The section is a narrative consisting of three superordinate themes and 11 subthemes. Those themes were formulated as results of applying the Phenomenological Interpretative analysis methodology. The researchers have leaned on criteria outlined by Nizza et al. (2021) paying special attention to the meanings the participants put in their words and the convergence and divergence of themes. Suitable extracts from seven participant interviews have been inserted in the narrative. All the extracts below are translations made by the authors because initially the interviews have been fulfilled in Russian. The audited non-verbal utterances (such as laughter) and pauses (longer than 3 seconds) were bracketed. Using of ellipsis is standard. The prime objective of the translations was to preserve participant's meanings. Below we provide the structure of themes.
1. Pandemic and vaccination are not only medical problems any more.
1.1. Vaccination isn’t solely a medical issue but a political, social, and psychological one.
1.2. There is administrative coercion applied to medical community
1.3. Availability of vaccines produced in other countries is a symbol of free will.
2. A doctor voluntarily narrows her epistemological horizon as a result of employment of a more meticulous analytical approach.
2.1. Official statistic, speakers, and administrative decision-making procedures cannot be trusted.
2.2. Rationality and logic have been lost in the current administrative decisions and the social policy concerning the pandemic.
2.3. There is a need for rational assessment of risks and side effects when vaccination is proposed to various social strata.
2.4. Verification of the information about the pandemic, COVID-19 mutations, side effects, and vaccine efficiency is made through personal professional communications.
2.5. Vaccine Sputnik V is not worse than others produced and recognized in other countries.
3. Professional ethic and personal emotions are often in conflict.
3.1. Doctors’ perception of pandemic confirms that our life has changed irreversibly.
3.2. There is anxiety and tension spawned by possible risks for close friends and family members.
3.3. It is somewhat unfair to endow medical workers with the total responsibility for what is happening in society during the pandemic.
The first superordinate theme “Pandemic and vaccination are not only medical problems any more” involves social dimension in the participants’ narrative. We can say that all of our interviewees express one or another aspect of this theme. It is important to note that many of them have raise moral or ethical issues connected with the situation of the pandemic. It is unlikely that the prompts used during the interviews have moved participants to observe that ‘administrative units, all of them, and they are trying to find use of it for themselves but the virus is using them’ (Doctor D, 2021).
The subtheme “Vaccination isn’t solely a medical issue but a political, social, and psychological one” is well supported. While four of our participants pointed to the moral issue of free will, e.g., ‘had there been a choice, that you could shoot a foreign one or something [pause] I think – yes [pause]I would give it a thought’ (Doctor N, 2021), the others concentrate on social problems, e.g. people resist vaccination ‘because the administrative resources will hold their frame’ (Doctor D.). Thus, ‘there’s an impression that there is some kind of marketing [pause] pressure, yes. Something else gets mixed in with the medicine, yes, yes’ (Doctor I, 2021).
Next subtheme “There is administrative coercion applied to medical community” was expressed unanimously by all participants. Their utterances were quite straightforward: ‘such are the instruction [pause] In professional activity [pause] uh in order to work and [pause] I would maybe not do it but they told me and I did’ (Doctor K, 2021). Orders from administrations could sound as ultimatum: ‘it all took place in a sort of an implied mandatory form. We either say good bye or we get vaccinated, like that.’ (Doctor V, 2021). Doctor T. almost repeats it verbatim: ‘I’ll put it this way: I would not have done it myself voluntarily. This is unambiguous, not voluntarily. But the management said: those unvaccinated can’t work.’ (Doctor T, 2021). Also, there is a problem with doctors who have medical conditions that make vaccination undesirable for them. For example, Doctor I. has arthritis; consequently, she is discriminated. ‘You know, I have medical exemption clear to anyone. And nevertheless, I am in the group discriminated by this criterion. I will not get the QR code. I have a medical exemption but here I am, already a second-rate quality person because of the QR code’ (Doctor I, 2021).
