example through vaccine development and foreign humanitarian aid. We situate our analysis in the historical, political, and social contexts to help explain Russia’s response to the novel coronavirus pandemic.

KEYWORDS:

• COVID-19
• coronavirus
• Russia
• government response
• global health
• infectious disease control

Introduction

By the end of 2020 there were over 83 million confirmed cases of COVID-19 and 1.8 million deaths from the novel coronavirus worldwide (Johns Hopkins Coronavirus Resource Center, 2020). The COVID-19 pandemic is not only a global public health crisis, but has already resulted in severe social, economic, and political consequences around the world. There has been extensive discourse on what government approaches are most effective. It will likely be some time before we will be able to draw conclusions both for short-term and longer-term impacts of the public health and social policy measures that governments have implemented. It is, nonetheless, crucial to addressing the current pandemic and drawing lessons for future pandemics that we begin to understand the politics involved in how governments are responding to COVID-19 (Greer et al., 2020). Russia, a country with one of the largest COVID-19 epidemics, provides an important case study in its COVID-19 response. This case study of Russia adds to the global discourse on how and why governments responded to COVID-19 in the initial months of the ongoing pandemic and can provide insight into drawing lessons learned about pandemic response in specific contexts.

Russia had about 1.2 million diagnosed COVID-19 cases at the beginning of October 2020 (Russian Federal Government, 2020a), making it one of the countries most affected by the pandemic. However, unlike other countries with large case counts, such as United States and Brazil, the official statistics indicate that there were just over 20,000 deaths attributed to COVID-19 in Russia during the first eight months of its epidemic (Russian Federal Government, 2020a). The first case of COVID-19 in Russia was documented on January 30, 2020. Despite sharing a 4,209 kilometre border with China, Russia was successful in containing the few diagnosed cases early in the year. Then as the virus spread across Europe, Russia soon after began to see the number of new cases pick up starting in March. At first, the capital city of Moscow suffered the hardest. However, by April, there were confirmed COVID-19 cases in all of the 85 federal subjects in the country. The epidemic in Russia reached its first peak in May and decreased over the summer months. In August, President Putin announced that the first vaccine in the world, Sputnik V, was approved and registered in Russia. Since then the federal government has been projecting that mass vaccination could start in the coming months. Nonetheless, the number of cases started to increase rapidly in October, with projections of a more severe peak in the winter months.

In this article, we describe Russia’s public health and social policy responses to COVID-19 in the ‘first wave’ – earlier in the pandemic when the concern was the border with China, later when the virus was spreading from Europe, to when it reached all regions in the country. We position our analysis of Russia’s COVID-19 response through a reflection on past infectious disease control in Russia and the Soviet Union. Our analysis is based on reviewing the limited published scientific literature and grey literature, government documents and websites, and Russian-language online newspapers, and on following Russian social media sources over the course of pandemic. We focus our analysis of the COVID-19 response on the period of late January to early October, 2020. We begin with a brief overview of the historical context of public health and infectious disease control in the country. We then describe several important themes, which we identified, in Russia’s policy response to COVID-19. Throughout the manuscript, we reflect on the question – what, if anything, is novel about Russia’s approach to the novel coronavirus?

Historical context of public health and infectious disease control in the Soviet Union and Russia

