Making the Best Out of a Crisis: Russia’s Health Diplomacy during COVID-19

: The article considers how Russia has reacted to the pandemic, especially in terms of foreign policy. Although internally the management of the pandemic has led to a further limitation of citizens’ freedoms, externally it has been exploited to improve the country’s image and strengthen its leverage through tactical activism and political generosity. Russia’s strategy has been articulated in two phases: ﬁrst, immediate aid to countries in need in order to channel the idea of a benevolent state, directly or indirectly discrediting other countries or organisations; second, the geopolitical use of vaccines. The article stresses the relationship between science and foreign policy and analyses Russia’s health diplomacy strategy, underscoring its opportunities and challenges through the analysis of two case studies (Italy and Belarus). From a methodological perspective, the article mainly refers to foreign policy analysis (FPA), using concepts such as soft power, health diplomacy, and geopolitics.


Introduction
The Russian Federation is among the countries hit the most by the COVID-19 pandemic, especially during the third and fourth waves. The Kremlin's anti-COVID-19 policy has been shaped, among other things, by its political events. In July 2020, a national vote on changes to the Constitution occurred, and on 19 September 2021, parliamentary elections were held. The government tried to avoid burdensome restrictions for economic reasons and due to the public's negative attitude towards certain measures (e.g., wearing masks, compulsory vaccinations, the need to have QR codes) (Wiśniewska 2021). Nevertheless, the pandemic has in some instances been used as a pretext to limit citizens' freedoms of assembly beyond what is plausibly necessary in order to combat the spread of the virus, i.e., as an excuse for further "autocratising" already illiberal democratic regimes (Shevtsova 2021). 1 Moreover, the pandemic has led to some transformations within centre-periphery relations. Contrary to the decades-long pattern of de-federalisation, since April 2020, regions and other sub-national authorities have been granted more powers by the Kremlin in an effort to tackle the crisis more efficiently, potentially leading to more decentralised governance (Makarychev et al. 2020;Ferrari and Tafuro Ambrosetti 2020).
While aware of the importance of the domestic dimension of the management of the pandemic, the article focuses on how Russia has tried to exploit the COVID-19 crisis to improve its external image and soft power, while at the same time further widening its influence. Russia is seeking to rebrand its external reputation to reduce tensions with some Western states, which have condemned Moscow for breaching international norms and disrespecting human rights (e.g., the 2014 annexation of Crimea, the alleged poisoning in the UK territory of the former Russian military intelligence officer Sergey Skripal, and, in Russia, of the political opponent Aleksei Navalny, as well as the repression of protests and political opposition more broadly).
We argue, therefore, that the pandemic has offered the Kremlin a window of opportunity to enhance its external appeal and influence through health diplomacy. The practice of health diplomacy abroad is also hoped to positively reverberate internally. Trust in the leadership can be reinforced by refreshing the narrative that the country is excelling in science and research to the point that it can aid even Western countries running out of medical equipment and can provide them with the Russian vaccine, Sputnik V. Russia was the first country to register a COVID-19 vaccine-though among accusations of disregarding scientific standards-demonstrating technological and scientific prowess. Moreover, Russia has relied on health diplomacy to strengthen bilateral relations to further its influence in the post-Soviet space and forge alliances with friendlier countries in Asia, Latin America, and Africa.
The article traces Russia's strategy over a year (March 2020, focusing on its external goals and methods. First, we analyse the impact of COVID-19 on the relationship between science and foreign policy. Although underfunding, plagiarism, bureaucracy, and political interference plague Russia's scientific community (Schiermeier 2020), the Kremlin has embraced health diplomacy to boost its influence abroad. Secondly, we will analyse Russia's strategy to enhance its reputation in science and in the health sphere. In the first phase of the pandemic, Russia sought to help other struggling countries, such as Italy, by delivering medical equipment at the beginning of the crisis. However, Russia's solidarity evidenced the difficulty of the EU to react promptly and the reticence of some member states to help the country. In the second phase, Russia used its Sputnik V vaccine following some geopolitical considerations. Russia has been generous with ex-Soviet countries, donating vaccines or proposing financing schemes, and has been ready to do the same with those EU countries willing to accept its offer.
From a methodological perspective, the article builds on Foreign Policy Analysis (FPA). We particularly consider the literature on soft power to explain how Russia has used health diplomacy not only for rebranding itself as a benevolent actor but also for reaching some geopolitical objectives. After a brief overview of Russia's international strategy, we focus on two cases: Italy and Belarus. The first is a member of the EU, entertaining a "special relationship" with Russia (Siddi 2016(Siddi , 2019Giusti 2017) based on close energy and political relations and therefore has a special place in Russia's EU strategy. The second is a former Soviet Republic ruled by an autocratic regime that depends on Russia and that is increasingly turning into a security problem for the EU. The analysis of these two cases will help elucidate Russia's modalities of action in two very different countries and different phases of the development of the pandemic.

