nhs vaccinations travel

Travel vaccination advice

If you're planning to travel outside the UK, you may need to be vaccinated against some of the serious diseases found in other parts of the world.

Vaccinations are available to protect you against infections such as yellow fever , typhoid and hepatitis A .

In the UK, the  NHS routine immunisation (vaccination) schedule protects you against a number of diseases, but does not cover all of the infectious diseases found overseas.

When should I start thinking about the vaccines I need?

If possible, see the GP or a private travel clinic at least 6 to 8 weeks before you're due to travel.

Some vaccines need to be given well in advance to allow your body to develop immunity.

And some vaccines involve a number of doses spread over several weeks or months.

You may be more at risk of some diseases, for example, if you're:

• travelling in rural areas
• backpacking
• staying in hostels or camping
• on a long trip rather than a package holiday

If you have a pre-existing health problem, this may make you more at risk of infection or complications from a travel-related illness.

Which travel vaccines do I need?

You can find out which vaccinations are necessary or recommended for the areas you'll be visiting on these websites:

• Travel Health Pro
• NHS Fit for Travel

Some countries require proof of vaccination (for example, for polio or yellow fever vaccination), which must be documented on an International Certificate of Vaccination or Prophylaxis (ICVP) before you enter or when you leave a country.

Saudi Arabia requires proof of vaccination against certain types of meningitis for visitors arriving for the Hajj and Umrah pilgrimages.

Even if an ICVP is not required, it's still a good idea to take a record of the vaccinations you have had with you.

Find out more about the vaccines available for travellers abroad

Where do I get my travel vaccines?

First, phone or visit the GP practice or practice nurse to find out whether your existing UK vaccinations are up-to-date.

If you have any records of your vaccinations, let the GP know what you have had previously.

The GP or practice nurse may be able to give you general advice about travel vaccinations and travel health, such as protecting yourself from malaria.

They can give you any missing doses of your UK vaccines if you need them.

Not all travel vaccinations are available free on the NHS, even if they're recommended for travel to a certain area.

If the GP practice can give you the travel vaccines you need but they are not available on the NHS, ask for:

• written information on what vaccines are needed
• the cost of each dose or course
• any other charges you may have to pay, such as for some certificates of vaccination

You can also get travel vaccines from:

• private travel vaccination clinics
• pharmacies offering travel healthcare services

Which travel vaccines are free?

The following travel vaccines are available free on the NHS from your GP surgery:

• polio (given as a combined diphtheria/tetanus/polio jab )
• hepatitis A

These vaccines are free because they protect against diseases thought to represent the greatest risk to public health if they were brought into the country.

Which travel vaccines will I have to pay for?

You'll have to pay for travel vaccinations against:

• hepatitis B
• Japanese encephalitis
• tick-borne encephalitis
• tuberculosis (TB)
• yellow fever

Yellow fever vaccines are only available from designated centres .

The cost of travel vaccines that are not available on the NHS will vary, depending on the vaccine and number of doses you need.

It's worth considering this when budgeting for your trip.

Other things to consider

There are other things to consider when planning your travel vaccinations, including:

• your age and health – you may be more vulnerable to infection than others; some vaccines cannot be given to people with certain medical conditions
• working as an aid worker – you may come into contact with more diseases in a refugee camp or helping after a natural disaster
• working in a medical setting – a doctor, nurse or another healthcare worker may require additional vaccinations
• contact with animals – you may be more at risk of getting diseases spread by animals, such as rabies

If you're only travelling to countries in northern and central Europe, North America or Australia, you're unlikely to need any vaccinations.

But it's important to check that you're up-to-date with routine vaccinations available on the NHS.

Pregnancy and breastfeeding

Speak to a GP before having any vaccinations if:

• you're pregnant
• you think you might be pregnant
• you're breastfeeding

In many cases, it's unlikely a vaccine given while you're pregnant or breastfeeding will cause problems for the baby.

But the GP will be able to give you further advice about this.

People with immune deficiencies

For some people travelling overseas, vaccination against certain diseases may not be advised.

