プーチンと医療関係者とのビデオ会議
ロシアのタス通信のニュースをチェックしている中で、新コロナ・ウィルスとの闘いにおいて、これまでにロシアの医療従事者約500人が命を失っているという記事を見ました。ロシアの感染者数は584680人（21日現在）で世界第3位（アメリカ2321667人、ブラジル1085038人に次ぐ）ですが、死亡者数は8111人で感染者数のわずか1.4％と際立って少なく、欧米諸国メディアから疑問視されるほどです。
6月第3日曜日（今年は21日）はロシアで「医療工作者の日」とされているそうです。プーチン大統領はこの記念日に先だって20日、医療関係専門家とのビデオ会議を行いました。その際のプーチンの発言がロシア大統領府WSに掲載されました。プーチンはその中で、コロナとの闘いにおける医療従事者の献身とプロ意識を賞賛し、そのことがロシアにおいて大量の人命を救ってきたと述べました。プーチンは、彼らの業績が祖国防衛戦争のそれに匹敵するとまで称えました。そして、彼らの功労に報いるべく、栄誉と勲章の授与、ボーナスの支給（課税対象としない）、有給休暇の提供等の措置を取ると発言しました。プーチンはまた、約15000名のインターン生も動員されたことを明らかにし、彼らに報いることにも言及しています。
プーチンは、ほかの国々では医療体制が危機に陥る例もあったが、ロシアはソ連崩壊後も医療体制の充実に努力を払ってきたとし、そのことが今回のコロナ対応に大きく貢献したと指摘しました。彼はまた、医療体制の充実は今後もロシアの至上解題であると確言しました。確かに、かつては社会保障最先進国であったイギリスは、サッチャー及びブレア政権のもとで新自由主義に基づく医療制度改革を急進的に進めた結果が今回のコロナで大きく現れています。すなわち、感染者数は304331人（世界第5位）ですが、死亡者数は42632人で、感染者数の14％を占めています。ロシアの実に10倍です。
ちなみに、新自由主義を推進してきた欧州諸国も軒並み高く、フランス（感染者数第7位）は18．5％、イタリア（同第6位）は14．5％、スペイン（同第4位）は11．5％です。ただし不可解ですが、アメリカは感染者数がダントツの世界第1位ですが、感染者数に占める死亡者数（121745人）の比率は6.5％です。これに対して、医療・社会保障に新自由主義を持ち込むことに慎重の対応を取ってきたドイツ（同第11位）の場合は感染者数に占める死亡者数の比率は4.7％です。参考までに、中国は5．6％、日本は5.4％となっています。
私は、プーチンの発言内容を読んで、日本（安倍政権）と思わず比較せずにはいられませんでした。日本の場合、かねてからコラムで指摘してきたように、安倍政権のコロナ対策を牛耳っているのは厚労省、特に医系技官であり、彼らは日本における新自由主義医療改革の総本山です。彼らは新自由主義医療改革の結果として今ある医療体制の崩壊（＝新自由主義｢改革｣の本質暴露）を阻止することが至上課題で人命は二の次、という世界に類を見ないコロナ対策を取ってきました（その結果として、私の寡聞の故かもしれませんが、日本ではこれまでのところ、コロナ対策に従事したことによる医療従事者の死亡という痛ましい事例は聞き及んでいません）。ロシアでは、医療従事者の献身プラス分厚い医療体制プラス市民の自発的協力によって第一波収束のめどが立ちつつあり、それを受けてのプーチン発言があるのだと思います。
今回の惨劇を経験した欧州諸国では、コロナ収束後には、新自由主義｢改革｣を医療体制にまで持ち込むことの是非が提起されざるを得ないでしょう。しかし、感染者数も死亡者数も｢まずまず｣の水準を維持するという｢奇跡｣（欧米メディア）を実現（？）している日本では、この｢奇跡｣が今後も奇跡的に続く限り、安倍政権は崩壊に追い込まれるとしても、医系技官主導による人命二の次の新自由主義医療政策は、政権交代とは関わりなく自己主張を続けることでしょう。すべてがゆがみきった日本政治の縮図を見る思いがします。
興味ある方の参考のために、プーチン発言を載せておきます。
＜冒頭発言＞
President of Russia Vladimir Putin: Good afternoon, friends.