Foreign Policy and COVID-19
In order to capture the features of Russia's response to COVID-19 for maximising its foreign policy goals, we refer to FPA, which is concerned with how states, or the individuals who lead them, make and implement foreign policy and react to other states' foreign policies. We consider foreign policy as the result of internal dynamics in terms of decision-making processes and people's expectations and goals to achieve them, and at the same time as a form of assertion and response regarding the outside. Through foreign policy, states defend and pursue their interests in the international arena. However, they can also use what they achieve outside for domestic ends, usually strengthening the leadership consensus. In a widely interconnected world, the boundaries between domestic and external politics have become less and less discernible, since domestic politics and international relations are often entangled (Putnam 1998;Hill 2003). The way the inside and outside solicitations and constraints interfere depends, among other things, on the nature of the polity considered (the specific political system and regime type).
As for Russia, foreign policy remains elitist (Efimova and Strebkov 2020, p. 4), as it is strictly controlled by the President (Burrett 2010;Morozov 2015) and his inner circles following a progressive verticalisation of power. Nevertheless, the country has geopolitically expanded its foreign policy goals, going well beyond the post-Soviet space, its traditional sphere of influence, to reach other regions such as the Middle East, Africa, and Latin America. In a relatively short time, Russia has employed all the instruments of the foreign policy escalation ladder, stretching from soft to hard power, from cultural influence to hybrid war. Russian foreign policy has, in rapid succession, served many goals: normalising and stabilising the country with the support of international organisations (e.g., the European Union, the International Monetary Fund, the World Bank); advancing in modernisation through the strengthening of relations with strategic actors such as the EU; regaining a power status and prestige in the international system; and reinforcing citizens' consensus for leadership after various protests have taken place also during the pandemic in support, for instance, of Alexei Navalny (Snegovaya 2021), in addition to people's dissatisfaction with the current leadership (Zafesova 2021). Unsurprisingly, among scholars, there are contrasting views on how to read Russia's external projection. Some believe that Russia acts following a realist balance-of-power rationale (Sakwa 2008), while others present it as a role player, performing according to its identity, norms and self/other perceptions (Neumann 1996).
FPA allows us to understand how Russia has used the question of vaccines as an instrument of both soft power and geopolitics. We can consider soft power under the guise of health diplomacy and geopolitics as the two extremes of Russia's foreign policy in the context of COVID-19. There is also another and perhaps more convincing possibility that sees health diplomacy as instrumental to reaching some geopolitical goals, reflecting the major orientations of Russia's foreign policy. So the two are not phases of a continuum, but rather the first is at the service of the other one. The following paragraphs will explain the link between soft power and health diplomacy and examine how Russia has in fact acted and implemented its health diplomacy. We will focus on two case studies portraying two different modalities of interventions undertaken at a different time and regarding one as a member of the EU and the other a strong ally of Russia. We will then try to assess tactics and goals, considering that the success of Russia's strategy also depends on the broader global political context. The Kremlin is tactically using the pandemic to brand itself as a benevolent country and strengthen its leeway according to geopolitical interests.

Soft Power and Health Diplomacy: The Russian Way
Since Joseph Nye elaborated the concept of soft power (Nye 1990), he came back to it in many essays and books (see, for instance, (Nye 2004(Nye , 2011 with the aim of fine-tuning and expanding it. Fully defined, "soft power is the ability to affect others through the co-optive means of framing the agenda, persuading, and eliciting positive attraction to obtain preferred outcomes". Often misused as a "for anything other than military" (Nye 2011, p. 81), the term stands, Nye argues, for a particular means of influence: the one that a country can achieve through its culture, values, and domestic practices, and the perceived legitimacy of its foreign policies (the three sources of soft power).
Science and technology (S&T) policies started to receive increasing scholarly and institutional attention as tools of soft power in recent years. This is not a new phenomenon: suffice it to say that scientific and technological progress represented one of the leading elements of superpower competition during the Cold War (Aldred and Smith 1999). Nevertheless, this tendency has gained strength lately. The European Commission, for instance, has been explicitly recognising the importance of S&T in its foreign policy as an "effective soft power tool (...) to support external policy objectives for peace, security, humanitarian aid, and social and economic development" (European Commission 2016, p. 76). In particular, health diplomacy, which was previously relatively overlooked by the soft power literature compared to other tools such as culture or democracy promotion policies, came to the forefront of soft power analysis with the COVID-19 pandemic, and it is likely to remain very relevant in the medium to long terms as well.
