A Republic Where Nobody Gets a COVID-19 Shot

In the summer of 2021, vaccination, or rather ways to avoid it, was among the “hottest” topics in the Republic of Dagestan, Russia's southernmost periphery in the North Caucasus. Prices of fake vaccination certificates and ways to obtain them were freely and publicly discussed. As we conducted our fieldwork in Dagestan, we quickly realised that, despite our broad network of contacts, finding voluntarily vaccinated individuals was proving difficult. It was, therefore, intriguing to understand why in a place where vaccines were readily available and promoted by the authorities, non-vaccination seemed to be the overwhelmingly popular and commonly accepted practice.

There is a tendency to tell a single story of health issues in any given nation-state (Sturmberg et al. 2022). The Russian Federation is, however, a highly diverse and multicultural state with complicated relations between the federal centre and the republics that remain in a quasi-colonial dependency. Therefore, a universalistic approach to vaccine hesitancy may prove misleading. Dagestan shares the biomedical healthcare system, and thus the approach to COVID-19 treatment and vaccination campaigns, with the rest of the Russian Federation. But, given Dagestani colonial entanglements, we ask if and how the quasi-colonial status of Dagestan influences vaccine hesitancy in the republic, and what this means for studies of vaccination in the Russian Federation. Can the scrutiny of COVID-19 vaccination narratives and practices regarding colonial legacies enrich our knowledge about vaccine hesitancy in places that remain quasi-colonised entities?

In this article, we analyse narratives and practices around COVID-19 vaccination, particularly vaccine hesitancy, in Dagestan. We use the WHO definition of vaccine hesitancy as a delay in acceptance or refusal of safe vaccines despite the availability of vaccination services (WHO 2015). Based on our field material from 2021 and previous research, we show that the colonial status of Dagestan adds to vaccine hesitancy in the republic by evoking fears stemming from its quasi-colonial legacy. Our analysis stems from medical anthropology (especially vaccine hesitancy studies) and postcolonial studies.

Colonial Entanglements of Vaccination

Colonial entanglements of vaccination and vaccine hesitancy have been addressed in the classically understood former Western colonies, in settler countries with a history of colonial rule over an indigenous population and among postcolonial ethnic minorities in former colonial empires (e.g. Greenwood and MacDonald 2021; Mosby and Swidrovich 2021; Anderson 2007; Bonhomme 2020; Simek 2023).

The postcolonial lens has been applied to explain various aspects of the COVID-19 pandemic and emerging vaccination campaigns. Some researchers point to the neocoloniality of the COVID-19 recommendations from organisations such as the WHO that issued recommendations based on the situation in high-income countries. The homogeneous global approach towards the pandemic has been criticised as bringing more harm than help in some specific local contexts (see Shah et al. 2022 on the situation in India). An uneven vaccine rollout, triggered by the rapid development of several vaccines in a handful of countries, has also been raised as a prominent example of postcolonialism (Penner and Sprague 2023; Fallah and Ali 2022).

The postcolonial framework is also commonly applied to unravel the impact of unequal and often deeply unethical treatment of ethnic or racial minorities during medical research and in healthcare provision (Mosby and Swidrovich 2021; Greenwood and MacDonald 2021). The knowledge of such mistreatment has contributed to, among others, the tendency of African Americans to avoid vaccination (Jamison et al. 2019; Quinn et al. 2016) and to the COVID-19 vaccine hesitancy among ethnic minority healthcare personnel in the UK (Armitage 2022). The rumours that state authorities had their hidden, nation-threatening agendas have also been discussed in relation to postcolonialism and vaccination. Niels Brimnes (2017) links the resistance to immunisations in India to the resistance to colonial power, showing that immunisation campaigns were perceived by some as a threat to the Indian nation by harming its natural immunity and moral power.

