Online Event: The Scramble for a Vaccine: Putin's Sputnik V— "Trust me!"

J. Stephen Morrison: Hello and welcome to today’s one-hour CSIS program, The Scramble for a Vaccine: Putin’s Sputnik V – “Trust me!” I’m J. Stephen Morrison. I’m senior vice president here at CSIS, where I direct our Global Health Policy Center. This session today is part of the work of the CSIS Commission on Strengthening America’s Health Security. That commission began in 2018. It’s continuing into 2022. It’s co-chaired by former Senator Kelly Ayotte and former CDC Director Julie Gerberding.

Today’s event is part of a series begun earlier this summer around the development of vaccines for the coronavirus. It follows an earlier session on July 11th on the COVAX facility. There is an issue brief that we put out that’s on our website about that COVAX, “Is It Possible to Avert Chaos in this Vaccine Scramble?” That would be on the 6th of August. And there was a public event that we did, The Scramble for Vaccines and the COVAX Facility, and a podcast that accompanies it. You can find all of those.

This also builds more directly to what we’re doing today on Russia and work that we’ve done. I was joined by Judyth Twigg and Heather Conley on a podcast that we put out on the 14th of August, “Coronavirus Crisis Update: Putin’s Sputnik V Vaccine – “Trust Us!” This even here is a follow-on to that. Judyth and I published a commentary on the 21st of August, “Trump and Putin’s Pandemic Duet: Trump’s America is Far More Out of Tune.” You can find all of these products on the CSIS website. I want to offer special thanks to the many people who helped us put this together today – Anna Carroll, Amith Mandavilli, Michael Rendelman on my staff, on the production side of things Clifton Jones, Travis Hopkins, and John Monts have all been very instrumental and very helpful in doing this.

We have three very distinguished expert speakers with us today: Heather Conley, my colleague and friend, senior vice president for Europe, Eurasia, and the Arctic at CSIS, and director of the Europe, Russia and Eurasia Program; Judyth Twigg – Professor Judyth Twigg, senior associate with the CSIS Global Health Policy Center and professor at the Virginia Commonwealth University; and lastly, we’re really honored today to have Vasily Vlassov with us, professor and senior research fellow at the National Research University Higher School of Economics, St. Petersburg campus.

Let me offer some quick remarks and then we’re going to move into a conversation. We’re going to invite comments from the audience. If you care, on the program you can register comments or questions. We’ll collect those and try and work those into our conversation.

We’re concerned with Russia as it figures in the global race for a vaccine. On August 11th, Russia was the first country to register a vaccine, named Sputnik V, for use with human populations. Now that made for a very controversial decision, given that it was reached without the vaccine going through the standard phase three trials. It had domestic dimensions to it. It had geopolitical dimensions, in terms of competition for prestige and influence outside of Russia’s borders. We can talk more about that.

This raised a number of issues that we’re going to talk about today. We’re going to talk about how this action fits in the broader global context of the race – the scramble for a vaccine. On the domestic front, what was President Putin’s motivation? And how are things moving ahead? What’s the public reaction? What’s the scientific reaction. How’s the internal environment evolving? We’ll talk about the geopolitical environment external to Russia with respect to: How is this being received in other major powers? How’s it being received by WHO? And how about those countries that Russia is courting to join it, for both trial purposes but also for purposes of – hold on one second – for purposes of donating dosages? And finally, we’ll come in the closing segment around where does – where do we go from here?

Let’s start with the big picture. And I’m going to say a few words and then I’m going to ask our speakers to jump in. Today, over 30 vaccines across the world are in human trials, and many more expected in the next year. The number will probably triple, in fact. The U.S., the EU, the Japanese, and the U.K have already made advanced purchases that have locked down future production of 3.7 billion doses. That’s a large sum, but it shows you the power and muscle of the wealthiest countries in the world.

Operation Warp Speed, the U.S. operation, has put a bet on six major candidates, over $10 billion. AstraZeneca, Pfizer, and Moderna are entering phase three trials right now. Others will follow later this year. President Trump, like President Putin and President Xi, very eager to begin delivery of millions – of tens of millions as soon as possible. And President Trump has said he wishes to do this as early as possible, as close to the election as possible.

Pressures are mounting here in the United States on the Food and Drug Administration to give an emergency use authorization to the AstraZeneca vaccine. There’s worry and ongoing debate as to whether FDA will come under undue intense political pressure, and whether politics will trump science in this decision. While the U.S. has been very cautious about what it says about Sputnik V, it might reach a decision soon that looks somewhat similar to the decision that Putin has come with.

So I want – this is a – this is an environment that is – that is moving forward very, very rapidly. China has four vaccines in final stages of field trials and has announced it’s beginning to administer those to its military, and may move ahead with other populations on an emergency basis. And China has promised doses to Pakistan, to Brazil, and Indonesia, where field trials are underway. India, the Serum Institute of India, has a billion doses ongoing from AstraZeneca. Half of that will go towards India’s population. And AstraZeneca, and the industry itself, has reached out – 100 million locked down for Brazil, 250 million licensed for Argentina and for Brazil.

