Michel Kazatchkine, course director
A huge amount of attention has been focused on the economic impact of sanctions imposed on Russia as a result of the invasion of Ukraine. Much of this has centred on the impact that this is having in Russia itself. While the reasons for imposing the sanctions as a reaction to Russia’s illegal invasion of Ukraine are understandable, the sanctions have crippled the ruble and will have significant consequences as the conflict continues.
The attention on sanctions is obscuring the resulting economic crisis that the war will produce across the entire Eastern European and Central Asia (EECA) region, one that will create a long lasting health crisis in the Russian Federation and in countries in the region that are economically dependent on its economy. The impact will reach beyond the first circle of countries that along with Russia belong to the Eurasian Economic Union: Armenia, Belarus, Kazakhstan, Kyrgyzstan.
The forthcoming regional scenario is an intimidating one: national budgets will be very constrained, currencies may crash, the ability to import will be very limited and unemployment will rise. An economic downturn will drive inequalities, which in turn will impact on the provision of, and access to, healthcare.
An additional consequence of the economic sanctions imposed on Russia will be to accelerate and amplify this crisis. The weaker ruble means less money for millions of households, especially in Central Asia whose countries depend heavily on remittances from Russia, the main destination for its migrant workers.
Since 1 January 2022, the ruble has lost 45 per cent of its value. In Kazakhstan measures are being taken by the national bank and government aimed at maintaining the current social and economic situation in the country as the tenge—the nation’s currency—continues to lose its value against the dollar. In Kyrgyzstan, the local currency, the som, has lost more than 40 per cent in value since February and the country’s health programmes have already been significantly hampered.
Almost all the region’s pharmaceutical production is located in Russia and while it is a major producer of medicines and vaccines, it still imports a number of life saving medicines, both in generic form and from Western pharmaceutical companies, such as cancer drugs. The Russian government’s ability to pay for locally produced medicines or import them from countries like India may also become severely affected. The same goes for the other governments in the region.
The longer the war goes on, the more likely it is that the region’s economic instability will morph into a health crisis, as regional governments exhaust cash reserves needed to procure essential medicines and medical supplies, and keep their own essential health infrastructures running.
This matters greatly in Eastern Europe and Central Asia which continues to be home to the fastest growing HIV epidemic in the world and the global epicenter of multi-drug resistant tuberculosis (MDR-TB).1 The region is already characterised by fragile and underfunded health systems that have been weakened by covid-19 and whose resilience during a prolonged conflict will be brittle at best.
Some 1.6 million people are living with HIV in the region (with Russia accounting for 70 per cent) and around 146 000 are newly infected each year.2 Drug use accounts for around 50 per cent of new infections, but unprotected sex is set to become the main driver in the coming years.
The greatest driver of MDR-TB is treatment interruption, which will no doubt be exacerbated in the weeks and months to come, as healthcare systems in the region come under pressure.
We are currently seeing the disastrous humanitarian impact of the Russian invasion of Ukraine. The World Health Organisation reports that 52 healthcare facilities in Ukraine have been attacked since the conflict began. Ukraine is also lacking essential medicines and is struggling to keep the most basic of health services up and running. The steady inroads that Ukraine has made against infectious diseases like HIV and tuberculosis will be set back years.
We must not forget either that the region is presently a hotspot of the covid-19 pandemic with high case numbers and hospital admissions being driven largely by the low vaccination rates within the region, and also in neighbouring countries.3 Controlling the pandemic is likely going to be much harder for governments the longer the conflict continues, and economic crisis spills over into the region.
The main focus and priority at present is understandably on the shocking humanitarian crisis in Ukraine, both for those in the country and for refugees fleeing the war. However, we also need to ensure that the supply of essential medicines and vaccines to Russia and neighbouring countries is maintained.
We must keep an eye on the health of a region whose immediate future is tied to the hope of a permanent ceasefire. While the sanctions levied by the West do not apply to medicine and medical equipment, they may well end up doing so indirectly. We are going to need some decisive policy measures that prioritise healthcare in the region and provide safety nets for people, especially the most vulnerable, to protect them from a crisis foretold, one that will superimpose itself on the covid-19 pandemic.
Read the original article on the site of The BMJ.