Public health in the Soviet Union was praised for providing free healthcare services to its citizens and for making great strides in infectious disease control. However, post-Soviet Russia has experienced several public health crises due largely to social and economic crises. It was also a time that offered more information about some of the existing problems in the healthcare system that were covered up during the Soviet Union. Nonetheless, changes to public health and medicine early in the Soviet Union resulted in many positive changes to a country concerning the burden of infectious diseases. One of the most successful elements was that in 1922, the Soviet Union established a state sanitary and epidemiological surveillance system designed to prevent infectious diseases and to improve the sanitary conditions in the country (Council of People’s Commissars of the RSFSR, 1922). By the 1930s, there was a network of sanitary and epidemiological surveillance stations in place around the country to monitor the public health situation in each of the regions. It was also during this time that all hospitals became state-run and all healthcare workers became state employees. The focus on equal access to care, strict investigations into infectious disease outbreaks, monitoring child health and nutrition status, and general development of the district health systems resulted in the Soviet Union’s successful management of infectious disease prevention and management (Tulchinsky & Varavikova, 1996). Infectious disease prevention, mass vaccination campaigns, and health education were important elements to facilitating steep declines in infectious disease mortality in the Soviet Union. By the 1970s, every institution and individual citizen were assigned a public health doctor. Leaders of businesses, organisations, and ministries were personally held responsible for enforcing public health rules and violation of these norms carried disciplinary, administrative and even criminal liability (Egorov, 2020). A characteristic of the Soviet infectious disease control system was ‘extreme authoritarianism’, which included a strong centralised power, little concern for patient confidentiality, and compulsory compliance with public health measures (Izmailova, 1996). Infectious disease control was quite successful in the Soviet Union until the 1990s. As centralised management began to falter and mass vaccination programmes started to weaken, infectious diseases started to reappear, including outbreaks of diphtheria and cholera (Tulchinsky & Varavikova, 1996). The diphtheria outbreak was particularly troubling as case numbers returned to those seen in the pre-vaccination period. The epidemic peaked in 1994 when there were approximately 40,000 cases and more than 1,000 deaths (Belov, 2012). The diphtheria outbreak was ultimately controlled through strong surveillance and improved vaccination coverage. Post-Soviet Russia has also experienced high case numbers of other infectious diseases – Hepatitis C, tuberculosis, and HIV. The first decade in post-Soviet Russia was characterised by a demographic crisis, shaped by the rising mortality rates unseen in developed countries and by the declining birthrates (Parsons, 2014). Russia has shown remarkable improvement in the steady increase in life expectancy over the past 15 years (World Bank, 2020).

After the fall of the Soviet Union, there were public health reforms in the successor nations. Russian healthcare services continue to be offered free of charge for citizens, currently through compulsory medical insurance plans (ОМС). Individuals and companies may also participate in additional voluntary medical insurance plans (ДМС). Healthcare reforms, including the insurance system, are ongoing. Another important characteristic of the changing healthcare system in Russia has been the introduction of private clinics, which can include both diagnostics and treatment services. It is arguable as to whether or not the healthcare received is of higher quality in private clinics, but they do offer options for people to avoid government bureaucracy, limited hours, long wait times, and in some cases anonymity. There are a large number of government healthcare centres across Russia, including polyclinics and hospitals. Russia has the third highest number of hospital beds per capita in the world (OECD, 2019). There were 71.1 hospital beds per 10,000 and 37.4 doctors per 10,000 in the Russia in 2018 (Aleksandrova et al., 2019a; 2019b). However, the Russian healthcare system continues to be underfunded and prone to the geographic disparities that follow the economic inequities between major cities and more provincial towns and rural areas. It is also important to note that doctors and nurses are state employees, and regional government authorities control the hospitals.

Infectious disease control approaches developed during the Soviet period have continued, especially concerning the tight control the federal government has over epidemiological surveillance at the local level, despite decentralisation of the system. One example, is in how rigid and directive the sanitary regulations are for organisations and business. This provides enhanced control over the sanitary standards; however, it also creates a situation ripe for corruption. Much has been reported on in the mass media about how formal inspections have resulted in bribery to officials in the context of strict regulation system with numerous contradictions and inconsistencies (see for example, Сотрудников Роспотребнадзора в Петербурге … [Rospotrebnadzor employees in St. Petersburg …], 2019 or Роспотребнадзор: защитник или нападающий. [Rospotrebnadzor: defender or attacker], 2019). In 2004, Rospotrebnadzor (The Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing), as well as new institutions at the regional levels of the Russian Federation, was formed. In 2012, Rospotrebnadzor moved from being under the Ministry of Health to directly reporting to the federal government. President Putin (2020) recently stated that despite the fact that the USSR collapsed, the public health and epidemiologic surveillance systems that were created in the Soviet Union have been maintained in Russia. In this regard, questions arise as to how the practices historically developed in the USSR are to this day being implemented in the period of new epidemiological challenges and threats, which of the practices turn out to be effective, and which, on the contrary, hinder an effective response.