Fazal (2020, p. 78) defines health diplomacy as "international aid or cooperation meant to promote health or that uses health programming to promote non-health-related foreign aims". Health diplomacy can be carried out by states, international multilateral organisations such as the Group of 20 (G20), or private philanthropic organisations such as the Bill and Melinda Gates Foundation. Such a distinction is often blurred as states often rely on cooperation with global intergovernmental organisations such as the World Health Organization (WHO), non-government organisations (NGOs), and pharmaceutical companies to enhance their global health policies. Health diplomacy's disciplinary boundaries are not clearly defined either, as it brings together public health, international relations, management, law, and economics. Finally, the nature of HD is transnational as it "relates to health issues and determinants that go beyond country boundaries limitations, are international in nature, and need global consensus to address them" (Fazal 2020, p. 78). Another catchphrase that became very popular during the pandemic is vaccine diplomacy. Hotez (2014) explained that vaccine diplomacy is an all-encompassing term referring to almost every aspect of global health diplomacy based on vaccines. It looks primarily at international organisations and NGOs. A key element of vaccine diplomacy is its humanitarian potential as a life-saving and conflict-resolution tool.
A subset of vaccine diplomacy is vaccine science diplomacy, which is a "hybrid of elements of global health diplomacy and science diplomacy (...) referring to the joint development of life-saving vaccines and related technologies", with scientists potentially coming from states that are ideologically at odds or even plainly hostile (Hotez 2014, p. 1). With the evolution of the COVID-19 pandemic, the term "coronavirus diplomacy" has also started to be used especially in relation with China, as part of its "broader public relations strategy, which is supposed to counteract negative perceptions of this country as well as to present it as a responsible citizen of a global society" (Financial Times 2020). "Coronavirus diplomacy" includes a first "emergency" phase marked by the so-called "mask diplomacy" (the delivery of medical aid) and a second one characterised by the diplomatic use of vaccines that has turned into vaccine geopolitics.
While China appears to be the most active country in this field (Kobierecka and Kobierecki 2021), Russia has also gained considerable relevance, especially in the pandemic's second phase, with the development of Sputnik V, the first vaccine registered in the world. However, Russia is not new to this endeavour. Despite Russia not being commonly described as a "vaccine powerhouse", its Gamaleya Institute has been working with adenoviruses since the 1980s and developed the Sputnik V based on GamEvac-Combi, Russia's internationally approved Ebola vaccine (The New York Times 2021). The Ebola vaccine, registered in 2015, contributes to bolstering Russia's health diplomacy strategy, especially vis à vis African countries. In 2017-2018, GamEvac-Combi was inoculated to 2000 people in the Republic of Guinea by Russia's Ministry of Health in tandem with aluminium producer Rusal, which ensured the "deployment of a field hospital donated by Russia and organised and funded the training of qualified military medical personnel for its operation" (Russian Ministry of Foreign Affairs 2017). There are other famous examples. Going further back to Cold War times, for instance, the Soviet Union worked with the US to eradicate smallpox (Carroll 2016).
However, Russia's health and vaccine diplomacy suffer from internal (lack of adequate health infrastructure and investments) and external (reputational) problems. Russia managed to come first in the global vaccine race despite the severe shortcomings facing its research community. While Russia inherited a relatively good health system and competitive research facilities from the Soviet Union, these have deteriorated due to underfunding and, lately, Western sanctions. As a result, before the development of Sputnik V, the country had under-achieved when it came to producing its own vaccines, especially new ones, even though Russia's extensive geography makes it highly vulnerable to importing new diseases (Hotez 2021, p. 140). For these reasons, Sputnik V's "success story" testifies more to the "priorities and patronage of the country's leadership" rather than to the thriving state of Russia's research field (Gel'man 2021).
Not everyone trusted or rejoiced about Sputnik V's efficacy results. The vaccine was met with scepticism in Russia as well as abroad. Even though an independent peerreviewed study declared that the vaccine was "safe and effective", giving around 92% protection against COVID-19 (Jones and Roy 2021), the international scientific community's keep having doubts about the Sputnik V's efficacy due to alleged insufficient trial evidence. In Russia, 58% of the respondents of an opinion poll conducted by the Levada Center in March 2021 said they were unwilling to be vaccinated with Sputnik V. (Levada Center 2021a) Russians' hesitancy may stem from "long-established conspiracy theories and deliberate disinformation" present in Russia-sometimes deliberately propagated by the government, such as the 1980s Soviet disinformation campaign entitled Operation INFEKTION 2 or, more recently, myths about the dangers of 5G (Grimes 2021, p. 12). Outside Russia, not only were there concerns about the Sputnik V's efficacy, but critics also pointed at its alleged propagandistic use by the Kremlin. The Washington Post highlighted the choice of the name "Sputnik V" as a reference to the Cold War's technological race. (Khurshdyan and Johnson 2020) EU's Council President, Charles Michel, openly dismissed Sputnik V (and Sinovac, one of the Chinese-produced vaccines) as propaganda tools and said: "We should not let ourselves be misled by China and Russia, both regimes with less desirable values than ours, as they organise highly limited but widely publicised operations to supply vaccines to others" (The Moscow Times 2021a).
