“Our clinic has been issued with a compulsory anti COVID-19 vaccination order for all employees. This is being supervised by the Moscow health department,” Olga Tsvetkova, deputy chief medical officer at Moscow’s Clinic Number 3, announced in a message to staff in October.
“If you refuse to get vaccinated, you could be suspended from work. There is a legislative basis for this,” she wrote in the WhatsApp message seen by Reuters, without elaborating.
Asked to comment, Clinic Number 3 said Moscow is one of the few regions where healthcare workers are given the opportunity to be vaccinated against the coronavirus, and the order to vaccinate employees of the clinic shows the degree of care it takes.
“The decision on vaccination is made by employees voluntarily and only after passing a medical examination,” it said in a statement.
Moscow’s health department did not comment on that order.
Savulescu, the Oxford professor, said a vaccine can be ethically rolled out while clinical trials are still underway if there is enough evidence it is safe. “If you have reached that point, then, it is possible to justify a mandatory policy,” he said.
He added that without knowing the safety data on Sputnik V, it was not possible to comment on Russia’s decision. The trial organisers have said there were no unexpected adverse events so far and monitoring of the participants is ongoing, but detailed safety data has not been published.
Mandatory vaccination is common in the US healthcare industry; the US Occupational Safety and Health Administration (OSHA) has said in the past that employers have the right to mandate vaccines. In Europe, there is a patchwork of national vaccine regulation. Some countries mandate childhood vaccinations, but experts say employers overall are unlikely to be able to do so for staff.
The world community has established norms for ensuring ethical participation in clinical trials. According to guidelines in the World Medical Association Declaration of Helsinki, used by most countries globally, individuals taking part in clinical trials must be capable of giving consent, informed of all aspects of the trial that are relevant to them, and taking part voluntarily.
Russia has adopted a different set of internationally agreed guidelines – from the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH). These also say participation must be voluntary.
The process includes signing an informed consent form. In Moscow, participants sign a similar 16-page document which says participation is voluntary, unpaid, and that “it is impossible to exclude the possibility of the development of an unexpected undesired effect.”
Staff in Martyanov’s department, like others who work for institutions that are financed from the Russian state budget, are known as ‘budzhetniki,’ or ‘budgetniks.’ Their ranks are often described in Russia as a reliable tool for the Kremlin when it needs large numbers of people to participate in projects such as voting in elections or referendums.
Sociologist Denis Volkov, deputy director of the Levada-Center, an independent opinion and sociological research organization, said many Russians with government-funded jobs feel duty-bound to deliver what the government wants as part of a social contract between them and the state.
“You are asked by the state, and in exchange it takes care of you and provides you with financial prosperity,” he said. “It is a delicate game. They won’t force you but will persuade you, convince and give recommendations.”
According to recent estimates from the Federal State Statistics Service, there are almost 19 million budzhetniki working in jobs in areas such as schools, hospitals, or municipal hygiene in Russia. That’s 26 percent of Russia’s working-age population of just under 72 million.
At a clinic in Solntsevo, a neighbourhood of high-rise apartment blocks on Moscow’s outer edge, five people turned up to join the trial over the course of an hour. All five, approached by Reuters, said they didn’t actually want to take part but had felt they had to – they were among the nine public sector workers who said their bosses had pressured them to take part.
“They herded us in here,” one middle-aged emergency services worker said. His whole team was told they had to sign up, he said. “It’s impossible to say no, you just can’t.”
Moscow emergency services said participation in vaccination trials was “absolutely voluntary, there was no coercion against the personnel,” and so far 101 volunteers have been vaccinated.
A teacher said that the school where he worked had been allocated a quota of trial spots, but it was more than simply an invitation to take part.
“If they say you have to come, you have to come,” the teacher said, adding that 17 staff members signed up.
Two hospital workers said they had been sent by their employer. And a worker with a street-cleaning company said he and his colleagues had been told participation was compulsory because they come face-to-face with city residents in the street.
Asked if he could decline, he laughed: “No, we work for the public sector.”
All five people at the clinic were ultimately deemed ineligible, so they wound up not receiving the shots.
But one woman aged around 50 at Polyclinic Number 68 in central Moscow took a different view. She said her employer had compelled her to attend, but she had only turned up to exercise her right to formally refuse a jab.
“I don’t want to be a guinea pig,” she said.
Most Muscovites Reuters spoke to were keen to join the trials. Asked about side effects, some volunteers who had already had one of the two-jab doses variously described feeling drowsy and said their temperatures briefly rose at the start. None reported any serious impact.
At Clinic Number 68, a worker with state bank PJSC Sberbank, the largest lender in Russia, said he was offered the vaccine at work and that the first stage of the process – the medical exam – could be done in the company’s office. Sberbank said it had actively supported the vaccine development and employees could volunteer for trials but no medical exams took place in its offices.
“You don’t need to go around the different clinics. If you want (to be vaccinated) – go ahead. If you don’t want to – so be it,” he said. “I didn’t see any downsides.”
Anton Shirkin, a park worker, said he decided to participate because he frequently visits his elderly parents and because “ultimately, someone has to do it.”
Reporting by Polina Ivanova, Rinat Sagdiev, Gleb Stolyarov in Moscow and Kate Kelland in London; with additional reporting by Maria Tsvetkova, Vladimir Soldatkin, Polina Nikolskaya and Anton Zverev in Moscow and Marisa Taylor in Washington; Edited by Sara Ledwith