So this is a highly, highly fluid, fast-moving situation that Russia has chosen to enter into. It’s a very, very crowded space. Let me just turn quickly to ask Vasily, Heather and Judyth for just a quick thought on the big picture. How do you see this big picture, and have I gotten I correct? Vasily?

Vasily Vlassov: I think that we have to look at it from two sides. The first side is historical and international, and the second is internal and modern. The historical, 60 years ago the States and Soviet Union started on a very similar German rocket technology. And when United States meddled with their Mercury suborbital flights, Soviet Union, after – (inaudible) – sent Yuri Gagarin right to the space. And Soviet Union became advanced successful country, and Sputnik became a world-known word. So cutting the corner is not a new business. Nowadays, again, the same technological base – very similar technological base in the State and in Russia. And again, Russians and Americans are cutting the corners to have the possibility to say that we are number one, and our system is greater, or our party is more effective.

So it is – it is very similar. This was 60 years ago, but this looks like the same. And from the modern and internal point of view for Russia, I believe that this step is very natural to now prove the vaccine, because it looks like – it looks like it is a vaccine. And it looks like it doesn’t kill people. And if you provide this vaccine, it will add some – (inaudible) – for the process of the normalization of life. And normalization of life, it’s what Russians want now, and probably not only Russians. People all around the world want normalization of life. So I think that these two aspects are most important for the way how we look at the Sputnik V.

Morrison: Thank you. Heather and then Judyth, any opening remarks in terms of the broad picture of the global scramble? Heather.

Heather A. Conley: Steve, thank you so much. Yes, absolutely. I mean, in some ways we had the race to the moon in the second half of the 20th century. We now – in an era of COVID-19, we have the race for the recovery. Which country will be able to recover first? And of course, vaccination is going to be a key element of a country’s ability not only to recover internally, but also to be able to help its allies, and its partners, and its friends. It becomes, in some ways, an attractive power to those who are urgently in need of that vaccine.

I think we’re also seeing where this is a race for regime legitimacy. And as we’re seeing across the board, how the legitimacy of a government is seen in handling the crisis is key. And the first one to get the vaccine could perhaps – that that leader will enhance their own legitimacy to preserve their power. And I think you can see that in both the United States as well as in the case of Russia.

Morrison: Thanks very much. Judy.

Judyth Twigg: Thanks very much, Steve. I’d just add to the points that have already been made by stating that this looks like a major step forward in Russia’s effort to overcome the inferiority complex that it’s had since the collapse of the Soviet Union. It was very interesting yesterday when President Putin gave his national speech to contribute to the celebration of the first day of school for Russian schoolchildren nationwide.

And he made the comment that it’s time for the international community to stop looking at Russia as just a gas station country, in other words a country whose only contribution to the global economy is through natural resource extraction through the sale of oil and gas. Putin specifically talked about how Russia’s scientific and technological capacity has been proven through its response to the COVID-19 pandemic and through the development of the Sputnik V vaccine. He’s proven where Russia stands, near the top of global contributors.

Morrison: Thank you. Well, let’s shift now and talk a bit about what’s happening internally within Russia. We know that there are similar forces at play in China, and the United States, and Russia, in terms of the scramble that you’ve all described. Looking inside what’s happening in Russia, let’s talk about what were Putin’s predominant motivations. I think, Vasily, you’ve given us a little hint at that in terms of the desire to normalize. And tell us a bit more about that. What is driving the motivation of Putin to make this such a centerpiece of his political career right now in this moment in time?

Vlassov: Thank you. I am not a political analyst, but my impression is that after the problematic process of the change in the constitution there is a big need – big need to prove this country’s going the right way. Second, September is the month of election in some regions of Russia. And people need to have some feeling of security. And right now, Putin is hidden in some underground space from where he’s speaking to the nation. So probably he even needs himself to go open to the public, but just he’s too afraid to go to the big congress like you have in United States, and to speak to lots of people in public. I think that it is the motivation to speed up the economy, to normalize the life of people, and to keep business as usual, as it was in 2019.

Morrison: Thank you. Let’s talk a little bit about how it’s been received in different populations. I mean, we have a medical community that’s been fairly vocal, and there have been specialized focused surveys of medical providers. There’s been broad public surveys that have been done. There’s an industry group of the association that does these types of vaccine trials that has been very vocal, and which has a global quality to it.

Judyth, tell us a little bit about the opinion climate within Russia and the reactions. How do we take the measure of what the reactions have been up to now among these different sectors, subpopulations within Russia?

Twigg: So thank you for framing the question that way, Steve, because I think it’s important to understand that there have been some slightly different reactions among different groups of the Russian population. Overall, with general public opinion, as Vasily indicated, Putin needed a win right now. His initial handling of the coronavirus pandemic in Russia was relatively passive. He wasn’t perceived as having been a forceful responder in the early phases of the pandemic. There were quite a few local or regional leaders in Russia who kind of took the lead in the pandemic response. Moscow Mayor Sergey Sobyanin probably first among those.

And so this was an opportunity for Putin to reestablish himself as the man in charge, with the big, splashy announcement of this vaccine. And over the last couple of weeks, since the August 11th announcement of the registration of that vaccine, there’s been mostly positive response among the general Russian public. And that’s understandable. It has been all over Russian state-controlled media. It’s been hard to avoid the positive propaganda coming out of the Kremlin about the vaccine.

