Are Kremlin politics bad for Russia?

“I don’t even know what is going on,” President Vladimir Putin complained to ministers last month, exasperated that even “well-educated people, with higher degrees” continue to refuse Russia’s Covid-19 vaccination. “Why wait for the disease and its severe consequences?”
For an administration obsessed with demographics, scientific reputation and global status, the blow has been devastating. With far too few citizens vaccinated, Russia suffered the deadliest September since World War II, and daily cases have kept rising. The Kremlin has been forced to impose a “non-working” week until November 7, with Moscow introducing a partial lockdown. Not for the first time since Putin came to power just over two decades ago, promising to reverse a demographic decline, political imperatives have hampered public health.
Russia was first to approve a coronavirus shot in 2020, to great fanfare, and has had one of the longest inoculation campaigns globally. Real world data suggest the shot is effective. Yet only roughly a third of citizens are fully vaccinated, a level far below Europe and the United States; the number of Russians who say they are not ready to get the shot has decreased, but is still 45%. After slowing over recent months, the rate of vaccination only began to speed up during October’s surge. Other parts of the world are also seeing cases rise as winter sets in, but inoculation has limited the damage. Meanwhile, Russia’s daily deaths have been at their highest level yet.
What’s behind the crisis? At the most basic level, competing Kremlin priorities have condemned the country to fight the virus for far longer than many of its rivals. Strong fossil fuel prices will blunt some of the economic consequences for Russia, but the impact on its consumers and society will linger. Between October 2020 and September 2021, excluding the effects of migration, the population
declined by close to a million people, according to
independent demographer Alexei Raksha.
All governments find it hard to change course. But authoritarian states in particular have found themselves pinned down. China remains trapped in its efforts to keep Covid-19 cases at zero, imposing draconian quarantines and accepting heavy social and economic costs to prolong a state that will prove impossible to maintain. More than 30,000 people were locked in and tested at Shanghai Disneyland, after one visitor a day earlier triggered a contact tracing drive. At least that harsh approach has saved lives. The same cannot be said of Russia.
Under Putin — for whom population is a proxy for might — there have been improvements to public health, even if spending remains muted in absolute terms and as a percentage of gross domestic product. The number of hospitals was rationalised, rebalancing the skewed Soviet-era distribution of resources; the proportion requiring major repairs shrank from 27% in 2000 to just under 17% in 2018. Much of the benefit accrued to Moscow and other big cities, but it’s still significant.
Consider efforts to encourage births. Improving conditions for women at home and at work, plus quality childcare, have made a difference elsewhere. In Russia, however, where Putin has positioned himself as a protector of conservative and family values, domestic violence was partially decriminalised in 2017 and abortion has been restricted. He has focused his efforts on welfare payments like “maternity capital.” The birth rate is shrinking.
Or consider efforts to tackle HIV/AIDS, hampered by the same social conservatism, the increased influence of the Russian Orthodox Church, efforts to marginalise crackdowns on non-governmental organisations. Adjusted for population, 2020 numbers suggest a rate of infection ten times higher than that in European Union countries. Most cases come from heterosexual contact.
A similarly toxic political combination has played out with Covid-19.
For one, although Russia’s system is one that centralises power and resources, Putin devolved pandemic responsibility to the regions. The result has been dramatically uneven. Judy Twigg, a professor at Virginia Commonwealth University who studies Russian politics and health, points out that regions with stronger leaders did better as they were more willing — and able — to test out their own ideas for Covid-19 prevention and vaccination. In Belgorod, a region to the south of Moscow, a strategy of paying medical workers to boost jabs yielded much higher vaccination rates, and fewer hospitalisations.

—Bloomberg