The EUvsDisinfo-the project of the European External Action Service's East StratCom Task Force against disinformation-has underlined that vaccines themselves have become commodities in global public diplomacy and the national promotion of locally produced vaccines has accelerated (EUvsDisinfo 2021, p. 1). Generally, the diffusion of COVID-19 has been a very fertile terrain for manipulating information. On 11 February 2020 at the Munich Security Conference in Germany, the Director General of the World Health Organization (WHO) said "We're not just fighting an epidemic; we're fighting an infodemic", referring to the fact that fake news "spreads faster and more easily than this virus" (World Health Organization 2020). A lack of reliable information and trusted sources can be as dangerous as the virus itself. Not only does inaccurate information misuses people, but it can also endanger lives by encouraging people to ignore public health advice, take unproven drugs, or refuse a vaccine (Hazelton 2021), and the above allow many actors to take the opportunity to spread manipulated information for geopolitical reasons. EUvsDisinfo has shown that during December 2020 and the first quarter of 2021, the Russian campaign to promote the Sputnik V vaccine developed into a whole-of-government approach including state authorities, state companies, and mass media in almost daily interventions. The promotion of Sputnik V has been accompanied by the emphasis on the EU's inefficiency, delays in science research, and divisions among EU members. Pro-Kremlin media have targeted the European Medicines Agency (EMA) several times for deliberately delaying the Sputnik V vaccine review and political bias (EUvsDisinfo 2021, pp. 2-3). 3 In response, internal markets commissioner Thierry Breton argued that the EU has "no need" for Russia's coronavirus vaccine as it can achieve immunity through local European production (Reuters 2021). However, the criticisms of several senior European officials about Russia and China's "propaganda use" of the vaccine seem the fruit of a cahooting and yet competitive climate and, in the end, contrast with the more "pragmatic" approach shared by several member states. Some of them, including Italy and Germany, pressed for the experimentation of Sputnik V and Sinovac, while others, such as Hungary and Slovakia, even bypassed the EMA and purchased Sputnik (Guarascio et al. 2021). In the following paragraphs, we analyse some cases to elucidate Russia's strategy better.

Russia's Health Diplomacy
Outside of Russia's neighbourhood, the Kremlin's strategy was consistent with the attempt to capitalise on the pandemic to boost soft power in both the emergency and the vaccine phases. Several friendly states both in the EU and in the Global South constituted the target of what has been labelled a "charm offensive" (Yatsyk 2021), although at the beginning of the pandemic Russia delivered medical aid to the US as well, scoring a "propaganda triumph" (Mackinnon and Gramer 2020) in Russia's old-time enemy. In the emergency phase, the Kremlin delivered COVID-19-related aid to many countries worldwide, including several European countries such as Italy, Serbia, and Bosnia and Herzegovina. In some countries-such as those involved in the Belt and Road Initiative and the 17+1 platform in Eastern Europe-Russia faced the "competition" of China's own mask diplomacy. For instance, in Serbia, the biggest Balkan country and a close ally of Moscow, Russia committed to sending 11 military planes carrying medical equipment. So did China, which sent supplies and equipment. President Vucic thanked Vladimir Putin on Twitter, saying friendship between the two countries was "reaffirmed". However, a much warmer reaction was reserved to the Chinese President, celebrated through a massive billboard in central Belgrade reading "Thank you, Brother Xi!", among manifestations of China's closeness, such as claims by the former Chinese ambassador that Serbia and China are "one family, truly" (Tafuro Ambrosetti 2020a). During the second phase of the pandemic, Russia managed to use the first-registered vaccine in the world, Sputnik V, to achieve foreign policy goals. The vaccine was authorised in 70 countries worldwide as of November 2021 (Statista 2021). While the other two Russian-produced vaccines approved at the time of writing, EpiVacCorona and CoviVak, are mainly meant for domestic use, Sputnik V started to compete on the global market shortly after it was registered in August 2020.
The Russian Direct Investment Fund (RDIF), the country's sovereign wealth fund, financed Sputnik V and looked after its international sale negotiations. In August 2020, Kirill Dmitriev, chief executive officer of RDIF, confirmed that Russia had received international requests for one billion doses of its vaccine (Burki 2020). Russia sold 250 million doses to India, which is also planned to produce 1152 million doses of Sputnik V per year; furthermore, Mexico ordered a total of 24 million doses of the vaccine (Statista 2021). Russia has reportedly offered the African Union 300 million doses of Sputnik V and a financing package for prospective buyer countries. Countries such as Algeria, Egypt, and Guinea have already secured some supplies of the vaccine (Usman 2021).