The colonial entanglements of vaccination have never, to our knowledge, been scrutinised in the Russian Federation. Anthropological or sociological studies on vaccination in Russia are scarce (Borozdina 2019) – broader comparative research is based on quantitative data (Tran et al. 2021; Kuznetsova et al. 2022), and many studies and surveys do not take into account the peculiarities of the regions (such as Tran et al. 2021; Borozdina 2019; Privivki 2021). They tend to rely instead on statistical data – an untrustworthy source of information in authoritarian regimes, as it is prone to obfuscation. While the ethnographic approach lacks the scope of quantitative sociology and does not provide tools to fully contradict statistical data, it aids in understanding the phenomenon in more depth, allowing researchers to find different, less articulated entanglements and connections. Even prior to the Russian invasion of Ukraine on 24 February 2022, the presence of foreign researchers who conducted fieldwork in Russia had been declining (Goode 2016). Local scholars received national grants for mainstream topics such as migration but were discouraged or even prohibited from embarking on projects exposing flaws of the authoritarian system (Yusupova 2019). A failure of the COVID-19 vaccination scheme would very likely fall into this category.

Researchers observing social and political issues around COVID-19 in Russia turned their attention first and foremost to pandemic management and outcomes (Smyth et al. 2020). We did not, however, come across any work that involved an analysis of local practices and narratives around COVID-19 vaccination, neither in the North Caucasus nor in Russia as a whole. We identified only one study that used partly ethnographic methods (interviews) and dealt with COVID-19 vaccine hesitancy in Russia. The study presented a typology of vaccine hesitancy in connection to health capital and agency, but its author, Anna Schneider-Kamp (2022), did not take regional differences into account in her research design. Her results concerning reasons behind vaccine hesitancy were presented as evenly spread throughout the Russian Federation as a whole.

The Republic of Dagestan and Its Colonial Legacy

Dagestan, a North Caucasian republic of the Russian Federation, is inhabited by indigenous ethnic groups such as Avars, Dargis, Lezgi, Tabasaran, Lak and others (mostly Sunni Muslims). Ethnic Russians make up only 3.3 per cent of the population (Rosstat 2018), although their number is growing due to the increased presence of military personnel in the region. Nominally, the republic is among the poorest subjects of the Russian Federation, but according to Maslova (2019), the unofficial incomes of its inhabitants are said to be higher than the official. Nevertheless, as a result of resource appropriation, the infrastructure is poor, and education and healthcare are underfinanced. While access to medical help is nominally free of charge, in reality, most visits, particularly in specialised medical care, require informal payment (Kaliszewska and Schmidt 2022).

Dagestan has a long and complicated history with the metropolitan centre that bears colonial traits (Jersild 2002). The colonisation of the North Caucasian territories by Tsarist Russia in the nineteenth century (preceded by the resistance of the mountain dwellers led by Imam Shamil), the establishment of the Mountainous Republic of the North Caucasus in December 1917, the deportations of Dagestanis to Chechnya in 1944 and the subsequent “civilising mission” of the USSR shaped the world views of its inhabitants.

After the fall of the Soviet Union, former republics of the USSR located in the South Caucasus and Central Asia gained independence, while republics within the Russian Federation, such as Dagestan and Chechnya, were denied that possibility and remained on the peripheries of a larger power, in a dependency of internal colonialism – a situation of maintaining colonial structures in parts of the state territory as a tool for regulating centre–periphery relations (Partlett and Küpper 2022). Although Dagestan is subsidised by the federal budget rather than economically exploited (although, since September 2022, conscription has been a form of exploitation), the quasi-colonial dependency reveals itself in social, cultural and political factors.

The Republic of Dagestan suffered from state violence from almost the start of Putin's rule in 2000. After the brutal crackdown on Chechen resistance, Dagestan became a hotbed for what the Russian government called “anti-terrorist” measures aimed at any kind of opposition. Inhabitants of the North Caucasus, in particular Dagestanis, Chechens and Ingush, began to be perceived as “Islamic terrorists” in “Russia proper” (Russia outside of the North Caucasus, popularly referred to by Dagestanis as “Russia”). In major Russian cities, they were treated as “second-class citizens” who experienced trouble with property rentals, frequent checks of documents based on their appearance (not a “typically Slavic” one) and their stigmatised depiction in popular culture (e.g. Kucharzewski 2019).