But there has been some significant pushback among key specific professional groups. There has been some pushback among doctors – some online polling of doctors showing that a relatively small minority of them will actually give this vaccine to their patients. Some pushback among teachers. Teachers are one of the high-risk groups that is slated to receive early doses of this vaccine. And Uchitel, the main teacher’s union in the country, has said that it feels nervous about the possibility that there will be pressure for them to receive this vaccine, that in fact it won’t be voluntary but will be something like mandatory. And they have several thousand signatures now on a petition pushing back against the idea that there will be pressure for them to take the vaccine.

Right when the Sputnik V vaccine was registered a few weeks ago, there was a very forceful statement from the Russian Association of Clinical Trials Organization indicating that it was simply not acceptable to bypass phase three field trials in this manner. And then right around the same time, we saw the resignation of the head of the Ethics Committee of the Russian Ministry of Health. And we don’t want to falsely assign motive to that decision. I mean, he has not spoken out specifically against the registration of the vaccine. But the timing certainly looks like it was more than just coincidental.

Morrison: Thank you very much.

Heather, you’ve written and examined extensively sort of disinformation, misinformation campaigns. We know that the anti-vaccine forces are a globalized phenomenon. We know that social media’s going to be both an outlet of seeing if things aren’t working or are working. Tell us a bit about how you’re looking at that, interpreting what is happening internally.

Conley: Well, it’s not easy, but I think just to pull both the threads of what Vasily and Judy were mentioning, this is a really fraught political moment for the Kremlin. And it’s all moving towards September the 13th, where there will be municipal and regional elections across Russia. Over, I believe, 18 governorships will be decided. Major cities, like Arkhangelsk and Yakutsk will decide their leaders. And of course, this comes against the backdrop of the largest demonstrations we’ve seen in the Russian far east, Khabarovsk, where a very popular and elected governor was taken to Moscow for criminal charges. And we’ve seen week after week very large demonstrations.

You’re seeing in, of course, Belarus, where a fraudulent presidential election held on August 9th has now sort of confronted the Kremlin with a challenge of that. And then, of course, the unfolding tragedy of Alexey Navalny’s poisoning. He was in Omsk. He was in Siberia in preparation for these municipal elections. He was doing what’s called smart voting, which is to basically have the opposition coalesce around a candidate that can perhaps defeat the United Russia or Kremlin Party backed candidate. And of course, today’s revelation that in fact it was novichok poisoning, which means that is a military-grade poisoning, which means the state had to be involved in that poisoning, speaks to the concern of what these municipal elections may embarrass the Kremlin.

And, again, to Judy’s point, this has just been such a challenging year for the Kremlin. It was envisioned to be a celebration year of both a major gathering of the 75th anniversary of the end of World War II, which of course there was an extraordinary sacrifice made by the Soviet Union. That didn’t happen because of the pandemic. It was supposed to lead the way to celebratory constitutional changes, which would keep Vladimir Putin in power until 2036. All of this has been changed. And now Putin’s favorability is quite low. His legitimacy is also low. So this is needed. This victory is needed.

What’s so interesting is that even though state radio and television have certainly been filled with the messages that the Kremlin wants to pronounce, really watching social media – which, although the Kremlin has made great strides in preventing and denying access – this is where the story is being told. This is where you’re seeing some coalescing not only of the protest movements but also the health care community and sharing with one another their concerns. That’s what I’m watching as we see how the vaccine and the trials take place.

But on the disinformation space, here you have – certainly Russia has been going back to a playbook well-established during Soviet era active measures where you can go back to the HIV/AIDS crisis, which was a successful Kremlin-sponsored propaganda effort that you know, was to convince that it was the U.S. – whether it’s U.S. biological weapons, or a U.S.-manufactured health crisis. Well, that’s very similar to today’s messaging from the Kremlin. Not only are they doing that externally, but they’re also doing it internally.

So this is, again, to increase anti-U.S., anti-Western sentiment inside of Russia, to create an enemy, to prevent public scrutiny of the role of the Russian government, or its lack of role, in managing the pandemic and, as Vasily said, really that the central government has pushed this crisis to the regions, and of which they are – just don’t have adequate resources to manage. So, it is a complicated tale of internal politics with external certainly manifestations and pressures certainly in the disinformation space.

Morrison: Thank you. Thank you, Heather. Thank you.

Vasily, I know you’ve got some things to say about all of these topics. Please come on in.

Vlassov: No, not about the last topic, but about what Judy said. We know that the drug industry is very effective in influencing doctors and academics to promote their products. But for me, it is a great surprise to find that in general the medical community, academics from the medical fields and biological field, mostly are very critical in relation to these – the precocious vaccine. It is – for me, it is a surprise. And I’m very happy to hear that our academic and medical world keep their critical mind.

Morrison: Thank you.