In many cases, Sputnik V buyers are countries for which access to the highly demanded Western-made vaccines is severely restricted. In this regard, Russia is boosting its antiimperialist image, a cornerstone of its soft power strategy (Tafuro Ambrosetti 2020b), especially in the Global South. This trend is reinforced by the fact that a proposal from South Africa and India to waive patents for COVID-19 drugs and vaccines was blocked by the EU, the UK, and the US, which in March 2021 changed its posture, supporting the patent waiver. The proposal drew the support of more than 100 countries, including Russia, with the President declaring that "we should not think about how to extract maximum profit, but about how to ensure people's safety" (The Moscow Times 2021b), in stark contrast with the countries that opposed the proposal. However, it is noteworthy that several countries in the Global South are cancelling their orders or showing some resistance towards Sputnik V. In October 2021, South African regulators decided to defer approval of the Russian vaccine, citing concerns over the safety of Ad5-vectored vaccines in populations at risk for HIV infection (SAHPRA 2021). In Brazil, a study found that people are significantly less likely to vaccinate "if they are told that the vaccine was developed in another country, with greater resistance for vaccines from China and Russia, as compared to those developed in the US and England" (Gramacho andTurgeon 2021, p. 2608).
In the EU, the Sputnik V has still not received the EMA's approval at the time of writing, but several countries advocate for its use. Leaders in the Czech Republic and Slovakia, which were struggling with very high mortality and infection rates and a slow vaccination campaign, purchased and advocated the use of Sputnik V. Yet, such an approach caused domestic political turmoil as in both countries, some government members and parts of the population did not trust the quality of any Russian products or saw the vaccine as a geopolitical tool. The Slovak Foreign Minister Ivan Korcok described Sputnik V as a "tool of hybrid war" (Holt 2021). The Slovak Prime Minister Igor Matovic affirmed that "I thought people would be thankful for my bringing Sputnik to Slovakia while instead, we got a political crisis, and I became an enemy of the people" (Higgins 2021). A survey by the Globsec (2021) research group found that only 1% of Poles and Romanians and 2% of Lithuanians would choose Sputnik over American and European vaccines among those willing to be vaccinated. Even in Hungary, only 4% want Sputnik V. Yet, in Slovakia, around 15% of those willing to be vaccinated expressed a preference for the Russian vaccine.

Russia's Strategy towards the Common Neighbourhood
This section analyses how Russia has used vaccines to pursue geopolitical objectives in an area where the enlarged EU and Russia compete more often than they cooperate. After the 2004-2007 enlargement, the EU has continued expanding its influence through the European Neighbourhood Policy (ENP) and the Eastern Partnership (EaP). While the EU presented the EaP as a normative/transformative project, Russia considered it an attempt by Brussels to interfere in what the Kremlin considers its "near abroad". European institutions have generally dismissed the power politics vocation of the EaP since this is consistent with the pretended normative nature of the EU. However, the EaP is not a neutral policy since it aims at extending the EU's leverage over the post-Soviet space (Giusti 2016, p. 166;Keukeleire and Delreux 2014, p. 28;Sjursen 2006) while containing Russia's ambitions. Cadier (2019, p. 5) employs the concept of "geopoliticisation" to describe the EaP that would in make attempts at "'winning over' countries of the Eastern neighbourhood and at 'rolling back' Russia's influence". Russia has in the post-Soviet space returned to any tool at its disposal for not losing control and has inhibited the EU's will to extend its power in a way that was veiled as normative. This approach is the line of reasoning of Russia's COVID-19 strategy in the common neighbourhood, as the case of Belarus highlights.
First aid and vaccines have become part of Russia's COVID-19 strategy in the post-Soviet space to further its influence. Countries such as Ukraine that have established a solid relationship with the EU have refused any form of support from Russia. In Ukraine, the Rada (Parliament) has overwhelmingly voted to ban the approval of vaccines made in Russia (Radio Free Europe 2021). In Moldova, one of the hardest-hit countries in the neighbourhood, the Russian Embassy donated medical tests and other equipment. However, Romania, an EU member state, has generously contributed (at least EUR 5.8 million) to support the country (IPN Press Agency 2021). Even though Armenia in 2017 has concluded a Comprehensive and Enhanced Partnership Agreement (CEPA) with the EU that is the biggest provider of financial support to the country, with annual allocations of EUR 40 million in grants, the country, which is at the same time Russia's only ally in the South Caucasus, received 2000 doses of Sputnik-V from Russia as a donation. Armenia is also in talks with the Russian Direct Investment Fund to start the local production of Sputnik V, as reported by the Russian ambassador to Yerevan Sergei Kopyrkin (Panarmenian 2021).