Government response to COVID-19 in Russia: Emphasis on government control

Overall, Russia has had a centralised, federally coordinated response to COVID-19, primarily led by the president, prime minister, and Rospotrebnadzor. However, regional authorities make the decisions around implementation and enforcement of lockdowns and stay-at-home orders. President Putin charged his political representatives in the regions to prepare for the local response to COVID-19. The public health response in Russia moved from one of strict measures to contain the virus in the winter, and early spring, to larger-scale mitigation efforts through lockdowns and travel restrictions in the spring, to relaxation of mandated restrictions by summer for most of the country. In early 2020, the public health response was largely focused on rigorous infectious disease control efforts, including closure of the border with China, a ban on Chinese citizens from entering Russia, and containment through strict quarantine and isolation measures of the isolated cases among Chinese citizens entering Russia and Russian citizens returning from China. As the epidemic began to take hold in Moscow, the mayor also implemented control measures to limit population movements, such as a digital pass system for entering the city; an intensive ‘social monitoring’ system to track COVID patients who were isolating at home through cell phone apps and GPS tracing; cameras installed around the city to track individuals violating stay-at-home orders; limiting the movement of residents over the age of 65; and, fines for violating COVID preventative measures. President Putin declared March 28–30 April 2020 as the ‘non-working’ period for all of Russia. And Prime Minister Mishustin recommended all regions to follow Moscow’s implementation of stay-at-home orders. All 85 federal subjects implemented some form of ‘self-isolation’ measures (TASS Russian News Agency, 2020). These included only leaving home to seek emergency medical care, if there was life-threatening reason, to go to the nearest grocery store or pharmacy, to throw away trash, to walk a pet within 100 metres from home, or to work (if not allowed to work from home). By late June 2020, the restrictions had been lifted across nearly the entire country. In August, President Putin announced that Russia registered the first vaccine against SARS-CoV-2. The federal government subsequently announced plans to begin rolling out mass vaccination campaigns in late 2020. Despite ethical concerns and fear that it had not yet gone through clinical trials, medical care workers and schoolteachers were slated to be among the first to be vaccinated (Gubernatorov & Filipenok, 2020; ‘Нет недостаточно изученной вакцине (No to the insufficiently studied vaccine’, 2020). President Putin announced in early October that a second Russian vaccine was approved; two government officials, the Chief Sanitary Doctor and the Vice Prime Minister, were quick to publicise that they received doses of this vaccine. A national mask mandate was issued on 28 October 2020.

Public health restrictions to prevent the spread of COVID-19 undoubtedly carry some financial consequences. In spring 2020, the Russian government implemented several social policy measures to offset the economic and social consequences of the pandemic (Russian Federal Government, 2020b). Monetary subsides were focused on families with children, unemployed, and Russian citizens stuck abroad. Visa and work permits were extended at no cost to foreign citizens in Russia. This included the many Central Asian labour migrants trapped in the country with no means to get home and experiencing loss of jobs, food insecurity, and housing crises (King & Zotova, 2020; Nechepurenko, 2020a). The Russian government also vowed to provide hazard bonus pay to medical care workers providing treatment to COVID patients; however, seven months into the epidemic there are still widespread complaints that these payments have not been received. The Russian government also allocated subsidies and interest-free payroll loans to businesses, loan payment deferrals (including on consumer and mortgage loans) to private citizens, and the provision of subsidised loans and the deferral of payment of taxes and insurance premiums to federally eligible, socially oriented non-profit organisations. During the summer, the Russian government had a payback system for tourists who travelled domestically. No new social policies were implemented in the fall, as most regions lifted restrictions on work and school attendance.

