In early October, as the second wave of Russia’s Covid-19 pandemic gathered strength, the bosses of central Moscow’s Clinic Number 3 instructed their employees to receive Sputnik V, the Russian-developed coronavirus vaccine starting a mass rollout this week.
“I hereby order the vaccination of all staff members,” said the document seen by The Moscow Times and signed by Elena Samyshina, the clinic’s chief doctor and a lawmaker on Moscow’s City Council.
While compulsory vaccination of frontline health, education and social workers is already underway, many of the medical professionals with priority access to Sputnik V are deeply sceptical of it.
The Moscow Times interviewed 12 medics based in the capital, most of whom expressed reluctance — or outright refusal — to take a vaccine that has not yet passed sufficient trials for international clinical approval and was greenlighted based on results from much smaller groups of volunteers than its Western counterparts.
Some said their managers told them they could be sacked for refusing the vaccine.
“We’re being offered the opportunity, or rather forced, to take it,” said Polina, a 23-year-old student doctor who works shifts at Covid hospitals.
“If I had a choice, I probably wouldn’t take it since I don’t trust the vaccine … but I guess I’ll have to do it.”
For many doctors, the central concern is the lack of publicly available information from the vaccine’s developers.
“I’m not saying the vaccine is bad, but I’m not happy with the limited information we have about it,” said Roman Stroganov, a surgeon at Moscow’s Clinical Hospital Number 50 who has been treating Covid-19 patients from the start of the pandemic.
“It has really been pushed on us from above. The doctors who are taking it now need to have clear insurance policies and not to be told the trials haven't even finished yet.”
Polling data suggests such fears are widespread within the Russian medical profession. In August, shortly after the Russian vaccine was first given regulatory approval, a survey by Spravochnik Vracha (Doctor’s Directory) — a medical reference app widely used by Russian doctors — found that 52% of those questioned would refuse to take the vaccine, with only 25% of respondents willing to do so.
These results were echoed in a September study by Doktor na Rabote (Doctor at Work) — a social networking site catering to Russian medical professionals, which found 50% of respondents rejecting the vaccine to 24% expressing openness to it.
Phase 3 trials for Sputnik V are less advanced than other vaccine candidates. But as Western pharmaceutical companies started to publish strong results from their mass trials, Moscow responded, pushing out data on the efficacy of its own vaccine within hours of Pfizer's first landmark announcement.
Moscow's analysis, however, was conducted at a much earlier stage of the trials. Russia first published interim results on Sputnik V’s efficacy — calculated by comparing infections among volunteers who were vaccinated with those who were administered a placebo — after it had found just 20 confirmed coronavirus infections. Its latest analysis, which shows a 91.4% efficacy, was based on 39 confirmed cases.
Western pharmaceutical giants had deemed such numbers too small for reliable analysis. Both Pfizer and Moderna, for instance, did not publish interim results until they had more than 90 confirmed infections — and have now published information on 170 and 194 cases, respectively.
Despite the skepticism, more than 50 countries have already asked to buy or produce Sputnik V, and scientists in Britain have said that the early results were "consistent with what we see with other [adenovirus-based] vaccines,"
According to doctors, the Russian medical community’s skepticism reflects specific doubts about the development process behind Sputnik V rather than a general aversion to vaccines.
“Doctors are not anti-vaxxers — I am sure they would be keen to take the Western Pfizer vaccine,” said Yaroslav, a cardiologist and adviser to Russia’s Health Ministry who spoke on condition of anonymity.
“The main reason for the distrust of the vaccine is that doctors haven't seen the Phase 3 results yet. The preliminary results have been promising, but without the full data how can we even talk about the quality of the vaccine?”
According to Alexei Levinson, director of the Socio-Cultural Research Department of the Levada independent pollster, medics’ caution over the vaccine is partly rooted in long-term problems, as cuts to the health system over the last decade have alienated staff members.
“There has been a rift between the medical community and the authorities,” he said.
“It started before the coronavirus — over the last decade Russia has made severe cuts to medical staff, which were handled very poorly.”
According to Levinson, the coronavirus has been the final straw for many medics, as their position on the frontline of the pandemic exposed them to the deficiencies of Russia’s healthcare system.