Let’s shift to the geopolitical environment that surrounds Russia, external to Russia, and what that – what the reception has been. I mean, the – when you think about this, this was quickly followed – this action by President Putin was quickly followed by a similar action by China, and by the expectation that you can have field trials conducted under the more standard and rigorous way generating some results fairly quickly. You have partnerships evolving with a lot of different organizations and the like. You have all of that happening. You could imagine WHO saying: Wait a second. Give us the data before we reach any judgement. You can imagine a lot of countries taking a wait and see attitude, those in Europe or elsewhere.

Look, this – we’ve got – you know, this is a dynamic environment. The claims that are being made by Putin, we’re just going to wait and see. Others may be cultivated to become partners early on. And we’ve had some very positive statements from Duterte in Philippines, and others. Why don’t we turn to that external environment, and how do you see this? We have the WHO we have to deal with. We have reaction from the United States, from China, from the European powers, from others. And then we have these states that are being cultivated as partners – Mexico, Philippines, Saudi Arabia, UAE, Brazil.

Judy, what do you have to say?

Twigg: Well, first of all, I’ll share the news that just today Kirill Dmitriev, the head of the Russia Direct Investment Fund that financed the Gamaleya Institute in Moscow in its development of the Sputnik vaccine, has announced that trials data will be published this week in what he says is a major Western scientific journal. He hasn’t said which one, but you know, we’re waiting. We’re looking forward to seeing that – to seeing those data published in a peer-reviewed outlet.

In terms of the international landscape, you know, we’ve all heard about vaccine nationalism. Steve, in your opening remarks you referred to the extent to which the United States, the U.K., Japan, Europe are engaging in advance purchase of vaccine. Some would call it vaccine hoarding. There’s definitely a concern about an emerging gap between rich and poor countries’ access to the vaccine. We heard yesterday that the United States will not participate in the COVAX facility. It seems to me that this is an enormous opening for Russia to practice some pretty aggressive vaccine diplomacy.

Morrison: With those who are left out? Those that are at risk at being on the side of the road?

Twigg: Absolutely. And I have been surprised that Russia didn’t walk through that door much more vocally and aggressively much earlier on. In other words, I would have expected much more specific details about the deals that Russia ostensibly is putting together with some of these other countries. I would have expected that kind of conversation and information to come out, you know, right in the second and third week of August, when Russia first announced the registration of the vaccine.

And yet, instead we’re getting information trickling out, you know, sort of one or two sentences at a time, about the kinds of arrangement that Russia is making with other countries. We know from information that’s been released just in the last couple of days that there is a handful of countries to have already received 1(,000) to 2,000 doses of the vaccine for purposes of field trials. We just learned today that there’s an agreement between Russia and India for India to purchase 300 million doses of the Sputnik V vaccine for next year. And we also have some vague information that there is a purchase commitment of a billion doses for the year 2021 from five different countries other than India.

So other than that, we don’t know details. And interestingly we don’t know anything about pricing arrangements. We don’t know to what extent Russia is going to play the card of making this vaccine, their vaccine, available to disadvantaged parts of the world in a way that would be quite a contrast to what seems to be happening with the vaccines that are coming out of the U.S. and U.K.

Morrison: Now, it’s safe to say, we really don’t know. There’s been no data presented that shows us whether this is safe or effective. So it’s a roll of the dice. It’s a high-risk proposition. But marching ahead and doing – making these deals and announcing these deals. Vasily, do you – are these deals real? Or how do we – how do we make a judgement about how much of this is smoke and mirrors and how much of this may be real?

Vlassov: I like to continue you comment – you last comment. When you come to the number of countries in the world and billions of doses promised, it appears that we know for sure that there is a vaccine and it is safe and effective, and we just need to have box checked. It is not the case. We don’t have the vaccine. It is not tried enough. Not Chinese vaccine, not Russian vaccine, no English vaccine. No vaccine is tried enough in the normal – in the normal trial. So all these collaboration – the international collaboration is OK, it’s good for humanity, of course. And this vaccine diplomacy is – we know it is a good example of the international diplomacy. For example, all of these polio vaccination campaign around the world. It is a wonderful example of international collaboration. But it should not be used for the promotion of the immature product.

May I remind, in Russia only 20 subjects received the vaccine. It is – it is not enough to find the side effect which kill 10 percent of the people. So if the vaccine kills 10 percent of the group, if you test only 20 you may not find it. So it is – it is absolutely untested product. And the only difference between the Sputnik vaccine or Oxford vaccine is that Oxford vaccine is not approved and not offered to the market. I believe that we have to repeat the phrase: No really tested vaccine. It does not exist yet.

Morrison: We do have published – we do have published data from some of these other vaccines for phase one and phase two. And we do have those that I’ve enumerated, the three American-supported ones that are in advanced field trials, with 30,000 folks enrolled in those, or they’re aspiring to 30,000, they’re making headway. But you’re absolutely right, we don’t have the data from those yet. What differentiates Russia from the United States is Russia’s taken the stand of registering and announcing its belief that it’s safe and effective. We haven’t taken that step yet. We’re suggesting we may with respect to AstraZeneca, based on what is not articulated, and very clearly.

Heather, on the European side of this, we’ve – as far as I know, there’s not been any sympathetic expressions coming from Poland, or Hungary, or Italy towards the Russian announcement of Sputnik V. And what’s been the reaction among those like Germany, France, the EU, that are really playing at a very aggressive level with respect to the development of the vaccine, and locking down supplies?