Several contested territories are also receiving the Russian jab. The Kremlin confirmed that Moscow is sending the vaccine to Donetsk and Luhansk in the Donbass. At the same time, the annexed Crimean Peninsula reportedly began a mass inoculation drive in December with Sputnik V. According to Russian state-backed media, the authorities of Georgia's two breakaway republics, Abkhazia and South Ossetia, also rely on Russian vaccine supplies (Kuznetsov 2021). Central Asian countries depend on Russian and Chinese vaccines and COVAX, an international vaccine campaign co-led by the World Health Organization. For instance, Uzbekistan has agreed to buy Sputnik V but committed to test and produce the Chinese Zhifei jab under the name of ZF-UZ-VAC2001 (Maracchione 2021).

Belarus: Vaccines for a "Brotherly Country"
Belarus is a symptomatic case for explaining how the pandemic offers Russia the possibility of increasing its influence, in contrast to the EU. Though surrounded by democratic countries, Belarus escaped the so-called "domino effect" of 1989 mainly thanks to a solid and unifying leader and economic assistance from Moscow, which has never ceased despite tensions between the two countries' leaders Aljaksandr Lukashenka and Vladimir Putin. Lukashenka's persistent dominance has been possible primarily thanks to Russia's determination to shield Belarus from the Western "sphere of influence" and its economic support. 4 Belarus is a part of the Eurasian Economic Union (EAEU) and Russia, Kazakhstan, Armenia, and Kyrgyzstan and has consented to a Union project with Russia, which has never really functioned, since Minsk feared a possible subjugation to the Kremlin. 5 Along with Russia, China has also progressively become a key economic actor in Belarus. Its investments as part of the Belt and Road initiative (BRI) are particularly significant because of Belarus's position as a potential gateway to European markets. Although Belarus does not fully participate in the ENP or the EaP, the EU has tried to support some programmes, especially those targeted towards civil society and economic development. Since 2016, the EU, the European Investment Bank (EIB), and the European Bank for Reconstruction and Development (EBRD) have allocated increasing funds towards the private sector in order to support small and medium enterprises, as well as towards several key infrastructure projects, most notably within the extended TEN-T, and climate action projects. 6 Thus, the EU has concentrated its efforts on civil society and has doubled its assistance to around EUR 30 million annually. At the beginning of 2020, the EU and Belarus signed a visa facilitation agreement and a readmission agreement, making it easier for Belarusian citizens to acquire short-term visas to come to the EU. 7 On 11 August 2021, after the official proclamation of Lukashenka (who claimed an 80.1% victory) as President of the country, a role that he has held since 1994, protests erupted in the country. The Lukashenka circle reacted with repression, arresting many people. The EU did not recognise the result of the elections, while Russia and China did. The EU de facto recognises the leaders of the opposition as legitimate representatives of the country. Due to an escalation of violence against protesters, the EU turned to sanctions, which have been undergone various rounds, including those against the person of Lukashenka. Furthermore, the 12 October 2020 EU Foreign Affairs Council recommended that the EU scale down bilateral cooperation with Belarusian authorities at a central level. This strategy is meant to increase its support for the Belarusian people and civil society by directing bilateral financial assistance away from central authorities and towards non-state local and regional actors, including through cross-border cooperation programmes with a EUR 24 million package, EU4Belarus: solidarity with the people of Belarus (11 December 2020). Therefore, it is clear that Russia and the EU have two completely different agendas regarding Belarus: Russia wants to keep tight control over the country, preventing it from falling into the EU's sphere, while the latter would prefer a regime change to put an end to the autocratic power of Lukashenka. Unlike other European post-Soviet countries (e.g., Ukraine), due to its peculiar non-transition, Belarus is less inclined to see the EU as a factor of change that is instead considered a fully autochthonous path. In the context of the pandemic, both the EU and Russia have designed a plan to help the country according to their respective goals and leverage. In the first phase, the EU has been actively mobilising an emergency support package for EUR 74 million to support immediate and short-term needs (e.g., emergency medical services such as ambulances and respirators). This has been a necessary contribution in a country where the President still, in late March 2020, affirmed "There are no viruses here" and decided not to impose any lockdown, fearing its economic aftereffects in view of August presidential elections (Kramer 2020).
Lukashenka's mishandled response to the pandemic brought a previously fragmented and weak opposition to coalesce around an anti-Lukashenka sentiment (Forbrig 2020;Korostoleva and Petrova 2021). 8 However, when it comes to vaccination, Russia has reinforced its position. After Russia, Belarus has been the second country in the world to register Sputnik V officially (21 December 2020). Furthermore, Sputnik V's first foreign clinical trials began in Belarus in October 2020, and in February 2021 the country started to produce the vaccine. Consequently, Belarus plans to launch the mass production of the Sputnik V, making 500,000 doses a month (TASS 2021). The fact that Belarus can rely on Sputnik V for vaccinations as other vaccines used in the EU are not available and that it can also produce them with some likely economic revenues reinforces the partnership with Russia.