Unlike independent Kazakhstan or Kyrgyzstan, in which decolonising discourses have recently and rapidly gained popularity (see Konurbaeva 2023), in Dagestan they are absent in the official public sphere. Any attempts by local historians to commemorate events connected with the colonial or imperial past have been restricted to small localities or events that had no chance to gain broader attention. Yet decolonising perspectives continue to shape world views in conversations on communication platforms such as the Telegram channels t.me/CaucasianGazavat or the recently blocked Utro Dagestan.

A Note on Research Methods

We conducted on-site and online ethnographic research during the COVID-19 pandemic in Dagestan between March 2020 and July 2021. Our research was conducted in Russian, the lingua franca in this linguistically diverse republic. Our Polish ethnic origin and nationality made us a part of the post-socialist block that our interlocutors felt to be theirs, but we were not from “the centre” – rather, we were seen as fellow subjects of Moscow's historical imperial rule.

We focus here primarily on the on-site fieldwork. Following snowball sampling, we interviewed 51 interlocutors from two main groups of people, originating from one village in the Dakhadaevsky region and from the so-called urban middle class of various ethnic origins from the capital Makhachkala and its satellite town Kaspiysk. People from the Dakhadaevsky region were of Dargi origin, had different levels of social or financial capital and were currently living in various semi-urban settlements or Makhachkala, but still maintained strong lineage or neighbourly ties with one another. Our informants were between 35 and 75 years of age; some were religious, others were not. Apart from interviews, observations in polyclinics and spontaneous conversations about the pandemic were crucial for us to better comprehend the practices of COVID-19 certificate purchases. We limited digital interviewing to people we knew from this and former projects (spanning over 18 years). Since the beginning of Russia's invasion of Ukraine in 2022, we have not entered the Russian Federation; nevertheless, we strove to keep in touch with some of our interlocutors via online communication. Additionally, we also systematically followed 15 Instagram accounts (independent and official) with around one hundred thousand or more followers, observed the Facebook profiles of our interlocutors and regularly read articles on topics connected to COVID-19 on the Dagestanska Pravda newspaper website.

Conducting fieldwork during the pandemic in an authoritarian context raised ethical concerns. We confirmed our project with the Ethical Commission of the Institute of Ethnology and Cultural Anthropology at the University of Warsaw, and we made sure all our data would be highly secure and anonymised. We also took precautions both regarding the virus and the possibility of surveillance of our interlocutors or ourselves (on fieldwork in authoritarian contexts, see Kaliszewska 2023).

The Pandemic in Dagestan

Dagestan was hit hard by the COVID-19 pandemic in the spring of 2020 (Zemtsov and Baburin 2020). Initially, in March 2020, our informants claimed that there was no COVID-19 in Dagestan, and community life, with frequent unannounced visits of relatives and neighbours, went on as usual. Then, as early as May 2020, Dagestani hospitals were overflowing with patients suffering from diseases registered either as double viral pneumonia or COVID-19.

The responsibility for managing the COVID-19 pandemic was distributed between the federal and regional governments. Before the vaccine rollout, the responsibility for the introduction of preventive measures was on local governors (Smyth et al. 2020), but the temporary guidelines and recommendations on the prevention, diagnosis and treatment of COVID-19 were provided by the federal centre – the Ministry of Health of the Russian Federation (Murashko 2020). This meant that the biomedical treatment was provided according to the same state-imposed and regularly updated guidelines throughout the entire Russian Federation.

At the start of the pandemic, before vaccines were developed, there was no real demand for them – neither among our interlocutors nor on the Dagestani social media platforms that we observed. People did not long for the vaccine, nor did they see it as a solution to the pandemic. This was a predictor for rather poor acceptance of new vaccines.

COVID-19 vaccination started in Dagestan on 11 January 2021, at first with the Sputnik-V vaccine (introduced in August 2020), then using EpiVacCorona (introduced December 2020) and CoviVac (introduced February 2021). The Russian Federation did not buy any Western vaccines. Vaccination was carried out by local medical personnel in local clinics, in hospitals and later by medical teams visiting workplaces. Medical and uniformed personnel were vaccinated semi-forcibly while on duty. Refusal could result in repercussions.