A constant theme in the Russian federal government’s response to COVID-19 has been that the situation is under control in the country. The image of everything under control remains an important strategy in the Russian government response, even as hospital beds are near or over capacity across the country. President Putin’s announcement of the government approval of a second vaccine (EpiVakKorona) in early October and promise to have it ready for production in the coming months is yet the most recent example of demonstrating that everything is ‘under control’.

A public health response that incorporates strict restrictions on individuals were expected in Russia, a country with a longstanding infectious disease control approach that favours the public good over worries of infringement on individual rights. At the beginning of the pandemic, individuals presenting with symptoms of an upper respiratory infection and having travelled to China or Italy were quarantined in isolation wards in infectious disease hospitals, where they were forced to remain until they had two negative COVID-19 test results. An early example that received media attention was a woman who escaped out of her locked hospital room in an infectious disease hospital in St. Petersburg. Rospotrebnadzor then took her to court and an ambulance escorted her back to complete the required quarantine. Another example was the use of the ‘social monitoring’ system of patients isolated at home through phone apps. The compulsory isolation and quarantine measures and the public good outweighing concern over patient confidentiality much align with previous approaches to infectious disease control in the country. For example, HIV test results visibly indicated on medical records and isolation of HIV-positive patients from others in the hospital were common practice for many years. Compulsory vaccination campaigns in the late Soviet period were credited with the control of infectious disease outbreaks. However, these approaches rely on mandatory compliance and potential breach of patient confidentiality.

Strengthening Russia’s image, domestically and globally

A successful response to COVID-19 would be an opportunity for President Putin to demonstrate his effective leadership, domestically and globally, and demonstrate that the country is doing well. Therefore, the federal government has been determined to show that the epidemic was under control. The importance of control, or creating an illusion of control, has been central to President Putin’s demonstration of strong leadership (Chotnier, 2020; Stanovaya, 2018). Putin’s rating among Russians was falling pre-COVID (Levada Center, 2020a). Ensuring that COVID-19 is under control was especially important to Putin given the nation-wide voting on constitutional reform in early July. This nullification (obnulenie) vote allows Putin the potential to serve as a president another two terms. Information from public opinion polls indicate that the Russian population had a slightly more positive view of the federal government since the start of the COVID-19 response in the country. President Putin’s approval rating increased from 63% in March to 69% in October (Levada Center, 2020a); and Prime Minister Mishustin’s approval rating increased from 51% to 57% during this period (Levada Center, 2020a). The federal government demonstrated its strong leadership through creating a centralised platform for reporting COVID-19 data, allocating federal funding to increase the number of ambulances and hospital capacity, a series of presidential orders, and instructing Putin’s political representatives in the regions to be ‘better safe than sorry’ by implementing federal recommendations for ‘self-isolation’ measures and hospital preparation. Thus, while there was a centralised approach for controlling the data and providing recommendations, the regional authorities were responsible for implementing the ‘self-isolation’ policies. This process was reflective of the ‘appearance of democratic legitimacy’ in Russia (Chotnier, 2020). Moreover, there has not been pushback from regional authorities on these federal recommendations. Regional authorities would be held responsible for outbreaks, high death counts, and lack of hospital capacity. Characteristic of how authoritarian-like tendencies play out in Russia, the regional authorities were vaguely threatened by the federal government with consequences for poor COVID-19 responses. This structure incentivizes local authorities to report data that shows that the situation is under control and to limit any information that indicates otherwise.

Social policy is another opportunity for a government to strengthen its image among the population. The social policy response to COVID-19 is characteristic of President Putin’s past approaches. For example, the focus on financial support for families with children is reflective of the ‘maternal capital’ policies implemented in 2007 to incentivize young families to have more children in order to address the demographic crisis in the country. The decision to focus social policy on families is characteristic of what Kulmala et al. (2014) demonstrate is the tendency for the Russian welfare policies to only benefit select groups of the population and that ‘pronatalist policies are a top priority of the state’ (p.526). The authors argue that, in fact, family policy (with an emphasis on pronatalist policies) is often integrated into other national priority social projects, such as ‘Health’ and ‘Housing’ (Kulmala et al., 2014).