Conley: Sorry, Steve, my internet was going out a little bit. I think I caught the end of it. You know, my one comment – just to reflect on Judy’s earlier comment – the United States has certainly had experience with the – procuring from the Russian Direct Investment Fund. We purchased $600,000 worth of Russian-made ventilators that were a fire hazard and could not be used. So I just would argue, buyer beware. And that was with equipment, nothing as vital as vaccines. So just a reflection of haste, of purchasing without a verification of safety and efficacy is so important.

No, the European Union, quite frankly, is not – at least, I don’t believe – interested in Russian vaccines. Although, the EU just over the last 24 hours has had a change of approach to collective vaccine purchasing. Initially the EU was going to have a purchasing facility for the 27 members, in part to make sure that one member wouldn’t – member state wouldn’t cut their own deals, to be unified about that. And in fact, the EU did not want to go through the WHO COVAX facility because they believed it went against EU procurement rules, it was slow and inefficient.

And I think they very much realized that that message, coupled with the U.S. decision not to proceed with the COVAX facility, now you see both the softening of WHO requirements. Now the EU – it looks like they’ll do sort of both strategies – utilize the COVAX facility to also support low-income countries that could not perhaps have access to vaccines, while they are negotiating with a variety of the manufacturers to make sure that the 425 million EU citizens do have access to those vaccines.

So you do see changes in strategy, of course, but I don’t believe any receptivity presently to Russia. I think in some ways it’s making sure that the EU has access to those vaccines, and they don’t get caught being left outside of the race for recovery and access to a vaccine.

Morrison: Yeah. Judy, I know you had something you wanted to add.

Twigg: Yeah. Just to build on Vasily’s and Heather’s points. I mean, it certainly wouldn’t be a surprise to see Russia trying to score diplomatic points off of a vaccine that has been incompletely tested. And as far as what we know about phase three field trials in Russia, they’ve announced just in the last couple of days that those trials will start this coming weekend. The only hard data we have about what’s happening is that you can go to the website of the mayor of Moscow and sign up. You can sign up to be eligible for one of the 40,000 slots to participate in phase three field trials over the next couple of months. So other than that, we have incredibly incomplete data about even what’s happening with the last phase of field trials, let alone what the results of those trials will be.

Morrison: And do you have any thoughts on the nature of these partnerships with all of these different countries? Do you have a judgement? I was asking Vasily, are these real or not? You know, what do you – how do we know whether they’re real?

Vlassov: I don’t know anything else about it. It was only just list of the collaborators. It is not given any details about it. Probably it is just preliminary agreements with no obligations. That happens many times, for example, between Russia and China – preliminary agreements, and it’s a dead end. So we know only what we know from the – such very special place like Moscow mayor website. It is – it is strange that people to the trial are invited, and volunteers through the city mayor’s site, but it is what is going on. It is what is going on with this trial.

By the way, if you go to ClinicalTrials.gov you will see that the trial in Russia is the double-blind perspective trial. But if you look at the internal information, the information is just invitation to go in, subscribe, and you will get the free shot. It is – that’s all. So people are not provided any details about the trial. So it is – it is different image in different mirrors.

Morrison: Thank you. Thank you.

Let’s talk about what the broader implications might be of this. You know, one question that comes up is, is this race – and Russia’s actions are part of a broader race. We started the conversation talking about the broader race. Under the pressure of the pandemic, right? The pandemic is crushing the economies, causing enormous health dislocations, aggravating disparities across the world. And there’s all of the nationalist competitive urges that are underway, particularly when we’re talking about the U.S., Russia, China. Do we think that what we’re seeing unfold in the Russia instance and now also with the Chinese, that this is a shift towards a fundamental change in the norms and practices of developing vaccines in global terms?

Judy, what do you think?

Twigg: Well, this is a pretty big risk/reward calculation on Putin’s part. I think in Putin’s mind he’s probably already realized some of the reward, in the flurry of attention that he got in this August 11th announcement. If you think back to what happened on August 11th, they made the announcement of the registration of a vaccine, and then they have this incredibly slick, glossy website ready to roll the moment that they made the announcement.

And if you compare this Sputnik vaccine website – it’s a vaccine with its own website – if you compare this website to other Russian public sector websites, clearly there was some extra expertise, let’s say, that was devoted to it. It’s in seven languages. While you wait a couple seconds for the page to load you’re encouraged to click on a button that actually plays for you the beeps that we heard from space back from the original Sputnik satellite in 1957. The PR benefits, I think certainly, especially within Russia, have already been realized.

But the potential payoff in the longer term I think is much more questionable. And here, Steve, we look out into the future, and what the vaccine landscape is likely to look like six months from now, 12 months from now, 18 months from now – as you said earlier, right now there are over 30 candidates. There are likely to be double or triple that as we move forward. In a year and a year and a half we hope there will be a pretty good handful of proven safe and effective vaccines. Some of those vaccines are likely to be more effective in different populations. Some will work better with older people, some with younger people, some in different circumstances.