Vaccination rates in the official statistics rose during the period of our on-site and online research (March 2020–March 2023), but the situation in the narratives and declarations of our interlocutors remained stable. After Russia's invasion of Ukraine in February 2022, our questions about COVID-19 and vaccination were ridiculed, and we registered no single case of anyone who had heard of someone who got vaccinated after that. Although our method does not provide precise quantitative results, it indicates that the vaccination rate was likely to have been very low. From our 51 interlocutors (most of whom were enmeshed in broad social networks), one person was vaccinated; three people knew someone who was; six had heard of someone; one person planned to be vaccinated. Since vaccination was a publicly discussed issue, all of our interlocutors had information about numerous family members in their lineage or extended family, as well as co-workers and neighbours. Our data thus calls into question the significant rise in vaccination rates present in official data – from 1,169,583 on 24 February to 1,732,420 on 3 December 2022 (Statistika vakcinacii 2023).¹

The official encouragement for vaccination was abundant. Illustrative posters were distributed online and displayed in public spaces by the Ministry of Health of the Republic of Dagestan. To address vaccine hesitancy and enhance availability, they set up vaccination buses at busy spots in towns and on roads to villages, while federal authorities organised big jackpot lotteries with automatic participation for those vaccinated (Schneider-Kamp 2022; Kuznetsova et al. 2022). According to an informant of ours, who had cooperated with the Spiritual Board of Dagestani Muslims (SBDM), official religious authorities were encouraged to promote vaccination during sermons, but they did not entirely conform. None of the SBDM employees got vaccinated, while many, including Mufti, the head of the SBDM, contracted COVID-19. To somewhat conform to the rules imposed by the Ministry of Health, the SBDM agreed that the vaccination bus could occasionally be set up next to the main mosque in the capital.

“They Want to Exterminate Us, but People of the Caucasus Are Not Idiots”

The visits of medical teams intended to half-forcibly vaccinate employees working in government-paid workplaces were vividly discussed among our interlocutors. Elmira, a music teacher in her forties, did not consider being vaccinated for COVID-19. She belonged to the Lak ethnic group, the fifth-largest in the republic, and lived in Kaspiysk. A week prior to our conversation, a vaccination team visited her school, but most teachers took a day off. “If something is good, they hide it from our people, but when it is bad, they force it upon them … Here, the people are suspicious if they get things for free; they got used to paying for everything. If they had to bribe for it, they would fight to be the first to get it,” joked Elmira. The fact that the vaccine was created so quickly, while other infrastructures, such as roads or water pipes, have always taken a long time to improve, only added to her suspicion. Elmira did not fully reject vaccination itself – while she was not vaccinated against influenza, as it was neither very popular nor advertised in the republic, her son received all compulsory immunisations in his childhood. Elmira's mother, a woman in her late sixties, was in the process of getting a vaccination exemption on the basis of her allergies. The mother, too, had a vaccination team come over to her workplace. Only one of her colleagues, who was present when the medical personnel came, hid in the bathroom until they left. Others, like Elmira's mother, took a day off. Most of her colleagues would rather have obtained COVID-19 certificates than be vaccinated. She voiced a popular opinion: “People say that they want to get rid of the people of the Caucasus; this is why they distribute this vaccine.” Elmira and her mother, along with most of our other interlocutors, voiced similar suspicions towards the motives of the state, fearing the extermination of the Dagestani population or the weakening of their health and “potency” that might be orchestrated through medical procedures. They also circumvented vaccination requirements with informal strategies similar to the above.

In her study in Russia and Denmark, Anna Schneider-Kamp (2022) identifies four types of vaccine hesitancy at the nexus of health capital and agency. The first applies to the interplay of powerful beliefs that vaccines cause long-term side effects and the mistrust of authorities who have created and evaluated the safety of these vaccines; the second refers to personal fears of people whose health is vulnerable; the third to the lack of understanding of the policies of health authorities that obstructs informed choices; and the last to feeling sufficiently empowered to make one's own choice based on one's health and social capital.

Schneider-Kamp's (2022) typology focuses strongly on individuals and their decisions and choices. When we applied her typology to our field material, we noticed that, although we traced all the above types of vaccine hesitancy in the narratives of our interlocutors, what remained in our data, not mentioned in Schneider-Kamp's typology, was hesitancy rooted in a more collective mode of thinking, more precisely a thinking about one's health in relation to the health of one's lineage or clan, or even “nation”. It is precisely this kind of thinking, rooted in recent and distant histories of the region, that we highlight in this analysis.