Russia is finding opportunities to strengthen its image globally during the pandemic. Russia sent humanitarian aid to Italy and the United States, Western countries that at the time were fairing much worse in the pandemic. During the surge of new cases in Kazakhstan over the summer, Russia sent medical care workers. Kazakhstan and Russia have strong economic and political ties (Laurelle et al., 2019). President Putin promised Belarus that they would be the first foreign country to receive doses of the Sputnik V vaccine. Russia, like other BRICS countries, has been increasing its capacity to offer development assistance to other countries. This position is opposite of the 1990s, when Russia was more a recipient than a donor of global financial aid (Berenson et al., 2014). However, Russia’s position in global health governance is messy; it has on the one hand contributed money to the global response to infectious diseases, while on the other hand has also spread disinformation about these same diseases (Morrison & Twigg, 2019).

The opportunity to strengthen Russia’s role in global health during the pandemic is most evident in the government’s effort to promote having the first registered COVID-19 vaccine. While this would undoubtedly be a significant achievement, there has been significant criticism about the lack of data and attention to protocols for clinical trials (see for example, Bucci, 2020; Vasileva, 2020; Zimmer, 2020). President Putin commented at the UN General Assembly that in response to COVID-19, ‘we are ready to share experience and continue cooperating with all states and international entities, including in supplying the Russian vaccine’ (Ministry of Foreign Affairs, 2020). The Russian government has repeatedly stated that it will offer mass vaccination to its citizens. Moreover, Russia, along with China, are pushing their global influence through ‘vaccine diplomacy’ at a time when the United States and European countries are focused on stockpiling vaccine supplies for their internal use (Morris et al., 2020).

The Soviet Union played important roles in both smallpox and polio vaccine research and development. The oral polio vaccine was determined to be effective and safe through large-scale trials carried out by Dr. Chumakov and his colleagues in the Soviet Union in 1959. International review showed that not only were the laboratories highly capable of producing the vaccines, but that vaccine distribution and infectious disease surveillance systems were well-developed and carried out (Horstmann, 1991). The Soviet Union provided 25 million doses of the smallpox vaccine to the WHO, invited researchers from other countries to learn to manufacture the vaccine, and produced over 1.5 billion doses used in 45 countries during the global smallpox eradication programme (Shchelkunova & Shchelkunov, 2017). The immediate dismissal of a potential Russian vaccine against SARS-CoV-2 neglects to account for the role that Soviet virologists have played in the development of vaccines for global disease threats in the past (Davidov, 2020). President Putin continues to promote the Russian vaccines both domestically and globally, especially to lower-resourced countries. This helps to demonstrate that Russia is able to play an important role in global health efforts.