And so it’s going to be a very crowded and very confusing landscape of who has access to what vaccine and who should be taking which vaccine. I question whether or not within that very complicated and confusing landscape, whether anyone’s going to remember or care very much that Russia was the first one to get a registered vaccine on the board. So, it’s not clear to me that the vaccine is anything of lasting value for Putin. And yet, the risk calculus is enormous, right? There’s reputational risk if there’s mass distribution of a vaccine that turns out not to be safe. There’s both reputational and epidemiological risk if it turns out that they’ve done premature release of a vaccine that’s not effective.

Think about all of those people walking around Moscow, and over time the rest of Russia, who will think that they’ve been given a safe, effective vaccine. And if it turns not to be as effective as promised, those people will stop practicing protective behaviors. They’ll stop wearing masks. They’ll stop practicing distancing. They’ll go into crowded places. And so we would have a chance of a resurgence of the pandemic.

And then to get into some of the disinformation space that Heather was talking about earlier, if there is premature release of a vaccine that turns out to be some combination of unsafe and/or ineffective, that just creates an opening for increase in vaccine hesitancy, vaccine denial. It creates more space for people to question the whole proposition of vaccines. And of course, the anti-vaccine movement will capitalize on this in any way that it possibly can. So the risks, compared to the rewards here, especially in the long term, for Putin and for the global community, seem to be out of balance.

Morrison: Thank you. Vasily, you’re a part of this world. I mean, this is the world where you set the norms. We’re just commentators here. What’s the – what do you see? Is the world changing, or is this just somewhat abnormal behavior in abnormal times?

Vlassov: I’d like to remind about two points. First, the whole business of the standardization of the drug approval and vaccine approval is not that long existing. ICH was arranged only 30 years ago. And all the good clinical practice, good lab practice standards are very new for the world. And this epidemic is the first – actually the first time these standards are undermined. I hope that after the epidemic the world will turn back to the standards because the standards are quite effective. I won’t develop this further but believe me the standards of the drug industry are not bad.

What I – what I think is a second point which is important: If we look at what we know about the agreement between the United States government and drug industry, it says that the vaccine should have an efficacy not less than 50 percent. Why 50 percent? Why so low efficacy is agreed for? Why not 70, why not 80 percent efficacy? It is because everybody understands that producing such a vaccine is very difficult. So I believe that part of our brain should be reserved for the thinking about how we would live in the world if there will be no coronavirus vaccine at all. There is a chance that – the world failed with HIV vaccine. And the same failure may happen with the coronavirus vaccine. So, there should be preparedness for this variant of the future.

Morrison: Thank you. Thank you.

Heather, your thoughts.

Conley: Yes. I mean, I think in many ways certainly Russia has – if you think of this as a racetrack, they’re the pace car. They have set the pace. And China and the U.S. are following that pace car. So in some ways they’ve accomplished that – (audio break) – which they have set out. In a perfect world. of which this is not, the U.S. would have played a role galvanizing the international response. Steve, the historic work that you’ve done with the Global Health Program at CSIS on Gavi, Global Fund. We have mechanisms where the United States and our closest partners and allies in Europe and elsewhere are working together to help provide those vaccines to countries that can’t afford them but working for a common cause.

And as Vasily mentioned in the very beginning, you know, there’s actually a historic precedent of working together on polio. So, we have opportunity to work together, but of course the age that we are in right now vaccine nationalism, the America first, Russia first, China first, who gets there first, that is the spirit of the age that we live in. Of course, we have instruments and multilateral frameworks that can be used, but we are choosing not to.

Just one final comment, it was – reflecting on Judy’s comment on the anti-vaccine movement – of course, Russian disinformation has amplified the anti-vaccine movement historically for quite some time – certainly quite heavily in Europe as well as in the United States. I find it ironic that the moment that Russia will be – (audio break) – efforts have been, in fact, not welcoming to a vaccine. But in some ways we may see it having it both ways – amplifying the anti-vaccine movement through disinformation while attempting to obviously advocate for Russian vaccines. So it’s – (audio break).

Morrison: Thank you. Thank you, Heather.

Just a couple points. I mean, there’s this paradoxical quality to everything that we’re seeing happen. At the level of practicing scientists in universities, in private sector institutions, in research institutes, those in foundations, those in many international organizations, special organizations like CEPI and Gavi, there’s a remarkable period – we’re in a remarkable period of transparency, of sharing, of sharing of data, sharing of protocols, best practices, unprecedented.

And when you look at that and you ask, why did that happen? Some of it was driven by the Ebola outbreak of ’14 and ’15, and many of the frustrations around how knowledge was hoarded or held too closely, and the consequences that they had. And ’14 and ’15 led to the – that Ebola outbreak led to some really fundamental changes in science, and R&D, and practices, and normative changes that – very much for the better, for the improvement globally. A denationalization in some ways.

On the other hand, what we see at the political level is hyper-nationalism and fragmentation and hoarding in the buying practices and the like. And so how do those things get reconciled at some point, because there’s an enormous tension around that. We also see an absence of high-level diplomacy. We don’t see the Security Council doing much. We don’t see the G-7 and the G-20 doing a whole lot in this – in this era. There’s been some diplomacy on getting the act accelerated and a COVAX facility going. The EU has been very fundamental to that, and some of the European states in particular.

