In challenging U.S. global power, Russia has made significant efforts to position itself in Latin America, a region that has long been the natural area of influence for the United States. The strengthening of the political left in Latin America—seen in the rise to power of Hugo Chávez and Nicolás Maduro in Venezuela, Luis Inácio Lula in Brazil, Gustavo Petro in Colombia, Evo Morales in Boliva, and Néstor and Cristina Kirchner in Argentina—has helped Russia build allies that potentially form a sustained regional counterweight to Washington.

As part of those developments, the diplomatic relationship between Russia and Venezuela has strengthened in recent years. As the world's democracies have aligned with the United States against the Maduro regime, Russia has become one of Venezuela's most important allies. Initially fostered by Cuba, the bilateral relationship began because of ideological proximity and focused originally on military cooperation. Today, however, the relationship encompasses many areas, including the tourism sector, and is increasingly palpable in Venezuelans' daily lives.

Although less evident than Russian tourists visiting Margarita Island, significant cooperative initiatives have launched in the health sector since 2019. Those initiatives, however, raise serious questions about the benefits Russia and Venezuela are getting from health cooperation.

Insulin Supply and Production

In 2019, Venezuela and Russia signed a cooperation agreement under which the Russian government would annually send Venezuela 8.2 million vials of insulin made by a Russian company, Geropharm. Additionally, Geropharm and the Venezuelan state company Espromed Bio agreed to produce insulin on Venezuelan soil.

In addition to the lack of transparency in Russian-Venezuelan health agreements, monitoring how they have been implemented is difficult

Neither Russia nor Venezuela, however, has made the agreements public or released information about the specifics of the deals, such as their duration or how long the shipment of insulin vials would continue. Whether Russia provided the insulin shipments as humanitarian aid, Venezuela purchased the drugs, or the insulin was exchanged for other goods is unclear.

Cooperation agreements between Venezuela and Russia often lack such information. During the COVID-19 pandemic, for example, Russia sent vaccines to Venezuela in what appeared to be humanitarian assistance. Subsequent shipments came with no information about whether they were Russian donations or whether the Venezuelan government purchased the supplies or acquired them through an exchange of goods.

Understanding those agreements requires knowledge of the problems facing the health sector in Venezuela. Since 2016, health system personnel have denounced severe shortages of medical products, including a shortage of insulin for treating diabetes. The Venezuelan government has denied that the health sector is in crisis, but, in reality, accessing medications for chronic conditions, such as diabetes, is not easy. Health cooperation on insulin supplies and production aimed to respond to Venezuela's health problem while allowing Russia to enter and influence Venezuela's pharmaceutical sector.

In addition to the lack of transparency in Russian-Venezuelan health agreements, monitoring how they have been implemented is difficult. The Venezuelan government has not provided information, for example, on how many insulin vials have arrived from Russia or whether such insulin is reaching patients through government agencies or private pharmacies. What little information exists never comes from the same institution or person—sometimes it is released by a government minister, a nongovernmental entity, or the Russian ambassador in Venezuela.

An opposition supporter holds a placard that reads: "I am diabetic and can't find insulin" and a copy of the Venezuelan constitution, during a protest due to the lack of medicines and to demand a referendum to remove President Nicolas Maduro in Caracas, Venezuela, August 2, 2016. — An opposition supporter holds a placard that reads: "I am diabetic and can't find insulin" and a copy of the Venezuelan constitution, in Caracas, Venezuela, on August 2, 2016. REUTERS/Carlos Garcia Rawlins

Further, the initiative to produce Russian insulin in Venezuela seems to have stalled. First struck in 2019, the agreement was announced a second time in 2024 during a visit of Russian Foreign Minister Sergey Lavrov—a clear indication that no progress had been made. The COVID-19 pandemic could have delayed implementation, but as of 2024 the Venezuelan government has not explained the lack of progress. Meanwhile, access to insulin in Venezuela has not improved through the public sector.

Russia's interests in the insulin initiative involve penetrating the Venezuelan pharmaceutical market, having a physical and stronger political presence in Venezuela, and using that presence as a platform for expanded engagement in the region. Advancing those interests extends beyond Venezuela: Russia has sought similar agreements with Brazil and Mexico to produce Russian insulin with existing manufacturing infrastructure. However, as with Venezuela, too little information on the progress of those agreements is available.

Although Venezuela and Russia signed the first insulin agreements in 2019, Russia's experience using its COVID-19 vaccines to enter the global pharmaceutical market has reinforced Moscow's interest in using health goods and technology transfer to gain political influence in more countries and regions, as well as harvesting the economic benefits such activities generate. The agreements with Brazil and Mexico—countries particularly important in the Western hemisphere—demonstrate Russia's intent to advance its interests through health diplomacy.

Tropical Diseases and Epidemiological Surveillance

In 2023, Russia and Venezuela signed an agreement to create the Russian-Venezuelan Center for the Study and Prevention of Infectious Diseases. The agreement builds on previous collaborative research that involved Venezuelan researchers participating in the early phases of creating the Sputnik V vaccine in 2020 to fight COVID-19. Once again, however, neither government has provided much information about the scope and substance of the agreement, making it difficult to understand the intentions of the parties to it.

Neither Russia nor Venezuela launched those initiatives primarily to improve health in Venezuela

By mid-2024, some joint activities for the new center have been announced, such as the delivery of courses at Venezuelan institutions and development of a work plan between the Rafael Rangel National Institute of Hygiene, the Venezuelan Institute of Scientific Research, and the Russian Federal Service for the Oversight of Consumer Protection and Human Welfare, or Rosprotebnadzor. But beyond those activities, little information exists about the center and how it functions.

Despite the establishment of a center on tropical diseases and epidemiological surveillance, the Venezuelan Ministry of Health has not published the Epidemiological Bulletin since 2016. The country still lacks official information on the presence and control of serious disease threats.

And the Winner Is?

In its relations with Venezuela, Russia has expanded its cooperation beyond the military sector to involve health initiatives—a model Moscow follows with other countries in the region. The available evidence, however, indicates that the Russian-Venezuelan health initiatives have not borne fruit, raising questions as to why no progress has been made. The answer might be that neither Russia nor Venezuela launched those initiatives primarily to improve health in Venezuela.

Immersed in the Ukraine war, Russia has been trying to expand its presence and influence globally through, among other things, health diplomacy. But the economic cost and political challenges of a prolonged war constrain what Russia can deliver, especially in areas, such as health, not traditionally part of Russian foreign policy. The strain of the war, for example, has factored into the delayed delivery of the second component of the Sputnik V vaccine to Latin America. Even so, Russia has increased its presence and political influence in Venezuela through the bilateral health initiatives.

For Venezuela, the health agreements with Russia have done little to increase patients' access to insulin or improve information on infectious diseases in the country. But the agreements have drawn President Maduro and his government closer to Russia, a potent ally when facing sustained hostility from the United States.

Venezuelan-Russian health cooperation might eventually produce positive outcomes for the health of Venezuelans, but both countries have already generated geopolitical benefits from that cooperation.

Venezuela's President Nicolas Maduro shakes hands with Russia's Foreign Minister Sergei Lavrov at Miraflores Palace, in Caracas, Venezuela February 20, 2024. — Venezuela's President Nicolas Maduro shakes hands with Russia's Foreign Minister Sergei Lavrov, at Miraflores Palace, in Caracas, Venezuela, on February 20, 2024. REUTERS/Leonardo Fernandez Viloria

EDITOR'S NOTE: This article is part of a series exploring Russia's foreign policy on global health guest edited by Nataliya Shok. The rest of the articles in the series can be found here.

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