When we look at Elmira's and her mother's narratives more closely, it is striking that their distrust was deeply ingrained in the memory of both distant and recent events, as well as in a strong perceived divide between “our people” and “the Russians”. The expression “our people” in Elmira's case and more broadly denominates the inhabitants of Dagestan, but sometimes it also covers one's own ethnic group or, less frequently, the inhabitants of the North Caucasus – as opposed to “Russians” (a term that denominates non-Muslim inhabitants of the Russian Federation of Slavic origin). Dagestanis have numerous reasons not to trust either local or federal state officials. This peripheral region was mistreated by siloviki (representatives of the power structures) in the so-called fight against terrorism and neglected in regard to various infrastructural projects. As a result, the state has gradually become perceived as predatory and violent (Kaliszewska 2023).

The fact that vaccines were given for free and encouraged by the state was perceived with suspicion among our interlocutors and juxtaposed with everyday medical situations: while nominally free, in reality, medical treatment often required bribes. Issuing the COVID-19 vaccine for free appeared unusual, therefore drawing attention and, as such, increasing vaccine hesitancy.² This sudden care of the state, in a place where disillusioned people have long managed on their own, was seen as suspicious (Kaliszewska 2023: 84–128). “We build roads and schools on our own, the state gives us nothing, and suddenly they care? Seems kind of suspicious?” commented a woman in her fifties. She alluded to the fact that, in many remote settlements, local affluent people, along with the inhabitants, finance roads or school buildings because the authorities have failed to do so.

In the USSR, medical care was free of charge, but the rampant capitalism of the 1990s and the normalisation of bribes for medical procedures (Rivkin-Fish 2005) made the inhabitants of the North Caucasus suspicious of a complementary vaccine distributed for free. In the USSR, child vaccination was compulsory, free and, with time, accepted as just another thing children had to go through. After the fall of the USSR, vaccines were no longer compulsory (although recommended), and postponing or refusing to vaccinate children became commonplace (cf. Hoang 2020; Borozdina 2019) – but not as common as COVID-19 vaccine hesitancy. This drop in vaccination rates in the late 1990s and early 2000s was explained by many researchers as a result of the socio-economic changes after the collapse of the USSR. Individualisation processes in post-Soviet societies were described as especially prominent factors causing vaccine hesitancy (Hoang 2020; King and Mukhina 2021). In Dagestan, these individualistic changes were not prominent enough to influence vaccination rates significantly. Colonial relations with Moscow, together with crisis and bribery in the healthcare system, were much more important in this regard. Dagestanis were also not used to the vaccination of adults, and the decision to vaccinate one's children seems to be a different decision-making process than vaccinating an adult, as many scholars argue (e.g. Quinn et al. 2016).

The interpretation frame of “they want to get rid of us” or “make our people weak” was very widespread during the prolonged “fight against terrorism”, when many – often innocent – people were killed for being purportedly involved in terrorist activity (Kaliszewska 2023). When vaccinations began, the memories of recent state-induced violence re-emerged: “Siloviki did not manage to kill us all, so now they are looking for other ways”; or “They say that the vaccine was invented to get rid of the troublesome people of the Caucasus.”