But it’s really a moment where we have this – these contradictions, and this question of whether the Russians and the Chinese are breaking the rules, and will the Americans break the rule, put people at risk, undermine trust and confidence, open the door for the anti-vaxxer crowd to jump in and further weaken public confidence and trust. All these issues, I expect, are going to come before the independent panel that was put – that was appointed by the World Health Assembly. It is co-chaired by former New Zealand Prime Minister Helen Clark and former Liberian President Ellen Johnson Sirleaf, Anders Nordstrom, former acting head of the WHO, is the director of it. We’re expecting the announcement of its membership in the next two weeks or so.

It will do an interim report to the World Health Assembly in November. It will do a – It will do a progress report. It will do an interim report at the executive board meeting of the World Health Assembly in January and report a full report out in May. Many of these questions are going to be front and center, I would guess, about what all of these experiences have taught us in terms of the weakness of norms and guidelines, and the limits of accountability, and the limits of transparency in this period.

One question that comes from a couple of different people in our audience that I think is a powerful, powerful question, and we’ve touched on it a bit, but I want to come back to this question, which is the poisoning of Alexis (sic; Alexey) Navalny. And now that we have what seems to be pretty rock-solid proof of what the agent was and the provenance of that agent. Does that action completely undermine whatever progress may have been made externally by Russia, by Putin, with respect to the vaccine?

Let’s start with Vasily, what do you think? It’s an awkward question, I realize, you’re there in St. Petersburg.

Vlassov: I think that these things have to be kept separated, because what’s happened with Alexey Navalny, it is the same – almost the same what happened with Litvinenko in London or this –

Morrison: Skripal.

Vlassov: Well, yes, the spy in Salisbury. It is – and there are others, dozens, dozens of killed people all around the world. I think that it is the big problem for the world and, of course, it’s a huge problem for Russia. But it is a struggle of keeping the power in Russia. And vaccine offers – it is – it looks like it is a move for move. I mean, that to kill Navalny, it is just to keep the power. But to produce the vaccine, it is to produce the good for the people. I mean, that it is a way – probably the wrong way. But anyway, the direction – the direction is making the good for the people.

Morrison: Yes, I understand your point. I think from an external audience it’s very difficult to separate those issues, as we saw in the consequences of these earlier cases which really generated a firestorm, particularly in Britain.

Judy, what’s your thought?

Twigg: Well, for an international audience, this certainly changes the subject of the conversation about Russia in a major and abrupt way. So, no one is now going to be talking about the possibility that Russia has entered the big leagues in terms of vaccine development. Now everyone’s going to be focused on this Navalny story and Putin’s now, I think, much clearer role in that event. Domestically, within Russia, we’re not going to be hearing about Novichok on the evening news in Russia. That’s not going to be something that is widely discussed in Kremlin-controlled media. But on social media, as Heather mentioned earlier, this is going to, and certainly already is, receiving an enormous amount of attention within Russia.

And I’ll just note that one of the most vocal and courageous voices on social media in Russia’s medical community has been Dr. Anastasia Vasilyeva, who is Navalny’s personal physician and is also head of the main sort of opposition doctor’s alliance, medical union. She has been quite vocal in speaking out from the very beginning of the COVID-19 pandemic, for example, talking about the poor quality of some health facilities, about the struggle for physicians to receive personal protective equipment, about the failure of the state to make its promised payments to doctors, bonus payments for working with COVID-19 patients. So on social media, from voices like hers, I expect that the conversation in Russia is going to be quite focused on this as well.

Morrison: Heather, what do you see? What do you see as the consequences? And how do you – how do you see the consequences of the attempted murder?

Conley: Well, I think looking at it externally this is now a pattern that cannot be ignored. And you’re hearing that from the strenuousness from the German government, a government that is usually quite reluctant to be that forward-leaning because they’re seeking dialogue with Russia, and believe they have a unique voice in assuming that dialogue. You now have poisonings that either happened directly in Europe, the Salisbury poisonings with the Skripals as well as the Litvinenko poisonings. You have assassinations on the streets of Berlin last year, a Georgian Chechen was assassinated. So now Russia’s internal dynamics are playing out externally.

And so I would foresee if, in fact, the Russians do not support a full and transparent investigation – of which they will not – then you may see an increase of sanctions. But the internal dynamic, again, to Vasily’s point, this is about providing a positive news story that hearkens back to Russia’s great scientific community and health care community, that they are able to achieve success. And it is supposed to dampen an extraordinary economic contraction this year, as well as a demographic contraction. And if there’s one thing that I follow, as well as Vladimir Putin follows, is Russia’s demographic decline, which is now accelerating. Obviously COVID is contributing to that.

So there is a real social-economic challenge within Russia that its leadership, again, to preserve its power and its control, will not be able to address sufficiently. And so this is why the Alexey Navalnys and other very brave opposition civil society leaders – whether they are environmental leaders, health care leaders, educators – they want a better life. And that regime is going to continue to struggle to address their demands for dignity. And I think this is just another manifestation of – Alexey Navalny was coalescing and organizing an opposition to this regime that obviously at this moment the regime took very seriously and had to remove that level of threat.

