Low uptake in Russia of the country's domestically manufactured COVID-19 vaccine Sputnik V reflects systemic mistrust in vaccination and the state health-care system. Ed Holt reports.

Despite being the first country in the world to register a COVID-19 vaccine, Russia's own vaccination campaign is faltering amid problems with vaccine hesitancy, supply issues, and even high rates of infection possibly affecting uptake, local disease experts have said.

Russian authorities registered the Sputnik V vaccine, produced by the Gamaleya Research Institute, part of Russia's Health Ministry, in August last year. But despite beginning a mass vaccination campaign in December, and approving two other domestic vaccines (EpiVacCorona and CoviVac), vaccination rates remain notably low compared with many other countries.

Although official statistics for SARS-CoV-2 infections and COVID-19 deaths are released daily, federal authorities are not regularly making public any data on vaccinations, although government officials and state institutions make statements on vaccination rates from time to time. On April 26, Deputy Prime Minister Tatiana Golikova said 11·9 million people, or around 10% of Russia's adult population, had received at least a first dose of a COVID-19 vaccine. According to the Our World in Data vaccination tracker, as of May 11, Russia had administered 14·93 doses per 100 people, compared with 39·29 per 100 people in the EU and 78 per 100 people each in the UK and the USA.The reasons behind the low rates of vaccination in the country are varied, local disease specialists say. Surveys since the start of the mass vaccination programme have shown that many Russians are reluctant to get vaccinated. Research by the Levada-Center published in March showed that 62% of Russians did not plan to get vaccinated. Such widespread aversion to vaccination is unsurprising, said Vassiliy Vlassov, an epidemiologist at Moscow's Higher School of Economics University. “Vaccine hesitancy is quite prevalent in Russia. There are anti-vaxxers here and some journalists and influential people, even medical people, dance to the antivaxxers’ tune.”A general mistrust in the population of vaccines for any disease and towards the state health-care system, rooted in childhood experiences of Soviet health care, is another factor behind apparent hesitancy. “It is not common for adult Russians to get vaccinated for anything, COVID or any other disease”, said Anton Barchuk, an epidemiologist at the European University at St Petersburg.

However, there is not just hesitancy among the general public. Research last year suggested as many as 50% of doctors were unwilling to take the vaccine. It is unclear whether there remains such high scepticism among Russian doctors today. Some do not think so. “The general message from doctors is that you should get the vaccine”, said Barchuk.

But others say there are many doctors who will not take any COVID-19 vaccine themselves nor recommend patients do so. One doctor who works at a private medical facility in Novorossiysk told The Lancet Infectious Diseases that he would not be getting vaccinated because he was deeply sceptical of the benefits of “Sputnik V or any other so-called COVID-19 vaccine” and the motives of pharmaceutical companies, politicians, medical institutions, and the global media in promoting their use. The doctor, who spoke on condition of anonymity, said: “I know other doctors will disagree, but I also know many who do agree with me”.

But hesitancy is not the only issue affecting uptake. Whereas people in cities such as Moscow and St Petersburg can get vaccinated with relative ease—walk-in vaccination centres have been set up in many shopping malls—in more remote places, the situation is more difficult. Russian media have reported shortages in regions outside major cities, with some describing this as a “systematic problem” that temporarily halted vaccinations in some areas.

Demand for the vaccine abroad—as of April, Sputnik V had been approved for use in 60 countries—is also believed to have contributed to shortages at home. “There has been demand for Sputnik V in other parts of the world, and it has been sent to many countries, even though there may be problems with not having enough in Russia”, said Vlassov.

It is also thought that the extent of the spread of COVID-19 among the population and misconceptions over post-infection immunity might be behind low vaccine rates. Studies by Barchuk and colleagues using antibody testing showed that in February there was evidence that up to 50% of people in St Petersburg had the disease, compared with 24% in November. He said that individuals infected during the winter months—when the vaccination programme was first being rolled out—are still waiting before they can get their jabs. Many doctors recommend people should not be vaccinated before at least 90 days after infection. But Barchuk also said, “there is this idea among the lay population that once you have been infected you don’t need to get vaccinated”, and that this might be contributing to low vaccination rates.

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DOI: https://doi.org/10.1016/S1473-3099(21)00277-2

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