Different analytical frames can highlight different aspects of vaccine hesitancy, and we were initially inclined towards a conspiracy theory framework. Shtyrkov quoted in Panchenko's paper (2016) looks at conspiracy theories in Russia as a kind of legacy of the Soviet meta-narratives of “the secret war between us and them”. In Dagestan, however, this “secret war” was not so secret, and we are therefore more inclined to interpret these narratives in relation to the everyday experience of the Russian power structures’ violence and discrimination against the inhabitants of the North Caucasus. The extermination narratives bore a similar emotional load to analogous narratives that we heard in the turbulent period of the “fight against terrorism”, in particular between 2007 and 2014 (Kaliszewska 2023), when Dagestanis were deeply concerned about the numbers of their (often innocent) youth becoming victims of anti-terrorist units. Over the years, despite the changing political leadership in the republic, the narratives of purportedly deliberate extermination of the people of the Caucasus and the supposed objective of a “Caucasus without Caucasians” were highly persistent. Emotionally loaded narratives about extermination resurfaced during the pandemic and again in September 2022, when Russian authorities set in motion the military draft (Kaliszewska 2022). The conscription and vaccination were both results of unexpected circumstances. The campaign to vaccinate adults, not children, was an unprecedented event that made it even more suspicious (cf. Holt 2021), and the rapid production of the vaccine seemed more questionable than its origin or composition. One could argue that the COVID-19 vaccination campaign differed from the military conscription since it was orchestrated by local rather than central authorities, but our interlocutors still perceived the COVID-19 vaccination regulations to be imposed by Moscow, despite the federal authorities’ decision to shift the responsibility for disease control and prevention to regional governments (Kurnosov and Varflomeeva 2020). Some similarities may be found here with Jamison et al.’s (2019) study among African Americans, where mistrust was attributed by participants to the history of oppression and, to some extent, race. In their study, African Americans often invoked the topic of trust towards the government, claiming that they did not trust it or anything it produced, while white respondents, on the contrary, rarely invoked mistrust in the government regarding vaccines or saw this mistrust as implicit or inherent.

It may seem contradictory that, in the gradually decolonising Dagestan, there has been a lack of narratives criticising Russian vaccines as such, especially in the context of the quality of Russian biomedical science (cf. Dobson 2022). The mistrust towards vaccines in Dagestan was not aimed at particular Russian vaccines (cf. King and Mukhina 2021; Dettmer 2021). It was motivated rather by a mistrust of state policies: “If this state cannot build proper roads over the last 30 years, how can it invent a vaccine over a couple of months?” said a journalist in his seventies. The comparison to regional infrastructure was often made and also appeared widely on Instagram accounts and Telegram channels. The narrative that the peripheral republics have been neglected was very prevalent. Conversely, some voices praised the Russian vaccine, claiming that Russia had made a “proper” vaccine and that it may be better than the Western one because it was based on an old, “reliable” Soviet-era technology. This narrative echoed an official media discourse, praising Sputnik along with its creators (Ajgunov 2020; Mollaev 2021; Noordenbos 2023; Tazhudinova 2020). However, even the praise of the Russian vaccine did not persuade the inhabitants of Dagestan to get vaccinated. Moreover, the lack of choice between Russian and Western vaccines was not framed as a problem or obstacle and did not seem to affect vaccine hesitancy.

Overall, our analysis revealed that the COVID-19 pandemic evoked similar reactions towards the state as other recent crises that have brought to the foreground a decolonial thinking about one's place in the world and in the Russian Federation, as well as an us versus them division.

Creative Forms of Resistance towards Vaccination

Elmira was ruminating on whether to buy her vaccine certificate or not: “They are getting more expensive every week, I wish I had bought one right away.” A week after our meeting, Elmira and both her mother and son contracted COVID-19, which left them debilitated for over two weeks. When they were recovering, Elmira admitted that it had been tough but immediately commented that now she did not need to waste money on the certificate because the antibodies would secure her a QR code, nominally required in supermarkets, cinemas or theatres. When we asked whether she ever needed it, she admitted to having shown it only once or twice:

A young man, when he asked me for the QR code [at the entrance to the supermarket], explained himself: ‘Please, understand, they are controlling us.’ He knew it was meaningless … Can you imagine, there comes a granny and they ask her for a QR code? Son, she would say, I was tucking you in, singing you lullabies, and you ask me for a QR code? … This is Dagestan, this system will never work. The harder they press, the less likely people are to comply. Our people are smart.

In June and July 2021, discussions about certificates – whether purchasing them was worthwhile and necessary – were very common among our interlocutors. The prevalent assumption was that scarcely anybody was vaccinated. Vaccination teams, visiting institutions such as schools, kindergartens or ministries to encourage or enforce employees’ vaccination, were perceived as yet another intrusion to deal with, either by taking a day off or paying a bribe. The visitations were compared to bosses taking overheads from their employees’ salaries (Kaliszewska and Schmidt 2022). According to our interlocutors, in some instances, vaccination teams were not actually involved in vaccinating but rather in issuing the vaccination certificates for money. We were unable to confirm whether this was true, but even if it was mere gossip, it fortified the perception of the vaccination process as yet another form of extortion. The teams were perceived as external (“not our doctors”), even if they consisted of Dagestani doctors (though not necessarily familiar ones), and were directed by Dagestani authorities who were sometimes perceived as “slaves of Moscow” and hence treated as part and parcel of the system. The local interpretation of the medical teams’ intentions was: “If they come and want something, it must be about money.” This view was so dominant that it did not cause much discussion or doubt among our interlocutors: it fit the well-known scheme, and thus nobody contested it.

