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Logistical Challenges Make Russia’s COVID-19 Vaccination Campaign A Matter Of Trust

A nurse holds a pack of Russia's Sputnik-V vaccine against COVID-19 during a vaccination in Kaliningrad on December 4, 2020.
A nurse holds a pack of Russia's Sputnik-V vaccine against COVID-19 during a vaccination in Kaliningrad on December 4, 2020.

Less than a week into Russia’s launch of the world’s first wide-scale COVID-19 vaccination campaign, questions persist about whether the Russian government and vaccine producers can ensure that the country’s Sputnik-V vaccine will actually reach most high-risk Russians.

For a country ranked fourth in the world for cumulative COVID-19 infections (over 2.46 million since March 2020), the answers to those questions could prove key.

In an October 2020 poll, 59 percent of 1,601 respondents told the independent Levada Center that they would reject a coronavirus vaccine, even if free and not compulsory.

Whether the government can reverse those misgivings is unclear. On top of a national shortage of prescription medicines and hospital beds, it now faces the logistical challenge of vaccinating roughly 3.5 million people – high-risk medical professionals, teachers, and social-welfare workers -- across 11 time zones.

So far, officials are emphasizing speed. On the weekend of December 5-6, just a few days after President Vladimir Putin’s December 2 call for a national vaccination campaign with Sputnik V, some 2,000 people in Moscow, the hub of Russia’s pandemic, received free, initial doses of the two-dose Sputnik-V vaccine, Moscow Mayor Sergei Sobyanin announced.

But the campaign appears to have started before details for the national vaccination campaign were finalized.

In Moscow, a city of some 12 million people, 70 city-run polyclinics are vaccinating at-risk individuals – a number the mayor’s office hopes to expand to 170 by the start of 2021.

In one of these 70 vaccination points, Polyclinic #6 in Moscow’s central Savyolovsky district, an entire floor has been set aside for vaccinating patients. During Current Time’s December 7 visit, however, the floor appeared to be entirely empty.

A noticeable line of people was waiting to be registered for the injections, however.

Sobyanin has stressed the need for patience with the immunization campaign, yet he already has announced that Moscow is equipped to move on to “mass vaccination” – if doses of Sputnik-V are available.

But some experts urge caution in making assumptions about production or deliveries of Sputnik-V.

Immunologist Nikolai Kryuchkov believes that Sputnik V's five Russian producers (the state-run Gamaleya National Center of Epidemiology and Microbiology, which developed the vaccine, plus pharmaceutical firms Binnopharm, R-Pharm, Generium, and Biokad) will not be able to manufacture sufficient quantities of the vaccine to meet domestic demand for at least the next six months.

“We have a single serious way out: attracting foreign production sites [to work] under contract for the massive release of the vaccine,” said Kryuchkov, general director of the Moscow-based Clinical Excellence Group, which conducts clinical trials.

How many vaccine doses Russia already has appears to be a toss-up.

On December 2, President Putin declared that over 2 million doses of Sputnik-V – enough to inoculate 1 million people -- had been produced “or will have been produced in the next few days.”

A day before the president’s remarks, however, Deputy Prime Minister Tatyana Golikova, who is overseeing the vaccination campaign, had stated that just 168,000 doses of Sputnik V were available for civilian immunizations.

By contrast, two unnamed sources in the Russian government and pharmaceutical sector have told the independent news outlet Meduza that 500,000 doses are in storage.

A larger problem is whether both doses of the two-dose vaccine are equally represented there. The second dose must be taken 21 days after the first for the vaccine to be effective.

An anonymous source from the management of one Sputnik-V producer told Meduza that, while the first dose poses no production problem, supplies of the second dose, based on a separate adenovirus, are “insufficient."

Russian medical facilities reportedly also face a potential challenge with storage temperatures.

The frozen version of the Sputnik V vaccine requires storage at a temperature of at least -18 degrees Celsius, while the freeze-dried version needs a temperature of 2 to 8 degrees Celsius.

Most Russian vaccines are stored at 2 to 8 degrees Celsius, but not every Russian medical center has the equipment necessary for storing the frozen version of Sputnik-V, Mikhail Kostinov, head of the vaccine laboratory at the Mechnikov Research of Vaccines and Serums, told the RBK news agency.

Transportation is a further hurdle. One logistics specialist, Stanislav Bulygin, quality-control manager for Retail Transport Agency, estimated that cargo trucks can each transport around 300,000 doses of the freeze-dried Sputnik-V to points within Russia. But ensuring a temperature of -18 degrees Celsius for the frozen version is still a “new process,” Bulygin told the Russian logistics-news site

That does not appear to have given pause to Deputy Prime Minister Golikova, who has predicted that Russia’s regions will start their own vaccinations by December 11.

The daily Kommersant reported on December 7 that most regions claim to be preparing for the vaccine’s arrival, but that some will not begin immunizations until early 2021. A few others could not or did not specify when they will receive doses of Sputnik-V.

So far, international deals to bolster production of Sputnik V, brokered by the Russian Direct Investment Fund (RDIF), also appear to be in the startup phase.

Companies from India and South Korea, both key emerging vaccine manufacturers, have agreed to produce 100 million and 150 million doses of Sputnik V per year, respectively. RDIF, Sputnik V’s financial sponsor, also includes Brazil, China, Saudi Arabia, and Turkey in this list, but production agreements have not been made public.

Belarus, Kazakhstan, and Uzbekistan -- three countries with close financial or economic ties to Russia but no extensive international experience as vaccine manufacturers – complete the roster. The exact quantity they will produce, beginning in late December at the earliest, is unclear.

But these unknowns have not delayed Russia’s so-called “vaccine diplomacy.” The government claims that more than 50 countries have expressed interest in Sputnik V. Total demand amounts to over 1.5 billion doses, foreign ministry spokeswoman Maria Zakharova estimated.

Officials emphasize to potential international markets that, at less than $20 for two doses, the vaccine, touted as 95-percent effective, is more price-competitive than those from the Western companies Pfizer and Moderna.

The Kremlin maintains, however, that vaccinating Russian citizens remains its “[a]bsolute priority.”

Some Russian medical professionals say they know that only too well.

The Alliance of Doctors trade union, an outspoken Kremlin critic, claims that employees from “around” four municipal polyclinics in Moscow – polyclinics #214, #3, and two unnamed facilities-- have ordered their employees to take the Sputnik-V vaccine or risk dismissal.

Those who express misgivings about the vaccine’s reliability, given its incomplete trial results, are “called on the carpet” and reminded that they are obliged not to infect others, said Alliance of Doctors Chairwoman Anastasia Vasiliyeva.

Vasiliyeva speculated that the these orders, also issued in writing, may come from the Moscow city health department “or higher up.”

As yet, though, the scale of these dismissal threats is unclear.

“For now, these have been only words,” Vasiliyeva said. “So far, we don’t see real results [from these orders], but the psychological pressure is quite serious.”

On December 3, the Moscow city health department denied that employees at one of these clinics, Polyclinic #3, had been forced to take the vaccine or had been fired for refusing to do so, Interfax reported.

In the education sector, Russian teachers, another high-risk group, have not yet faced any such stipulations, according to Vsevolod Lukhovitsky, co-chairman of the Uchitel (Teacher) interregional labor union for education professionals.

Although many teachers question the vaccine’s reliability, generally, “disciplinary measures are not used” against teachers who refuse any mandatory vaccines, he added.

Ultimately, though, the main issue for Russia’s Sputnik-V vaccination drive lies elsewhere, Lukhovitsky said. Rather than the vaccine’s reliability, it is “how much do we trust what our authorities say.”