Contention around statistics

One of the major topics related to COVID-19 in Russia has been the discourse over statistics and criticisms of the transparency in the data. Early in the pandemic, the Financial Times published an article arguing deaths from COVID-19 could be 70% higher than the Russian official data indicated (Foy & Burn-Murdoch, 2020). And, the New York Times reported that the Russian data were also underestimated (Nechepurenko, 2020b). The Russian government, including Ministry of Foreign Affairs and Ministry of Health, accused the international community of trying to undermine their data reporting systems and reporting false information (Yakushova & Boletskaya, 2020; ‘FT сообщила, что реальная … [FT reported that the actual … ’, 2020). At least at the beginning of the epidemic, there were few disaggregated data on the epidemic available for Russia. To have information reported only about Moscow concerning excess mortality meant that little was known in a country with vast geographical disparities, including economic, social, and accessibility of quality healthcare. In August, the Federal State Statistic Service (Rosstat) released a report that showed 3.1% more deaths (or 28,036 excess deaths) in the first six months of 2020 compared to the first half of 2019 in the country. Several citizen watch groups have noted that the data at the regional level has been missing or the frequency of excess mortality data has been changed to less frequent intervals (see for example, Chernyi & Zhilova, 2020). Several months into the epidemic, the federal website started providing data broken down by region. Nonetheless, it remains difficult to assess any inequalities among populations based on gender, ethnicity, urban/rural, etc. Moreover, a major contention in the Russian data are how the country is categorising a ‘COVID death’. Early on in the pandemic, a death was only listed as a ‘COVID death’ if the primary cause of death was due to the novel coronavirus. In the August report by the Federal State Statistic Service (Rosstat) (2020), they clarified that there are several clarifications for the excess mortality numbers, including COVID-19 as the direct cause, COVID-19 suspected as the direct cause but not confirmed, an underlying health issue exacerbated by COVID-19, or COVID-19 diagnosis had no influence on the death. Alexey Raksha, now an independent demographer, stopped working for Rosstat in July because of the discrepancies in data reporting. He claims that the real number of COVID deaths are three times the official daily mortality rates, and that this practice of hiding the data is a ‘throwback to some of the worst practices of the Soviet Union’ (Andrianova & Kravchenko, 2020).

Discrepancies in the reporting of data are not new for public health issues in Russia. This is similar to what we have seen with the HIV/AIDS data reporting. Russia is one of the few countries where the number of new HIV infections continues to grow at an alarming rate. Russia accounts for 61% of new infections in the WHO European Region (WHO, 2019). The WHO surveillance report also includes numerous footnotes indicating either no data or inconsistent data reporting from Russia. Russian government officials are hesitant to call it an epidemic in the country, even as official cases have reached over one million. Russian officials have criticised international estimates of HIV cases and casted doubt on how they are calculated. A similar situation is seen in regard to the ‘unrecognized epidemic’ of hepatitis C. Experts put the number of hepatitis C cases to be more than 3.5 million people (TASS Russian News Agency, 2019). However, it is not officially recognised as an epidemic given that most of the people living with hepatitis C are not officially registered and not getting treatment (Del’finov, 2015). Epidemiological surveillance has been lacking and the monitoring system has been fragmented, which accounts for the underestimation of hepatitis C in Russia (Bivol & Sarang, 2011).

Russia has been criticised for hiding the true scope of COVID-19 in the country. This criticism has come from both international organisations and, more importantly, from within the country, among non-governmental entities (Verkhovskii, 2020; Zhvik, 2020). Doctors’ Alliance and independent journalists have referred to COVID-19 in Russia as a ‘virus of silence’ (Shikhman, 2020). More than half of Russians express some level of doubt in the official data and information about COVID-19 in the country: 27% do not believe any of the information and 39% only believe part of the information (Levada Center, 2020b). Nearly half of doctors reported that the number of cases (49%) and deaths (47%) were an underestimate of the real scope of the COVID-19 epidemic in Russia (Levada Center, 2020c). The manipulation of data to cover up disasters is not a new approach. And, this ‘culture of silence’ is typical of the disaster response tactics that existed in the Soviet Union, for example with the infamous Chernobyl catastrophe (Abbott et al., 2006). Another example, was the manipulation of statistics during President Gorbachev’s anti-alcohol campaign in 1985-1987. The officially recorded data on alcohol consumption were deliberately underestimated by government officials (Treml, 1994, 1997) and it is likely that the population life expectancy data were adjusted upward in order to demonstrate the campaign’s success (Dudina, 2015; Leon et al., 1997). The past has implications for how COVID-19 information is received in Russia. On one hand, there has always been manipulation of statistics, on the other hand, it has become more apparent in today’s world and there is the possibility to assess the scale at which statistics are being manipulated. The historical lack of transparency means that Russians are accustomed to perceive official information with skepticism and to distrust the authorities and their recommendations (Veselov et al., 2016). This may result in grave consequences for preventing the further spread of the novel coronavirus, for which effective public health prevention relies heavily on individuals’ compliance with behaviours such as wearing a mask or social distancing.