“During the Covid crisis things only got worse, when the Health Ministry and local hospital directors took the side of the authorities when doctors and nurses started speaking out about the dire conditions they were in.”
The result has been a serious erosion in trust among medical professionals. In July, a Levada poll indicated that 60% of Russian doctors do not believe the official coronavirus figures published by the authorities.
And in a further sign of mistrust, Russian and Belarussian doctors in April launched an unofficial list of their colleagues who have died from the virus.
“Our vaccine doesn’t have, to put it mildly, the best evidentiary basis,” said Pavel Brand, the director of Klinika Semeynaya, a chain of family clinics in Moscow.
“But the total lack of trust toward the Health Ministry also plays a big role. Distrust of Russian-manufactured medicines is growing all the time,” he added.
Even among those doctors who do back Sputnik V, there is a strong feeling that vaccination should not be compulsory for medical staff.
“I don’t see anything to worry about,” said Pavel Korolyov, a urologist at Hospital No. 67 who took part in Sputnik V trials.
“The main thing is to keep this whole vaccination business voluntary.”
Skepticism concerning a coronavirus vaccine is far from unique to Russia. A recent study of global attitudes to vaccines published by The Lancet showed suspicion toward vaccines on the rise across much of the world, posing clear issues for the coming global effort to eradicate the coronavirus.
However, the depth of vaccine scepticism among the Russian medical community is a unique challenge for a nationwide vaccination push.
Though most countries, including the U.K., are planning to rely on doctors — traditionally one of the most trusted professions — to whip up public support for the vaccine, many Russian doctors are unlikely to be willing to front a public relations campaign.
“It says a lot that Russian doctors don’t trust the vaccine,” said cardiologist Yaroslav.
“If we don’t trust it how do we get the general public to trust it?”
Since the August announcement that Sputnik V had received regulatory approval, Russian public opinion has been sceptical of the vaccine hailed as the world’s first anti-coronavirus inoculation.
In October, the state-run RIA Novosti news agency reported that polling conducted for the ruling United Russia party showed that 73% of Russians were not prepared to take the vaccine.
Levada’s Levinson believes public distrust of the Russian vaccine has deep cultural roots that have been exacerbated by the pandemic.
“Traditionally, Russians prefer foreign medicines over Russian-made ones,” he said.
“This is something that has been ingrained in the mentality for decades. In a pharmacy, the staff will usually recommend a foreign drug over a Russian one.”
Levinson’s research suggests that around two thirds of the Russian population disbelieve official coronavirus figures, believing them to be either exaggerated or understated.
“In this climate, anything that comes from the government is treated with suspicion,” said Levinson.
This sharp decline in Russians’ trust of the state has shown up in international studies. The 2020 edition of the Edelman Trust Barometer — an annual report into how far people trust their fellow citizens — placed Russia 26th of 26 countries for social trust.
Crucially, many Russians do not see the pandemic as serious enough to merit taking a vaccine they regard as suspicious.
With the authorities having shrugged off suggestions of a new lockdown amid the pandemic’s second wave, much of Moscow is functioning as normal, with restaurants and bars open during the day.
“We noticed there is no massive panic around the pandemic,” said Levinson.
“People are thinking about the virus, but life goes on and few are desperate to take the vaccine.”
Doubt about the vaccine has even been expressed by prominent doctors fronting the government’s coronavirus strategy.
In October Alexander Myasnikov, head of Russia’s Coronavirus Infocenter, said in a radio interview that the vaccine will not stop the pandemic.
“We don’t know how effective it really is,” he told Radio Komsomolskaya Pravda.
Levinson also believes that Sputnik V’s rapid rollout has further eroded confidence among healthcare workers who have a “professional understanding” of the corners cut during the vaccine’s approval process.
For most of the doctors who spoke to The Moscow Times, many of whom said they had already had Covid-19, the main concern is Sputnik V’s rushed deployment.
“I won’t take the vaccine,” said Lilya, a 23-year-old medical student at Moscow’s First City Hospital.
“I don’t trust it, the risks seem to be bigger than the benefits. None of the doctors I know want to take it.”