I am very glad to see and hear you. And of course, I want to sincerely congratulate all of you who have gathered for our meeting today and all healthcare professionals in the country on your upcoming professional holiday.
I would like to wish you happiness and good health and of course, to thank you for your dedicated service – I have done so many times indirectly, without contacting you, and now I want to do it directly – for carrying out your duties courageously and with dignity in this difficult time. You have helped, saved and literally nursed back to life hundreds of thousands of our citizens, those who contracted the coronavirus and those whose heath came under threat from other dangerous diseases.
I can say without exaggeration that we are genuinely proud of and admire your actions and your professional feat. It helped all of us to more fully comprehend the true value of life and the significance of the service you dedicated your lives to, the true moral grandeur and professional complexity of your work.
Without exaggeration, you have been at the forefront from the onset, risking your lives each minute. Many have been separated from their friends and families, fighting, in the true sense of the word, for the people in the so-called hospital 'red zones', and oftentimes indeed to the limit of human capabilities and strength. Practically everyone worked like that – ambulance crews, aero-medical units, general practitioners, specialist doctors and paramedics, nurses, junior medical staff, technicians and drivers. They did this everywhere – in cities, villages and remote areas.
Despite all odds, you have shown an inexhaustible supply of love, empathy and compassion, something that a doctor cannot work without, as well as reserve, stamina and humanity. I am sure that you have done everything you could and beyond, displaying real miracles of professionalism. The main thing you did was bringing down loss of life to a minimum. This is your achievement.
However, the terrible and insidious virus did not spare your colleagues. I would like to express my heartfelt condolences to all those who lost their loved ones, to the families of doctors, paramedics and nurses.
Let me stress that the sacrificial feat of medical professionals during the epidemic will enter the annals of the history of our medicine and our nation forever, similarly to the heroic service of doctors and nurses during the Crimean War, World War I and the Great Patriotic War.
Outstanding medics have been honoured and glorified in the country at all times. The best of them have traditionally been awarded the Vocation prize as an expression of appreciation of the professional community. I would like to use this opportunity to once again congratulate this year's winners. I know that many of them remained at their workplaces during the award ceremony, and many of them are still there.
I am confident that unparalleled feats for the benefit of their people and Motherland deserve special appraisal from the state. This is why I have signed an Executive Order on instituting state awards for outstanding merits: The Pirogov Order in honour of our great doctor and researcher, founder of military field surgery, a participant of the defence of Sevastopol; and the St Luke of Crimea medal in honour of the doctor, educator and innovator who was totally devoted to his mission of healing people's souls and bodies.
These high awards will soon be presented to the most deserving doctors, researchers, paramedics, and middle and junior medical personnel who distinguished themselves in combating the coronavirus.
Friends, at the outset of the epidemic special measures were taken to support specialists who are directly involved in helping coronavirus patients. As a reminder, first, these are incentive payments. Additional funds were transferred to the regions for that. Second, these are special bonuses for working in hazardous and demanding conditions. You know this but I would like to remind you: 80,000 roubles a month for doctors, 50,000 for ambulance medics and middle medical staff, and 25,000 rubles a month for junior medical staff, paramedics, nurses and drivers.
I would like to point out that we made a decision that all payments for special working conditions are exempt from personal income tax. Which means that medical workers will get the money in full without tax deductions, net amount, as they say.
However, that is not sufficient in my view. We resolved such a sensitive issue as paid annual leave alongside taxes. It is even more urgent since many medical professionals are putting off their holiday until a later date.
In this connection, I find it right to do the following: additional bonuses must be considered when leave allowances are calculated for medical workers regardless of when a specialist takes his or her leave during the year.
This decision puts extra pressure on the regions' finances – that much is also clear. This is why we will render special support to the constituent entities of the Russian Federation to make these payments.
I would like in turn to ask the Government and the Healthcare Ministry to closely monitor the issue of the increased leave allowances for medical workers so that no failures occur, not even technical ones.
