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In August 2020, Russia became the first country in the world to approve a COVID-19 vaccine. One year later, just . With such a low vaccination rate, a summer surge in infections has produced the highest death rates since the pandemic began. According to official figures, since mid-July close to , and these numbers are almost certainly undercounted.

While other countries have struggled to meet vaccine demand, Russia has faced the opposite problem: an excessive supply, resulting from tepid uptake among a deeply hesitant population.

English-language coverage of the failures of the Russian rollout has focused largely on concerns about in the vaccine development, the prevalence of , and fear mongering by the media.

Each of these factors plays a part, but Russian-language research (Natalia Mukhina, one of the co-authors, translated the Russian-language research for this article) complicates this picture, highlighting the importance of attending to both the historical roots and contemporary specificities of public health challenges.

From passive subjects to responsibilized consumers

In the former Soviet Union, there was no room for vaccine hesitancy. The was massive and mandatory. It was also , mobilizing domestically produced vaccines to eradicate polio, smallpox, measles and a host of other communicable diseases.

This approach to vaccination started to change in the late 1980s, when the last Soviet leader, Mikhail Gorbachev, launched that would loosen the stranglehold of the authoritarian regime and open a path for the free market.

For the first time in almost seven decades, people were allowed to criticize the Soviet way of life, including the health-care system. Then, during the 1990s, foreign vaccines gradually became available, and new laws required citizens to consent to any medical procedure, .

Citizens in what was now post-Soviet Russia went from being passive recipients of state-controlled health-care interventions to , who, if they had the necessary resources, could make choices about how to protect their health.

Vaccine skepticism, which was intensifying globally during the 1990s, became . But mistrust was rampant across the political spectrum, and vaccine decision making became an arena for the enactment of resistance to the state, even for Russians who believed in vaccines.

Mistrust and marginalization

It is within this context that Russian sociologist Ekaterina Borozdina cautions that public hesitancy about Sputnik, the Russian COVID-19 vaccine, is not “.” Rather, hesitation or refusal to get vaccinated emerges in the context of fraught relations between citizens and the state.

In , Borozdina reveals how perceptions of a technocratic, heartless and incompetent government bureaucracy shape the attitudes of Russian parents towards the vaccination of their children.

For educated and economically privileged citizens especially, postponing vaccination, following an alternative schedule, or choosing a particular make of vaccine to be delivered at a particular clinic, are all ways of asserting choice and delineating their independence from the state as they protect what they believe to be the best interests of their children.

Sociologist Anna Temkina further complicates the picture. She says the educated middle classes, a demographic which overlaps significantly with the “activist classes” opposed to the Putin regime, . These dissidents make the argument that not everything emerging from the government is bad, and they try to break the link between what they see as a corrupt and oppressive state and effective epidemiological measures.

It may seem surprising that the most enthusiastic consumers of the vaccine are the economically privileged who have the benefit of being able to work from home, but Temkina explains that those who are “indifferent” to vaccines are the couriers or cashiers who worked through the pandemic and “.”

At the same time, the massive population of migrant workers in Russia who may want protection have largely been denied access — even as Putin offers foreigners the chance to .

Regaining trust

The latest spike in infections has prompted a slight improvement in vaccine uptake, but mistrust is not an easy thing to fix and Russians are once again facing as part of an effort to jumpstart the campaign.

This time, the responsibility for enforcement has been offloaded to employers. And employees are finding creative ways to circumvent the new policies. The lengths to which people go to obtain may make for lighthearted news coverage, but is an indication of a historical context worth taking seriously if we are to make sense of the challenges ahead.

, Professor, Kinesiology and Health Studies, and , PhD Student, Kinesiology and Health Studies, .

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