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Expert on Eastern Europe health care voices concern about COVID-19 in Russia and Ukraine

“There are real questions about the ability of these health systems to handle something major.”
close-up view of a globe

Judyth Twigg, Ph.D., a leading expert on health care policy and economics in Eastern Europe, has serious concerns about the ability of Russia and Ukraine to fight a major outbreak of COVID-19. 

In recent weeks, Twigg, a professor in the Department of Political Science in the College of Humanities and Sciences at Virginia Commonwealth University, has written numerous articles on the subject and has been quoted in various publications. The goal, she said, is to keep the issue in front of policymakers who are grappling with how to fight the contagion. She is especially concerned about Ukraine, given that the country is an important U.S. ally in the region.

“It’s in America’s foreign policy interest not to have Ukraine weakened by this,” Twigg said.

Ukraine has over 4,000 cases of the virus, according to data from the Johns Hopkins University Coronavirus Resource Center, and a central government with limited ability to fight the outbreak. On the Council on Foreign Relations “Think Global Health” website, Twigg wrote an article titled “Coronavirus in Ukraine,” in which she urged Western leaders to support Ukraine’s coronavirus efforts. Russia and Ukraine are fighting a war in eastern Ukraine, and Russia “is using the pandemic as cover to escalate pressure on Ukraine,” Twigg said. Western leaders should support the current government in Ukraine and not allow Russia to use the pandemic to advance its goals, she said. 

Judyth Twigg
Judyth Twigg, Ph.D.

Inadequacies in the health care system

But Russia has its own problems with the virus. People have questioned whether Russia has been intentionally misreporting the number of cases in the country.  In mid-April, Russia had reported 25,000 confirmed cases, but many public health officials have been skeptical of the data. 

As Twigg highlighted in a recent essay for the Bulletin of the Atomic Scientists, there are doubts about these numbers because Russia has long conducted disinformation efforts related to health and medicine. Some have suggested that Russia has made a concerted effort to conceal its number of cases, but Twigg believes the number is more a reflection of the inadequacies of the Russian health system.

“I really don’t think there is one set of numbers for [Russian President Vladimir] Putin and another set of numbers for the public,” Twigg said. “That would be pretty hard to pull off. Russia, especially in Moscow, has too much connection to social media and other forms of modern communication to hide a major outbreak.”

Twigg pointed to recent posts on social media that showed a mile-long line of ambulances waiting to drop off COVID-19 patients outside a Moscow hospital. 

“There is no way they can cover that up,” she said.

"I really don’t think there is one set of numbers for [Russian President Vladimir] Putin and another set of numbers for the public. That would be pretty hard to pull off. Russia, especially in Moscow, has too much connection to social media and other forms of modern communication to hide a major outbreak."

‘A systemic weakness’

Twigg has been studying Russian health care policy and the health care system since the end of the Cold War. She did her doctoral dissertation at the Massachusetts Institute of Technology on jet fighters in the Soviet Union, but interest in that area waned once the Soviet Union collapsed. That changed the trajectory of her career. 

“What really fascinated me was the Soviet economy and how dysfunctional it was,” Twigg said. “Conceptually, defense economics is not that far from public health economics.”

Over the past 20 years, Twigg has analyzed how Russia transformed itself into a more market-based economy and modernized its health care system. The country invested heavily in neonatal health care and improved its response to tuberculosis outbreaks. The problem, Twigg said, is that the current health care system is not set up to contain and manage a major infectious disease.

So far, it appears Russia has only had major coronavirus outbreaks in Moscow and a few small hot spots, Twigg said. Russia has administered nearly 2 million tests, similar to other Western countries, but the lack of positive tests shows problems with the system.

“Some of Russia’s inherent structural and demographic factors may help it cope,” Twigg wrote in an article last week for The National Interest. “Others put it at a disadvantage.”

As in the United States, some local governments across Russia have stepped up and are filling the void where the national government has been lacking. The mayor of Moscow has played a key role in managing the coronavirus outbreak there, and local officials have provided support across the country.

Twigg believes the health care system in Moscow and some of the large metropolitan areas can handle the outbreak. But there are already some reports of strain on the health care system, and some are saying the system in Moscow is near a breaking point. Twigg’s real concern is the small towns and rural areas. 

“Moscow has a health care system that has risen to the occasion,” Twigg said. “The quality and capacity outside Moscow, however, are not adequate.”

saint basil cathedral in moscow
Twigg believes the health care system in Moscow and some of Russia's large metropolitan areas can handle the outbreak. Her real concern is the small towns and rural areas. “Moscow has a health care system that has risen to the occasion. The quality and capacity outside Moscow, however, are not adequate.”

Trying to contain the virus

The response in Ukraine has been very different. The national government has been paralyzed and has not been able to address the crisis as it focuses on the war with Russia and on meeting the pre-conditions for new financial support from the International Monetary Fund. That has led individual citizens and the private sector to take a leading role, meaning the response to the crisis has been more decentralized and local.

“Individual businesses and regional governments all over the country have been joining the global queue for ventilators, personal protective equipment and other supplies from China,” Twigg wrote in her Think Global Health article.

Overall, Twigg said she has enjoyed the increased public focus on her work, but it has been challenging. She works 13-14 hours a day monitoring a situation on the other side of the world. Twigg has been a prolific writer in recent weeks and has appeared on multiple podcasts and webinars. She hopes her work keeps Russia and Ukraine in the eyes of public policymakers in the United States and across the globe, but she is worried these countries might not be able to contain the virus.

“There are real questions about the ability of these health systems to handle something major,” Twigg said. 

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