The Case of Italy: From Mask Diplomacy to Vaccines Strategy
Italy, a country having historically good political, economic, and cultural ties with Russia while being a long-time EU member, makes a good case study for Russia's health diplomacy in both phases. In early March 2020, Russia supported Italy when the COVID-19 pandemic hit the country hardest, and Rome urgently needed medical equipment and personnel. After a phone call between President Putin and the Italian Prime Minister Giuseppe Conte (21 March 2020) in which Conte asked for help, a contingent of doctors, health workers, masks, and ventilators arrived from Moscow to the military airport of Pratica di Mare, Air Force Base near Rome, with military airplanes as the operation was managed by the Russian Defence Ministry. 9 However, the operation, widely discussed in Italian media, split Italy's public opinion down the middle. On one side were those who expressed sincere gratitude to Russia and compared Moscow's generosity (the operation was labelled "From Russia with love") with the perceived inaction or coldness of fellow EU member states and institutions. On the other side were those who accused Russia of delivering useless aid and exploiting anti-EU sentiments shared by many Italians to perform a propaganda offensive (Tafuro Ambrosetti 2020b). Some Italian political parties strengthened Russia's idea as a benevolent partner, particularly the League (Lega), which concomitantly criticised the EU's lack of empathy and unity in line with a sovereigntist narrative depicting the EU as distant, bureaucratic, and ultimately useless. However, the positive narrative around Russia's intervention was partly marred by a portion of the Italian press. In particular, one reportage criticised the Russian Ministry of Defence's Russian health mission, suggesting that it was part and parcel of a hybrid war conducted by Putin with the alleged presence of intelligence officers among the military doctors (Iacoboni 2020). The expulsion of Aleksey Nemudrov, who had managed the logistic of the Russian aid operation, due to its involvement in a spy affair in April 2020, seems to go in that direction. The US was also very concerned about the presence of Russian military staff on a NATO member state's soil. With this rapid intervention in response to the Prime Minister's request, Russia immediately fulfilled at least four goals: (1) it showed its solidarity and friendship to a country that is historically close to Russia and among the most inclined to cooperate within the EU, (2) it highlighted the difficulty for EU member states that were either unable or unwilling to send the requested equipment to respond promptly and generously to the Italian needs, (3) it showed the EU's inability to react efficiently to such an emergency, and, (4) on the domestic front, it coagulated public opinion around the idea that Russia is well-equipped for supporting other countries and doing so despite the EU's sanctions still being in place.
In the second phase of the pandemic, the Italian government was among the EU countries willing to give Sputnik V a chance, with PM Mario Draghi showing openness to the possibility of purchasing the Russian vaccine (provided that the EMA approves it) if European ones proved insufficient. Furthermore, the Spallanzani institute in Rome agreed to start a double Sputnik V experiment in collaboration with the Gamaleya Institute. Yet, similar to the previous phase, the possible use of Sputnik V sparked controversy in the country. At the beginning of March, Italy found itself in the eye of the storm due to a misinformation case. Many Italian and international media have spread incorrect information about an agreement between the RDIF and the Italian-Swiss pharmaceutical Adienne Pharma and Biotech to produce 10 million doses of Sputnik V by July 2021 at the company's plants near Monza (see, for instance, Euronews 2021). However, Adienne's CEO later denied this information-initially spread by the Italian-Russian Chamber of Commerce-and said that the start date and the extent of production is yet unknown and is linked to the provision (not yet granted) of the necessary permits from the European and Italian drug agencies (RaiNews24 2021). Despite Adienne's clarifications, the news fuelled the already tense debate around the Sputnik V in Europe. It caused further polarisation among the EU governments and populations and within the country among those who support a join European approach towards vaccines and those who blame the EU for its slowness and inefficiency.

Conclusions
This article has focused on how Russia has exploited the pandemic to strengthen its soft power through a health diplomacy strategy and achieve at the same time several of its foreign policy goals. Therefore, the article has shown that Russia has used health diplomacy for geopolitical considerations, reinforcing some relationships and discrediting some countries and/or organisations. In Russia, measures to contain the pandemic have been relatively soft in order to limit the damage to the economy, which has already been hit by international sanctions, and avoid possible criticism of the regime by a resentful population.
The health diplomacy strategy has been articulated in two consequential phases: the first, so-called "mask diplomacy", characterised the earliest phases of the pandemic. It helped channel the image of Russia as a friendly and supportive country likely to helping others beyond their institutional belonging, as testified by the Russian delivery of medical equipment to Italy, a member of both the EU and NATO. The second has been constructed around developing the world's first vaccine, its production, and its distribution. Russia has built a strategy highlighting contrasts; it has tried to show its presumed excellence and benevolence in opposition to Western inefficiency and dysfunctionality, especially in regard to European countries. For both phases, the manipulation of information was meant to reinforce the message of Russia as a benevolent and cutting-edge country in vaccines. Whereas this communication strategy might have worked for a domestic audience, it has instead been heavily criticised in the West.
