By Irina Glushchenko
MOSCOW — Not so long ago, all that most Russians knew of serious infectious diseases was what they read in the classics of their national literature. After surviving a bout of typhus, Tolstoy's heroine Anna Karenina had her head shaven. Dostoyevsky in Crime and Punishment described the horrifying spots on the dress of Katerina Ivanovna, coughing blood from her consumptive lungs. Other 19th century writers provided harrowing accounts of sickness and death from diphtheria and other diseases.
Russia's present rulers, it seems, are not just intent on returning to the last century in matters of economic structure and social policy. Along with stock markets, commodity exchanges and bankruptcy courts, other phantoms from the past that have now rematerialised include cholera, typhoid fever and even plague.
Most Russians, exhausted by the struggle to keep themselves fed and clothed, have been remarkably indifferent to warnings that serious infectious diseases are on the way back. Foreigners are often astonished at this complacency — "If there were just one case of cholera in our country, there'd be an outcry!" But in Moscow, despite increasing rates of infection and a growing number of deaths, the reaction has been muted.
During the first six months of 1993, around 4000 cases of diphtheria were registered in Russia. During this period there were 104 deaths from the disease, compared with 131 for the whole of 1992. The worst-afflicted centres included Moscow and St Petersburg. During the first eight months of 1993, diphtheria claimed the lives of 45 Moscow residents.
Diphtheria is an almost wholly preventable disease, and in the days when mass vaccinations were kept up, cases were rare. Now, the proportion of Russians who have had their "shots" for serious infectious diseases has fallen well below the critical level at which carriers begin frequently to come into contact with people lacking immunity.
One reason is the calamitous state of Russian health care. There are shortages of vaccines, and the real wages of workers in the public health system have been allowed to shrink to pitiful levels. But even where vaccinations are free and readily available, many people still refuse to take advantage of them. In the mid-1980s, the advent of AIDS brought a wave of alarming press reports about the dangers of vaccination, and single-use syringes are still far from generally available. As a result, many parents are afraid to allow their children to be vaccinated.
Many Russians are also hostile to the idea of universal vaccination, associating it with violations of individual rights. Now that official pressures have been relaxed, the rate of vaccination has plunged.
"According to the statistics, barely 60% of the children in Russia have now been immunised", leading paediatrician Professor V.K. Tatechenko noted in January 1993. "In order to avoid outbreaks of various infectious diseases, a level of 90 to 95% is needed."
Of the formerly banished diseases which have now reappeared in the former Soviet Union, one of the most dangerous is cholera. The first reports in the Moscow press of cholera outbreaks concerned cases in Armenia, Azerbaijan and Tajikistan — all countries where wars were being fought and the authorities could do little to combat infectious diseases.
But the cholera bacillus did not halt its advance at the Russian border. Cholera is essentially a disease of areas where sewerage systems are non-existent or poorly maintained, and sewage carrying the bacillus can leak into water supply systems. With the drying-up of funds for replacing decrepit infrastructure, many of Russia's cities now fall into this category.
Urban centres affected in July included Krasnodar, Nizhny Novgorod and Naberezhnye Chelny. Then in the second half of August, cholera returned to Moscow, with three cases recorded.
If the confirmed cases of cholera in Russia last year total only a few dozen, the number of sufferers from typhoid fever was in the hundreds. In one outbreak of the latter disease, in Volgodonsk in southern Russia, 33 cases were confirmed. The outbreak was preceded by numerous accidents and breakdowns in the city's water supply system.
The Russian government has been as complacent as anyone about the prospect of massive epidemics. The attitude of present-day functionaries recalls that of the government officials in Nikolai Gogol's classic 19th-century play The Inspector-General: "The closer you are to nature, the better. We don't use expensive medicines. People here are simple. If someone dies, they die, and if they get better, they get better."