Let me emphasise – thanks to the efforts of the entire society and, of course, your heroic work, the epidemic is retreating. But the fight with it is ongoing, as you know better than I do. Therefore, the risks for and pressure on medical workers are still high. I think it is necessary to maintain all federal and regional bonuses for medical workers who keep working with coronavirus patients for another two months, that is, July and August.
And one more proposal. During the epidemic, over 15,000 medical students, interns and postgraduate students were working shoulder to shoulder with their senior colleagues. They have had a true baptism of fire, a trial of loyalty to their future profession. I think it is necessary to reward those young people, your colleagues, and I ask the Government to submit proposals for mechanisms, including benefits and incentives for those who will continue studying in their chosen field.
I am sure that you have your own ideas, suggestions and interesting experience. All that is vitally important, primarily for long-term progress of Russian healthcare and improving the quality of life for our citizens. This is the topic I suggest we discuss today.
＜締めくくり発言＞
Vladimir Putin: Let us finish up. This is what I would like to say in conclusion, colleagues. Of course, I want to once again sincerely congratulate you on your professional holiday and thank all of Russia's medical professionals for their work, and for their crucial and irreplaceable contribution to combating the coronavirus.
The entire Russian medical community has been engaged in solving this issue. The staff at hospitals, in-patient clinics, military doctors, Emergencies' Ministry units, and private healthcare organisations. A considerable contribution was made by scientists, lecturers at medical colleges and universities, and certainly out leading medical scientific and practical centres and research institutes.
Let me specially stress that medical professionals displayed unity and team spirit, and we have spoken about that. You saw a good example of that when doctors from cities went to assist the regions or arranged quality remote consulting despite the circumstances and fatigue since they also had worked a lot in the capital. I will also note that specialists in different areas and profiles took over a significant part of the workload of their colleagues who were rendering help to coronavirus patients.
The world experience in fighting the epidemic has shown how crucial it is for the national healthcare to work as a system, from ambulance services to the leading clinics. Thanks to the fact that Russia does have such a system, you and your colleagues worked as part of a single whole. You summoned all your strength and we forced this devastating epidemic to retreat.
Indeed, there is a lot of work ahead. Nevertheless, we successfully prevented a critical spike in deaths, failures and a paralysis of medical facilities, which unfortunately, happened in some places abroad. Significant advances were made in the treatment of COVID-19 patients, thus saving thousands of lives – in a nutshell, we managed to give a proper response to a colossal challenge.
All these results were made possible by the fact that the national healthcare system and medical science have great traditions and a huge potential. Many generations of our compatriots contributed to its establishment and progress. Among them are district doctors and nurses, prominent scientists and healthcare administrators. We have managed to achieve a great deal in the past years, including within the framework of our programmes.
I am aware that we have many problems in this area. However, I recall that back in the early 2000s, we were launching our new national projects, and a project on healthcare development was a key one. It was then that new equipment and technology began to arrive at outpatient clinics and hospitals, which was indispensable during the epidemic, by the way. And we followed this strategic priority regardless of the financial and economic circumstances, however complicated.
Now we have to move forward relying on the experience we gained, among other things, from combating the coronavirus. Along the way, we must honestly analyse both our achievements and unresolved issues, of course. It is not about our readiness to counter an epidemic but also about generally increasing the efficiency and reliability of the entire healthcare system.
The priority is to significantly improve the state of the primary healthcare tier – rural health posts, outpatient clinics and hospitals, ambulance and emergency care services, to enhance their staffing, to substantially increase the accessibility of modern diagnostics and, importantly, to ensure broad digitisation, the use of AI technologies in the operation of medical facilities at all levels. Ms Golikova has just said that we have to slightly postpone the launch of this work but it will be started and completed.
I want to stress again that this must be done not in individual organisations or cities and villages but across the whole country so that people get high-quality medical care and live a long healthy life while medical professional can work under modern conditions, use cutting edge equipment and regularly raise their qualifications.
These are our top priority tasks. We will resolve them together with due account of the opinions of the public and our entire society.
I will reiterate, addressing now our doctors, nurses and all medical professionals: we see your attitude towards your work; we love you, we value you and we will support you.
Once again, greetings on your holiday and all the very best.
Thank you.