ACURA ViewPoint: Krishen Mehta: US Sanctions Policy Endangers Global Public Health

Western-led sanctions on Russia don’t extend to medical supplies, but ordinary Russians will soon go without needed medications anyway. Starting in 2024, the American pharmaceutical company Merck & Co. will halt exports to Russia of Zepatier, a drug used to treat hepatitis C. Merck has also already stopped supplying Russia with vaccines against chickenpox, measles, rubella, and mumps, as well as with Raltegravir, a medicine used to protect HIV-affected people against developing AIDS.

Another drug, Micardis, which is used to treat blood pressure, heart failure, and diabetic kidney disease, is also in short supply in Russia. The German pharmaceutical company that manufactures it, Boehringer, announced in July 2022 that it would stop supplying the drug to Russia. Earlier this year, Eli Lilly announced its decision to withdraw from the Russian market, with the result that Russia is now experiencing a severe shortage of the antidepressant drug Prozac.

Medical supplies are theoretically exempt from sanctions. But this mass exit of pharmaceutical companies from Russia illustrates that, for all practical purposes, healthcare often gets swept up into sanctions packages anyway. In Russia’s example, SWIFT sanctions have made international payments by Russia difficult, and the halting of air traffic with Russia has disrupted supply chains. These impacts from sanctions have affected all forms of trade, including medical supplies. Almost all pharma companies have been forced to stop using their Russian sites for drug research, which is not protected against sanctions. Pharmaceutical companies are also subject to political pressure from Ukraine and other countries to stop doing business with Russia, and many have obviously acquiesced. 

Finally, it’s simply becoming less profitable for pharmaceutical companies to do business in Russia. The route of medicine delivery from the other side of the country has become so unpredictable, long, and expensive that pharmaceutical companies find it prohibitively costly to transport drugs through the country.

Together, these factors mean that Western medicines are disappearing from Russia. The intent of sanctions is achieved indirectly. But few in the collective West care to object.

As we know, sanctions tend to be very regressive, hitting the poorest hard and often even benefiting the elites of the targeted country. But Article 25 of the Universal Declaration of Human Rights specifies that “everyone has a right to a standard of living adequate for…health and well-being,” which explicitly includes medical care. Both international law and the ethical principle of justice require guaranteed access to healthcare, regardless who a person is or where he or she comes from. 

What’s more, even wealthy countries stand to lose out when medical resources become subject to sanctions. The fight against infectious diseases is intrinsically global and holistic. If we exclude “pariah” nations such as Iran, Cuba, Russia, Venezuela, and North Korea from this struggle, diseases will thrive in those places, posing a continued danger to the world.

Yet when the Covid pandemic started in early 2020, the US government tried to prevent Iran from buying respirator masks from overseas, as well as thermal imaging equipment that could detect the virus in the lungs. The US also vetoed $5 billion that Iran had requested from the International Monetary Fund to buy equipment and medicine from the foreign market. These actions put the whole world at risk. The withdrawal by pharmaceutical companies from Russia could have the same effect.

Since sanctions do not have a timeline, they can continue indefinitely without any challenge to the administration or to Congress. In this way, sanctions can be worse than war, because the Geneva Conventions place strict limits on harming civilian populations during combat. Under the sanctions regime, though, civilian populations are harmed constantly.

American foreign policy now relies heavily on economic coercion through sanctions. But our sanctions policies strip needed medical care from private citizens and are endangering global public health. It’s time for us to reconsider them. Sanctions should not be a way to have foreign policy on the cheap, nor should they, as acts of war, replace diplomacy. The State Department and Congress should reconsider the policy of sanctions, and there should be more public dialogue about their effects on ordinary people and the world at large. 

We must return to diplomacy rather than pursue our own agenda through sanctions, which are a form of economic warfare. It is diplomacy, not sanctions, that represent the inherent generosity and compassion of the American people. We need a renewed era of diplomacy to set the stage for peace and prosperity, not only for America, but for the whole world.

Krishen Mehta is a member of the Board of ACURA (American Committee for US-Russia Accord). He is a former partner at PwC and is currently a Senior Global Justice Fellow at Yale University.