Among our interlocutors, purchases of vaccination certificates were discussed openly during family get-togethers or even on bus rides. During our fieldwork, we heard numerous conversations about the current prices. The discussions were along the lines of “how much?” “where?” and finally: “are they real?” and “will they be accepted in Russia?” Dagestanis worried that in “Russia”, where rules are believed to be stricter, they might get into trouble with a purchased certificate, and there would be nobody to defend them. The certificates that were considered the most secure were the ones arranged in clinics, where the medical personnel opened the vaccine, poured it out and even faked a dressing on the shoulder of the patient, who was asked to wait 15 minutes in case of “unexpected after-effects.”

Informal practices in healthcare systems in the former USSR have often been analysed through the post-socialist analytical frame, where attention has been paid to the poor performance of a healthcare system in which underpaid doctors need to be bribed (cf. Temkina and Rivkin-Fish 2020; Bukovcan 2022). Certificate purchases, as our analysis shows, barely belonged to the medical sphere – rather, the requirement to possess a certificate was seen as yet another requisite formal procedure, similar to other requirements and certificates one needed at work or to run a business. They were arranged mainly to keep the state away from people's bodies and to ensure freedom of movement.

Thinking through the post-Soviet lens and exposing flaws and strong points of the healthcare system obscures, we believe, what is important for our analysis: the tension between the North Caucasian peripheries and the federal centre, rooted in a colonial history of discrimination and permanent distrust. This tension has resulted, on the one hand, in state violence and control and, on the other, in the population's growing distrust towards the intentions of the state. Although COVID-19 vaccination in the Russian Federation (as in other parts of the world) was not compulsory, the state authorities tried to enforce it by sending vaccination teams to workplaces and requiring COVID-19 certificates or QR codes in public places, such as supermarkets.³ Polina Loseva (2022), analysing the official data on vaccination in Russia, shows that changes in the law regarding mandatory COVID-19 certificates (June and November 2021) correlated with a number of fake certificate purchases, judging by the number and popularity of websites offering them. More pressure on vaccination did not cause more compliance (cf. de Figueiredo et al. 2021) but instead resulted in increased purchases.⁴ The proliferation of practices dedicated to circumventing the rules might be understood as Grier and Cobbs's (1968: 161) “‘healthy’ cultural paranoia”, which is (in their understanding) an adaptive, reasonable, wise and valid approach in contexts within which people interact with systems that have a long history of racism and discrimination. As demonstrated above, Dagestanis certainly had reasons to distrust the state and engage in “everyday forms of resistance”, characteristic of populations that have perceived their status as subordinate (Scott 1989: 34–52). We observed the ubiquity of this “‘healthy’ cultural paranoia”, which resulted both in the avoidance of vaccination and a focus on the ways to circumvent the formal obstacles caused by not having been vaccinated.

The purchase of certificates is obviously not a Dagestani specificity; it has been encountered in different parts of the world. The research that we came across was, however, only conducted online, on darknet users (e.g. Georgoulias et al. 2023). In these studies, actual purchases, or any narratives about them within communities, were impossible to observe. In our on-site research, a strong opposition between “metropolitan Moscow” and “us Dagestanis” (an outcome of colonial rule) resulted in sharing intimacies of informal arrangements among “our people” (and empathetic researchers).