Government control over information

Control over information has been important for the Russian government during the pandemic. This control is central to maintaining the image of a strong state. It has been important to control information about any problems or mistakes that could get out to the media, sometimes to the extent of concealing information that could damage the image of strong governance (Kevere, 2020). The control expands beyond more than just over statistics. Some healthcare workers, who are state employees, are afraid to report poor hospital conditions, lack of personal protective equipment, and the vulnerabilities of hospital staff to COVID-19. Hospital administrators are afraid to report that healthcare workers have died from the virus, and life insurance policies have not been paid to family members (Petlyanova, 2020a). There have even been reports of suicide among healthcare administrators (Bakin, 2020; Tsikulina, 2020). Healthcare workers not being able to speak out about poor hospital conditions was an issue in the Soviet Union and has continued to be the case in Russia. Soviet doctors kept out of politics, were not likely to be agitators of the system, and maintained low civic profiles given that they were state employees (Feshbach & Friendly, 1992). Moreover, doctors in Russia are a socially vulnerable population and work in an ‘overregulated and centralized’ healthcare system that does not offer much professional autonomy (Litvina et al., 2020). Russian doctors find themselves in a difficult situation in negotiating how to provide reasonable care to patients and operate in the bureaucratic healthcare system filled with contradictory rules and regulations (Temkina, 2020). By mid-October, there were reports of healthcare workers quitting because of conflicts with management, being overworked, and poorly compensated during the pandemic (see for example, Petlyanova, 2020b; Priemskaya, 2020). More recently, the Ministry of Health has prohibited healthcare workers in federal institutions of speaking publically about coronavirus with the explanation that this will improve how the population is informed and all communication in the media will be coordinated (‘Минздрав запретил врачам … ’ [The Ministry of Health banned doctors … , 2020]).

The Russian government has demonstrated that it is attempting to battle misinformation or the infodemic. One way that they are doing this is through the federal website https://стопкоровирус.рф. The federal government has also lead an extensive social media campaign that centres around providing information about COVID-19 prevention methods and responses to ‘myths’ circulating about the pandemic via a variety of sources, such as Instagram, Facebook, VK, Telegram, and Odnoklassniki. In the spring, they featured ‘stories’ in Instagram from patients, who were quarantined in Kommunarka, the main COVID-19 hospital just outside Moscow, telling about the favourable conditions and comfort of their stays. In the fall, the social media campaigns were largely dedicated to discussions about the vaccine and fears about a ‘second wave’. Social media has undoubtedly been a topic of discussion and concern during the COVID-19 pandemic. Russia has been blamed in the past for the spread of false information about global health issues. For example, ‘Operation InfeKtion’ was used to spread disinformation around the world that the United States government created the HIV epidemic (Grimes, 2017), and Russian trolls have contributed to amplifying and politicising the vaccine debate and spreading disinformation about the measles vaccine via Twitter (Broniatowski et al., 2018). Researchers found that the largest group of people contributing to the infodemic on Russian social media is ‘COVID-dissidents’ or those claiming that the threat of the virus is being exaggerated and the government is using it to promote their own interests (Arkhipova et al., 2020). Arkhipova et al. (2020) postulate that social media use for information about COVID-19 is so high in Russia because when there is such low-levels of trust of institutions and official sources of information, people prefer to receive the information via horizontal channels. Social media and the internet have changed how the Russian government controls information and the media narrative, and caused the state to ‘rewire its propaganda’ (Oates, 2016). The COVID-19 pandemic presents yet another challenge to the government’s control of information flow. It also presents the latest public health issue for which ensuring that correct information is disseminated and consumed by the public is a critical aspect of the response.

