A powerful ‘motivational lever’

Meduza uncovers how the Belgorod region became the most vaccinated part of Russia

The Belgorod region has the highest coronavirus vaccination rate in Russia — nearly 35 percent of the population, more than half a million people, have received their first dose. By comparison, even Moscow and the Moscow region are lagging behind, with just over 25 percent of their residents vaccinated against COVID-19. What’s more, unlike other parts of the country, the Belgorod region didn’t make vaccination against the coronavirus mandatory. How did they convince so many people to get the jab? Meduza discovered that the key to the Belgorod region’s success is a measure the local authorities aren’t advertising: making additional payments to local doctors for every vaccination.

Vaccination against the coronavirus was rolled out in the Russian regions in late January and early February 2021, as soon as supplies of the Sputnik V vaccine became available. Vaccination rates in the Belgorod regions began to rise quickly. Of the 1.54 million people living in the region, around 550,000 have received their first vaccine dose already.

The goal set for the Russian regions is to vaccinate 60 percent of the adult population; in the Belgorod region’s case, that’s 750,000 people. If the region keeps up its current pace of vaccination, it will achieve this goal by September, and without the introduction of mandatory vaccination at that.

“For some reason, in Belgorod, the people really just go to get vaccinated,” a spokesperson for the federal Health Ministry said to Meduza, commenting on the region’s success.

In turn, the governor of one of Russia’s central regions told Meduza that he’s been watching how the Belgorod Region has encouraged people to get vaccinated with interest. For example, since May, enterprises in the region have been giving their employees a day off to go get vaccinated, and since June, the regional United Transport Company has been providing vaccinated pensioners with free transit coupons. What’s more, vaccination is available not only at Belgorod’s hospitals, but also at shopping centers and offices; they even opened Russia’s first vaccination center located on the grounds of a monastery. And there are even more mobile vaccination teams than stationary vaccination points.

That said, the regional government believes that rather than these measures, the most effective thing of all has been the daily publication of detailed coronavirus statistics on social networks. “Since the very beginning of the pandemic we’ve provided the most detailed information every day, [and] demonstrated the emotions and experiences of people who recovered, as well as those who lost their loved ones. Enterprises began to introduce a day off on the day of vaccination in May, but we took the lead earlier in terms of vaccination rates, in late March or early April, so this isn’t a decisive measure,” said Lyudmila Krylova, the First Deputy Head of the Belgorod region’s Health Department, in conversation with Meduza.

The Belgorod region is simply a very disciplined region, says Moscow State University Professor Natalya Zubarevich, an expert in regional socio-economic development. “In Belgorod, there’s great trust in the authorities and a well-built management system; this combination has yielded results. This was all built under former governor Evgeny Savchenko and was transferred to the new one,” she explained. (Vyacheslav Gladkov has been acting governor of the Belgorod region since November 2020. Savchenko resigned last September after 27 years in office).

“I think that we have a very responsible population in our region. This is why there’s no sharp leaps in our vaccination rates. Our work is fairly steady and planned. I really like how efficiently the doctors work. We aren’t forcing anyone, but we’re conducting an active information campaign,” the Belgorod region’s Acting Governor Vyacheslav Gladkov recently explained to Russia’s Health Minister Mikhail Murashko.

According to Meduza’s findings, however, the key factor in the success of the Belgorod region’s vaccination campaign in recent months isn’t the disciplined nature of the local population, but monetary incentives for doctors — something the authorities have tried not to advertise. After the introduction of this measure, the region’s vaccination rate increased so much that they began to experience vaccine shortages.

‘Tellingly, there are no complaints’

Motivating doctors to encourage people to get vaccinated has been the most important factor in the region’s success, a source close to the Belgorod region’s current leadership told Meduza. “Our main vaccination driver is doctors. Unlike other regions, where doctors discourage people from getting vaccinated and don’t want to do it themselves, in the Belgorod region physicians convince people to get vaccinated and get vaccinated themselves,” the source said. “But they also have a financial interest: [the doctors] are paid for each vaccinated person.”

Financial incentives can sometimes backfire. Another source close to the regional government told Meduza that at one point, when the region’s vaccination campaign was going fairly well, employers also began offering monetary incentives — paying people 1,000 to 2,000 rubles ($13.50–$27) to get vaccinated. This was reported in the media with reference to messages on social networks. However, contrary to expectations, it actually provoked distrust in people and slowed down the pace of vaccination.

At this point, the regional government decided to offer monetary incentives to physicians — to pay them for each person they vaccinate, Meduza’s source said. This practice has been spreading through the region since May.

Meduza’s journalists obtained an explanatory document that describes the system for promoting vaccination in the region. In addition to outlining the planning and monitoring of vaccinations, it mentioned payments for medical workers for vaccination in June and July 2021.

According to the document, the payments depend on the successful implementation of a weekly plan: if it's at least 96 percent fulfilled, the doctors are paid 299 rubles ($4) for each vaccinated person, if it’s 85–95 percent fulfilled, they get 184 rubles ($2.50) per head (after tax). The money for each vaccinated person is divided among four medical workers: the specialist who obtained the patient’s written consent for vaccination, the doctor who performed the examination prior to the jab, the nurse who administered the vaccine, and the medical worker who recorded the vaccination in the federal registry.

For these purposes, the explanatory document says, 96 million rubles (nearly $1.3 million) were allocated from the regional budget on the basis of two government orders for June and July 2021.

Meduza was unable to find these orders from the Belgorod regional government in the public domain. The only documents similar in content and signed by Acting Governor Gladkov on the same dates are decrees on subsidies for private clinics in the Belgorod region to pay medical workers for vaccinating people. However, Meduza’s sources close to the regional government are confident that this system extends not only to private clinics, but also to state medical institutions. At the time of publication, the Belgorod regional government hadn’t replied to Meduza’s inquiries addressed to the acting governor.

These payments are a powerful “motivational lever,” the explanatory document says. Thanks to them, five municipal districts had already met the target of vaccinating 60 percent of the adult population at the beginning of July and are continuing work. By providing incentives for doctors, the municipalities sped up vaccination rates by 1.5 fold compared to the previous period. “Tellingly, there are no complaints from the medical workers about the increased volume of work,” the document adds.

This has also allowed the Belgorod region to avoid introducing mandatory vaccination for certain segments of the population, the document notes.

The Belgorod region currently has three districts where more than 70 percent of the adult population is vaccinated against COVID-19 — the Krasnoyaruzhsky district, Veydelevsky district, and the Chernyansky district, the regional government told Meduza. In fact, in the Veydelevsky district, which is home to 19,000 people, 85 percent of the adult population is now vaccinated. In addition to stationary vaccination centers, there are mobile vaccination teams operating in the Veydelevsky district.

In conversation with Meduza, the Deputy Head of the Veydelevsky district’s Social Policy Administration, Alexandra Shabarina, attributed the local vaccination campaign’s success to the close-knit nature of the community. “We’re a small agricultural district, we all know each other, [people] communicate, our neighbors are almost like relatives. There were people who were sick, they lay in the ‘red zone’ [the coronavirus ICU], they came back and said it was hard, that it’s better not to end up there. We have a different mentality: if someone is grieving or someone is ill, everyone knows and worries,” Shabarina explained.

According to her, it helped that the head of the local pensioners’ union was one of the first people to get vaccinated. “She’s a wonderful person, she’s respected — looking at her, a lot of people also went to get vaccinated,” Shabarina said. “This is our way.”

Story by Anastasia Yakoreva, Svetlana Reiter, and Andrey Pertsev

Edited by Valery Igumenov

Translation by Eilish Hart