The purchase of COVID-19 certificates that we have heard about and observed can therefore be viewed as a creative and, to some extent, silent resistance towards directives from the centre. Likewise, the purported readiness on the part of medical personnel to issue them (also by means of wasting a vaccine dose) could be viewed as a similar act of defiance. This readiness could have been influenced by the COVID-19 vaccine hesitancy present among medical personnel (Karaeva 2021). As Reich (2016) shows in the example of the nineteenth-century American smallpox vaccination campaign, teachers, principals and school personnel may be largely uninterested in public health enforcement. The same might be true for the Dagestani medical personnel and the QR code checkers at the entrances to various public premises, who, being a part of society, might privately share reservations against the restrictions with other members of their lineage.

The perception of the COVID-19 vaccination in terms of “just another regulation” from the centre is part of a larger phenomenon: the situation of being an inner colony (Loring 2014)⁵ results in an ambiguous interaction between the federal centre and the local authorities, who, in order to be further supported and financed, need to demonstrate loyalty and complicity. This was not only the case for COVID-19 vaccines, but also for example for elections that local authorities made the effort to fake sufficiently for them to appear democratic and fair (Kaliszewska 2023). At the same time, local authorities understood that, with their lack of authority among the local population, they would not be able to exercise any coercion. As a result, they pretended to comply with the federal centre, while citizens pretended to obey the imposed rules in front of the local authorities, at the same time circumventing or ignoring them. As a result, in Dagestan documents or declarations are often void of meaning – disability certificates do not certify real disability (Kaliszewska and Schmidt 2022), halal certificates do not guarantee the halalness of food and COVID-19 certificates did not bear “safety” value. Again, similarly to doctors who might have praised the vaccine publicly or in front of people from “Russia proper” but did not encourage their relatives to vaccinate, such practices as purchases of COVID-19 certificates stayed confined to the local “cultural intimacy” (Herzfeld 2004). The transactional relationship that characterises, on a more general level, the dynamic between the federal centre and the Dagestani government was reflected in the vaccination scheme.

Conclusions

There is no single story of vaccine hesitancy in the Russian Federation. Despite a relatively homogeneous healthcare system, narrations and practices around vaccination in this vast and diverse country need to be analysed with respect to different social contexts. COVID-19 vaccine hesitancy in Russia results from, among other things, a mistrust towards state policies – an attitude common in the Russian Federation as a whole (Schneider-Kamp 2022; Holt 2021). The quasi-colonial status of Dagestan has added to this pan-Russian phenomenon by evoking associations with other crises, such as the so-called “fight against terrorism”, unequal treatment of Dagestanis in the Russian Federation and their self-perception of being perpetually threatened by the state. The quasi-colonial status of the republic has also provoked the perception of vaccination as yet another imposition from the centre. As a result, vaccination is seen not as a medical procedure but rather as a formal one, resulting in the switch of focus from vaccination to certificate arrangements.

Despite the fact of the vaccine being encouraged, broadly available and free of charge, our analysis shows that in postcolonial contexts, one's health may be approached not in strictly individualistic terms, but in relation to one's lineage or “nation”.

What do the results of our research mean for state-centred studies of vaccination? The Dagestani anti-vaccination case cautions us against uncritically trusting statistics in settings with a history of falsifying data. In Dagestan, the vaccination statistics were not just slightly altered or “improved” but rather were disparate from reality. A lack of access to official information should not, however, be an obstacle in approaching the topic ethnographically.

The case of Dagestan highlights a form of vaccine hesitancy distinct from the Western perspective, which is grounded in part in individualistic thinking (Reich and Gross 2022). In the Dagestani context, one's health is associated with the well-being of the entire lineage or even the nation. As a result, collective notions about health and the prioritisation of local solidarities, rooted in a colonial legacy, paradoxically contribute to stronger vaccine hesitancy.

Different analytical frames may highlight different aspects of vaccine hesitancy. We have tried to demonstrate that the colonial frame of reference can broaden the understanding of vaccine hesitancy in the region by pointing to its features that would be omitted if we applied the post-Soviet interpretative frame. We therefore encourage researchers to look for everyday colonial entanglements both in places where decolonisation discourses are a part of the public debate and in places where such discourses are restricted from public discussion, but where they nevertheless exist and influence health-related decisions, among other things.

Bearing in mind that vaccine hesitancy is seen in the biomedical realm as a source of crucial social and epidemiological problems, researchers need a nuanced and diversity-sensitive approach to vaccine hesitancy.