Morrison: Thank you.

We have one – we’ve got enough time for one more question that’s come from our audience, which is a great question, and then I’m going to come back for, like, a one-minute closing. And on that one-minute closing let me give you a preview. What I want each of you to respond to is: What’s the best possible outcome we could see in Russia with respect to this vaccine in the next year? What’s the – what’s the best possible – in a realistic sense, but what’s the best possible?

The question is a very tough one, which is: The Russian government has been engaged systematically for some time in the spread of misinformation and disinformation with respect to vaccines and many other topics, subjects. Now they’re in an enterprise where they’re attempting to convince their own population that they’ve come up with the right thing, and ignore – trust us, we have. You don’t need to see the data but trust us. How do they square those two things? And is there – are citizens walking around with a lot of dissonant energy in their heads as a result of this? But how does this all get squared?

Vasily, I’m going to ask you, because this is probably a daily experience for you.

Vlassov: I believe that the explanation is that still Russian government believe in the power of the television. I think that the brainwashing with television is the arms with the government believes the power of. It the only explanation for me.

Morrison: OK. Judy, how do people square that? How does this get squared, do you think?

Twigg: I think it’s important to look at generational differences here. Older people still get most of their news from television outlets that the Kremlin controls. Younger people are increasingly getting most of their news from the internet, from social media, from Telegram and other channels. And so as we see a younger generation start to come into its own, I think we’ll see more and more questioning of the Kremlin’s line here.

Morrison: OK. Heather, any thoughts on how these two things get reconciled?

Conley: If anything goes wrong inside Russia due to the vaccine, it will be America’s fault. It will be some contamination by the United States or the West. It will not be the regime’s fault. I think that’s how they square that, in some ways how their internal messaging works to do that. But again, I could not agree with Judy more. I think even watching Belarus right now and as that’s unfolding, TV and radio, absolutely for a generation work. But that is no longer working.

It is social media. It is organizing not only protests or social movements, it is galvanizing. And I think that more trouble we see internally to Russia as it uses its vaccine if – you know, we don’t want there to be problems. Let me be clear, we want vaccines to be successful and safe. But if we do start to see problems, I think one signpost will be there’ll be selective shutdown of internet, because that is how the stories will start to spread that they’re having problems with their early trials.

Morrison: If there are serious adverse effects.

Conley: Mmm hmm, exactly. So that may be one indication. But again, we want there to be a safe and efficacious vaccine for the Russian people.

Morrison: OK. Thank you.

All right, we’re going to do one minute each. We’re going to go a little over time. This is our closing lightning round here. And we’re going to start with Vasily. What’s the best possible outcome we could see with respect to the vaccine in Russia in the next year?

Vlassov: I hope that the vaccine which is going to be provided from tomorrow in Moscow is safe enough. I don’t believe that is quite effective. And I think that it will provide for people some feeling of safety. And I hope that this will bring some – a little bit peace in the country. The country now is very disturbed by absence of the trust in general – in general, and trust in the vaccine. And my major point, I repeat it’s a short time for this hour, we have to be prepared that the efforts to create the effective vaccine, that all may fail – that all may fail. So we need to be prepared for the worst.

Morrison: Thank you. Thank you, Vasily.

Heather, your thoughts on what’s the best possible outcome in the next year, internally within Russia.

Conley: Well, the best possible outcome, I would say, is for Russia to go through the process, have the trials, have this vigorously tested, and be successful. I think that’s what we want – the world needs and wants a successful vaccine, go through the process. And if I was really – you know, to take Vasily’s – I am concerned about a vaccine mirage in Russia, that it may be kind of akin to saline solution but it gives a sense that – it may not harm, but it will not help, and then COVID will continue to ravage the population, which we don’t want.

And ultimately, what we want is to get back to, even during the Cold War, the United States and the Soviet Union did have scientific collaboration. Let’s return to that. Let’s increase our transparency. Because the U.S.-Russian relationship is really at such a low point, let’s find opportunities where we can work together, our scientists, our health care workers can learn from one another. Let’s try that.

Morrison: Thank you. Thank you so much.

Twigg: I couldn’t agree more with what Vasily and Heather have said. I think none of us is a fan, clearly, of the authoritarian, anti-democratic Putin regime. But in vaccine development, this is one place where we wouldn’t mind seeing Putin succeed, that we have nothing but goodwill for the Russian people. The best-case scenario is they publish those trials data this week, and it all looks good, and Russia moves forward with administration of a safe and effective vaccine over the next year.

Morrison: Thank you. I’m really glad that we can end on that, such a – such an astute, positive set of points. And I want to thank Vasily, Heather, and Judyth for such a rich conversation, taking a big chunk out of your day. I want to thank our audience for joining us on this. I want to, again, thank John, Travis and C.J. on the production team for pulling this off flawlessly. And for my colleagues, Anna Carroll, Amith Mandavilli, and Michael Rendelman for their prodigious work in preparing us for all of this over the last week.

So we’re going to adjourn. We will come back to this series soon with a follow-on. I guess our next piece will either be on Operation Warp Speed or will be on the Chinese. So stay tuned. We’ll be advertising our next session soon. Thank you.