We put the subtheme “Availability of vaccines produced in other countries is a symbol of free will” under the above superordinate theme because of its ethical facet though the theme is connected to the issue of reliability of existing Russian vaccine which will be discussed below. All participants except for one expressed that availability of vaccines produced in other countries would widen peoples’ options to choose. ‘The sensation of freedom, of course. You can choose what you want’ (Doctor T, 2021). Yet, they were rather uncertain that it will influence the pandemic dynamic significantly. Such care about psychological well-being is unlikely to be deployed by the administration: ‘Well, of course with pink sunglasses on and diving into the world of pink ponies where everything is free, well [pause] maybe it would have softened. But we live in Russia, after all [laughter]’ (Doctor V, 2021).
The second superordinate theme “A doctor voluntarily narrows her epistemological horizon as a result of employment of a more meticulous analytical approach” seems to be the most important and yet unexpected finding. It highlights the epistemological status of our participants who experience difficulties holding their rationality: ‘When there are a lot of orientation cues, it means there are no orientation cues’ (Doctor D.).
The subtheme “Official statistic, speakers, and administrative decision-making procedures cannot be trusted” was expressed by all interviewed doctors in a very straight manner: ‘so [pause] ehm [pause] it’s not very clear to me this game with statistics and somewhere it’s exaggeration, in others it’s detraction and I don’t really understand for what all of that was done’ (Doctor V, 2021). Doctor T. says that ‘нам не говорят правду’ (Doctor T, 2021). Doctor D. puts it as total distrust to officials: ‘we have already developed a, so to speak, idiosyncrasy. Just something like, everything that the hand of the management touches turns into, yes, garbage, into garbage’ (Doctor D, 2021). Such distrust does not seem to be a mere opinion because of the existence of keen cases seen by participants. It is worth to insert a long explication from the experience of Doctor N. She says that the protocols of the second stage of Sputnik V trial could be somewhat compromised.
Yes, I was on duty for vaccines when I saw crowds of people, when this study took place, crowds of people being brought, give them shots and shots, their salaries were revoked [pause]. Well, this prompts some distrust towards all of this. When people are forced. When they come, they ask, teary eyed: please, give me a medical exemption. You understand, you sit there [pause] you were told [pause] the Health Ministry said not to give medical exemptions. Well, it wasn’t very [pause] I was there how long? About four months that study lasted.
Doctor N (2021)
Also Doctor N’s observations show that the sample in the above trial could be clusterized: ‘they brought in crowds of immigrant workers who had no choice, all the butchers, all the communal services employee’ (Doctor N, 2021)
Taking into account the above concerns about the reliability of information, the next subtheme “Rationality and logic have been lost in the current administrative decisions and social policy concerning the pandemic” looks almost as modus ponens. The appeal to the need of logic was verbalized in similar terms by all participants except for one. For example, one’s thinking may follow as this: ‘We were put in quarantine then, when there were three hundred sick. Now, when there are 50 – 10 thousand sick in Moscow [pause] we are wandering around and leading a regular life, in general’ (Doctor N, 2021). Consequently, ‘Of course, I understand that they want, like, mass vaccination so that nobody was sick. But it comes out illogical’ (Doctor N, 2021). Similarly, the validness of official communiques is often a failure: ‘Well [pause] well it just neutralizes everything. One argument destroys another argument’ (Doctor D,2021).
Next subtheme is “There is a need for rational assessment of risks and side effects when vaccination is proposed to various social strata”. The participants have demonstrated the most diverse spectrum of opinions here. Given the discrepancies in their opinions, we count this subtheme as an umbrella for participants’ attempts to make sense in situations of communication with patients. Thus, such opinions about vaccination as ‘to an eighteen-year-old I would advise to get sick’ (Doctor I, 2021) and 'if it is a young guy, I tell him: yes, go for it and don’t worry if you don’t have any chronic diseases (Doctor K, 2021) are in one basket. What is in common among all those different approaches is a unanimous opinion that recommendation of vaccination should be more cautious considering the patient’s health conditions: ‘Well, of course I will say to get examined, well, at least get a blood analysis and a PCR, that are, well, at least a week old. I will advise an examination first’ (Doctor I, 2021).