Conclusion

By early summer 2020, the Russian government removed many of the restrictions and was encouraging its citizens to travel domestically through cashback incentives. Much of the official rhetoric was the Russia fared well, indicated by it having avoided the concerningly high death counts that other countries in Europe and the United States experienced. Russian officials, including President Putin, have reiterated that the country will not likely return to a ‘lockdown’. The federal government postulates that the healthcare system will be prepared to deal with the new COVID-19 cases and continuously expresses much faith in the Russian-developed vaccines, in both their effectiveness and soon-to-be availability to all citizens. However, by late October, many hospitals were already reporting near or over capacity, and healthcare workers are suffering and even dying.¹ The question remains as to how much control the federal government will continue to have over the virus and the response to COVID-19. It is important to reflect on the Russian response in the first year of the pandemic and to understand how the existing historical, social and political context influences the response to this novel coronavirus. As we have seen in our case study, any challenges in addressing new public health threats fit into some existing practices. We have noted how in many ways the Russian public health system has relied on some of the practices and policies from the past. We can also see that Russia had to adjust some of its practices to reflect the current day situation, given, one, how information flows and two, that the whole world is tuned into the public health emergency of COVID-19 and all eyes are on how different countries are approaching their responses.

We have seen several trends in Russia’s response to COVID-19 that are similar to its past approaches. One is the centralised, federal level control and attempts to coordinate everything from the top down. Researchers have previously argued that federal control of the healthcare system has not resulted in consistency and coherence across the country; and the lack of decision-making and long-term planning at the local level is a noted barrier to an effective public health response in Russia (Tkatchenko-Schmidt et al., 2010). The Russian federal government makes policies and recommendations for local authorities to implement, threatens consequences if they fail in the epidemic response, and places the responsibility on local authorities. There is, thus, great incentive for the local authorities, including local ministries of health and heads of state-run, public hospitals, to show that everything is under control, which may pressure them into suppressing information. Another element that is reflective of past epidemics is the lack of criticism at the regional levels. This has created what Shikhman (2020) and others have called a ‘virus of silence’, as government healthcare workers are not readily able to voice their concerns. Issues of (mis-)trust and lack of information are once again apparent in the COVID-19 epidemic. Lastly, Russia is forging attempts to strengthen its role in global health governance during the pandemic, namely through vaccine development. At the time of writing this article, Sputnik V has been approved for emergency use in several other countries, for example Belarus, Argentina, Serbia and the United Arab Emirates.

At the same time, some other factors required Russia to have a more novel approach to its response to COVID-19. The main one being the flow of information in today’s global world, including greater availability of information via the digital world. The spread of false information on social media, often with the intent to undermine the public’s trust in science and medicine, has been a major problem around the world (see for example, Wardle & Singerman, 2021). Russian government officials have dedicated resources and time to combating the infodemic and calling attention to the risk of disinformation being spread about COVID-19. The federal government has been running its own social media campaigns to inform people and address myths and potential barriers to utilisation of services. At the same time, people have more information about what is happening and what the authorities are doing, in contrast to the USSR, where information was usually very closed. Control over the epidemic has also meant control over the spread of information, evidenced in part by the centralised reporting system of COVID-19 cases and deaths and the most recent attempts to use a centralised approach to inhibit doctors from speaking about the epidemic.

Russia continues to battle the spread of the virus as well as the spread of disinformation. It will also be important to continue examining the role of healthcare workers, both in treating patients but also in finding ways to voice concerns over the healthcare capacity to address the newest surges in COVID-19 cases. The contention over statistics and concerns over the rush to approve a vaccine are both areas that create an environment ripe of public mistrust. We know from past and current epidemics around the world that mistrust is a critical issue to address in order to successfully intervene. As the COVID-19 pandemic continues to be a major global health threat, policymakers are confronted with important decisions that have been highly politicised, domestically and globally. Russia is not an exception to this, and its response to the pandemic will likely have implications both for its own growing COVID-19 epidemic, and for the global health sphere as well.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 In February 2021, Rosstat reported that there were 17.9% more deaths in Russia in 2020 than in the previous year; however, no official cause of death has been cited for more than half of the 323,802 excess deaths in the country (Lomskaya, 2021).