Russia has been very active in the post-Soviet space, which it perceives as a sort of battleground to contrast the EU's growing leverage and reassert its traditional influence instead. The case of Belarus proves the Kremlin's ability to reinforce its friendship with the leadership in a challenging moment for the country: the opposition, supported by the West, is confronting the leadership, which responds with the use of violence, while the EU and the US are hitting the countries with various rounds of sanctions. Belarus has thus far not been granted access to other vaccines available in the EU, though the latter tried to bring aid to the country when the virus first began spreading. The Kremlin has sought to use the pandemic to boost soft power further outside of Russia's neighbourhood, in accordance with its desire to ascend to the role of a global actor.
In both the emergency and the vaccine phase, Russia's health diplomacy has targeted several friendly states in the EU and the Global South. The case of Italy, considered one of Moscow's closest allies in the EU, illustrates Russia's activism in both phases. Rome received medical aid and personnel in the framework of the "From Russia with love" operation. At the same time, several high-level members of Italy's institutions, research centres, and companies have promoted the purchase of or experimentation on Sputnik V, both at the national and the EU levels. Finally, because of the initial scarcity of vaccines within the EU, some member countries and even individual regions have decided to administer doses of the Sputnik vaccine ahead of the EMA's approval. This decision has created or, in some cases, furthered societal cleavages within countries, an outcome that several Western governments accuse Moscow of having purposefully pursued. Therefore, it seems that Russia's health diplomacy has become yet another thorny issue dividing EU member states. As the pandemic's political and economic effects become more explicit, further research will have to confirm this preliminary assessment of the results of Russia's health diplomacy strategy in terms of gaining influence. The link between domestic and foreign strategies would be worth exploring further.
Author Contributions: Both authors equally contributed to this manuscript. All authors have read and agreed to the published version of the manuscript. Notes 1 Standard categorisations of Russia's government include "illiberal democracy" and "electoral authoritarianism". Both terms indicate a democratically elected regime that, despite formally adopting democratic institutions (such as elections, political parties, and a legislature), are essentially authoritarian and impose severe civil society constraints (Zakaria 1997;Gel'man 2015). 2 Operation INFEKTION is the name of an active measure (aktivnye meropriyatiya) disinformation campaign run by the KGB in the 1980s to spread the claim that AIDS was part of a biological weapons research project launched by the US. 3 Though it is impossible to make any concrete/substantial correlation, it is worth mentioning, as Levada Center (2021b) reports, that from November 2019 until May 2021, the Russians' attitude towards the EU has gradually become more negative than positive, with 38% in May 2021 who hold a positive attitude and 45% a negative one. 4 Russia is Belarus's foremost trading partner, accounting for 49.2% of Belarus's international trade (EU Trade). Belarusian exports primarily consist of potash and petroleum products refined from Russian oil that used to be discounted before the Kremlin decided to use energy as a political instrument (Hadfield 2008). 5 In 2010, Russia's decision to raise the previously highly subsidised energy prices "persuaded" Lukashenka to ratify the EAEU, granting Belarus a $3 billion loan from the organisation some other economic benefits (Vieira 2017;Deen et al. 2021). 6 In this field, the EU has assisted 4500 Belarusian companies with funding, training, and exporting support to new markets through the EU4Business initiative: 5700 new jobs were created, helping small-, and medium-sized enterprises grow. The EU has also supported the improvement of energy efficiency in educational facilities to benefit 2000 school-age and pre-school children. In addition, support for modernisation has improved the living conditions of 10,000 citizens and reduced electricity bills for ten municipalities. For a detailed account of the EU's interventions, see Consilium (2020). 7 Several categories of travellers, including journalists, students, and members of official delegations, will be able to receive multiple-entry visas with increasingly longer validity while having to submit fewer supporting documents to prove their purpose of travel. Belarus has unilaterally introduced measures to facilitate short-term visa-free travel for EU citizens arriving in Minsk. The main objective of the EU-Belarus readmission agreement (2020) is to establish, based on reciprocity, procedures for the safe and orderly return of persons who reside irregularly in the EU or Belarus, in full respect of their rights under international law. 8 In the absence of state support and precise prescriptions, citizens mobilised to provide information, collect money and equipment, and assist vulnerable groups and medical workers. In doing so, they also diminished their reliance on a paternalistic state and shattered the image of the nation's benevolent father that Lukashenka has acquired over time. 9 The military airport of Pratica di Mare has a considerable symbolic value. On 28 May 2002, it hosted the heads of state and government of NATO member countries and Russia for the signature of the declaration on "NATO-Russia Relations: A New Quality", establishing a new NATO-Russia Council (NATO 2002) that was later suspended because Russia annexed Crimea.