The subtheme “Verification of the information about the pandemic, COVID-19 mutations, side effects, and vaccine efficiency is made through personal professional communications” was the most unexpected finding. Only two among the participants stated clearly that they made themselves familiar with some research dedicated to Sputnik V published in peer-reviewed journals. Yet, all of our participants asserted that the most credibility is given to the evidences obtained from their close colleagues or the observed cases: ‘these are rather not even articles, but some [pause] conversations with the knowing people [pause]. Articles - there is one decent one, maybe a couple. The majority of it is stories from the experience of such knowing people’ (Doctor K, 2021) Often, the experience of the work in the field seems to be in contradiction with the so-called official medical practice: ‘When you ask the doctors, the ones that practice, they, too, are like: what is this?!’ (Doctor I, 2021). Finally, some statistically unverified information may begin to influence doctors’ opinion: ‘well [pause] as far as I've heard, let's say, if we're talking about pregnant women who have been infected with COVID during the 2-3 trimester [pause] they are different. Their children are born deaf’ (Doctor V, 2021). This statement appeared interesting to the researchers; therefore, a clarifying question was asked and the response fell into the subtheme: ‘It’s rather something personal, also, by smaller groups. With doctors. That is, they began to notice that the newborns of the mothers who have had COVID, they have a problem with hearing’ (Doctor V.).
The subtheme ‘Vaccine Sputnik V is not worse than others produced and recognized in other countries’ is connected to other superordinate themes because it was linked in interviews with the issue of vaccination policy. Yet, we put this subtheme in the thread connected with epistemological problems for two reasons. First, it is unlikely that this subtheme was prompted by the structure of interview questions. Second, the rationality of participants’ thinking demonstrated some interesting features. All but one participant asserted that Sputnik V is not worse than any other vaccines; they did not say that Sputnik V is more efficient than the others. The unfolded meaning of participants’ propositions was formed in line of comparisons of side effects: ‘everywhere there are the same problems with these vaccines’ (Doctor K, 2021). Another reason for the subtheme was that the doctors trust Russian scientific school in the area of virology: ‘I do believe in Russian science. And I don’t think it’s worse’ (Doctor V, 2021). We should note that the only doctor who avoided straight assessment of Sputnik V was a person who took part in vaccine tasting procedures and had personal experience and feelings that those procedures could be somewhat compromised.
The last superordinate theme “Professional ethic and personal emotions are often in conflict” highlights psychological problems and pitfalls experienced by the participants. All participants support the subtheme “Doctors’ perception of pandemic confirms that our life has changed irreversibly” unanimously: ‘The virus progresses, the virus is changing’ (Doctor D, 2021). In other words, as Doctor N quotes her colleague: ‘your life will not be the same [pause]’ (Doctor N, 2021).
The subtheme “There is anxiety and tension spawned by possible risks for close friends and family members” could be prompted by the interviewer’s questions. Yet, the difference in the degree of anxiety among the doctors regarding themselves and their families and friends should be attributed to their inner milieu: ‘Myself, I am not afraid of getting sick. So. The main concern is the parents and the elderly [pause] eh [pause] For those I am concerned’ (Doctor K, 2021).
What was unexpected for the researchers is the last subtheme “It is somewhat unfair to endow medical workers with the total responsibility for what is happening in society during the pandemic”. Interviewees have raised this issue without any prompts from the interviewer: ‘what I am being injected with I don’t know, I don’t know the side effects, no insurance is provided, yes, for the period of this vaccination [pause] yes. And it turns out that it’s a bit dishonest option’ (Doctor I, 2021). This subtheme appeared in more than half of the interviews and was mostly at a rather unconscious level. For example, when such sentence as ‘I will definitely not talk anyone into it’ (Doctor D, 2021) and ‘I have my own small family here’ (Doctor D, 2021) occurred in the same context of recommendations for their patients, researchers suppose that this is a problem of cognizing the personal level of responsibility of the doctors. Thus, sometimes a doctor can try to employ a personal mode of communication with someone who asks for a vaccine recommendation: ‘I am cautious towards it. I respond: I got vaccinated and nothing has happened to me’ (doctor T, 2021).
We hope that the above description sheds some light on rationality of doctors who may experience vaccine hesitancy. Yet the very term “vaccine hesitancy” may mislead us. One may suppose that “vaccine hesitancy” is a kind of vaccine denial. Another approach is that it is rather a cautious assessment of problems related to vaccines without too much of excitement and enthusiasm. Further we’ll discuss briefly the implications of our findings.