This may be the case if:

• you have a condition that affects your body's immune system, such as HIV or AIDS
• you're receiving treatment that affects your immune system, such as chemotherapy
• you have recently had a bone marrow or organ transplant

A GP can give you further advice about this.

Non-travel vaccines

As well as getting any travel vaccinations you need, it's also a good opportunity to make sure your other vaccinations are up-to-date and have booster vaccines if necessary.

Although many routine NHS vaccinations are given during childhood, you can have some of them (such as the MMR vaccine ) as an adult if you missed getting vaccinated as a child.

There are also some extra NHS vaccinations for people at higher risk of certain illnesses, such as the flu vaccine , the hepatitis B vaccine and the BCG vaccine for tuberculosis (TB) .

Your GP can advise you about any NHS vaccinations you might need.

Find out about NHS vaccinations and when to have them

Page last reviewed: 16 March 2023 Next review due: 16 March 2026

Travel health advice and travel vaccinations

You should make an appointment for a travel health risk assessment if you’re travelling abroad and think you need:

• a malaria risk assessment
• further advice

A travel health professional will take you through your travel health risk assessment.

Your GP is no longer your point of contact for a travel health risk assessment, including travel vaccines.

NHS travel health service

NHS Scotland provides a travel health service that includes some free vaccines.

To find information on how to make an appointment for a travel health risk assessment in Scotland, contact the NHS health board where you live.

Private travel clinics

You can also visit an independent (private) travel clinic for:

• a travel health risk assessment
• travel advice
• other travel vaccines

You should arrange a travel health risk assessment 6 to 8 weeks before you travel. This gives time for any vaccines you need to become fully effective.

If your trip is sooner, remember it’s never too late to get advice.

Travel health risk assessment

If you’re planning to travel outside the UK, your travel health needs will depend on your individual situation. This includes:

• your destination
• how long you’ll stay
• what you’ll be doing
• your general health

The fitfortravel website provides country-specific advice on:

• recommended vaccines
• other risk prevention advice

If you think you need vaccines and/or a malaria risk assessment, you should make an appointment with a travel health professional.

A travel health risk assessment is also recommended for some people, even when vaccines or malaria tablets aren’t required. This includes:

• older people
• those with a weakened immune system
• those with long-term conditions that need medications
• pregnant women

Travel vaccines

The following travel vaccines are free on the NHS in Scotland:

• diphtheria, polio and tetanus (combined booster)
• hepatitis A

It’s likely that you’ll have to pay for vaccines against:

• yellow fever
• Japanese encephalitis
• tick-borne encephalitis

You may also have to pay for the following vaccines if they’re only needed for travel purposes:

• hepatitis B
• tuberculosis (TB)

Proof of vaccination

To enter some countries you may need proof that you have had particular vaccines. This includes the yellow fever vaccine.

Yellow fever vaccines are only available from designated centres. To find out if you need a yellow fever vaccine or proof of the vaccine, you should contact a yellow fever clinic.

To request a list of any other vaccines held on your GP record, contact your GP practice. GP practices cannot provide proof of COVID vaccine.

Preventing risk while travelling

Vaccines or anti-malarial tablets will not protect against all travel health risks. This means you’ll need to take extra steps to protect your health whilst travelling abroad.

The fitfortravel website has further advice on preventing health risks whilst travelling. This includes information on:

• general travel advice
• disease prevention

Travelling abroad to visit friends and relatives

If you’re travelling abroad to visit friends or relatives, you may be at higher risk of developing travel-related illnesses. For example, malaria or typhoid. This could be because:

• you may be living with the local community
• your trip might be longer than the average holiday
• you might be visiting more rural areas where it’s difficult to take precautions that reduce your risk

The fitfortravel website provides information and advice on visiting friends and family abroad .

Travel safety advice

You can find country-specific safety and security advice through the UK government website .

Travel insurance advice

Many countries don’t have the same access to medical treatments as the UK and can be expensive.

It’s recommended that all travellers get comprehensive travel insurance before travelling.

When you return home

If you become unwell and/or develop a fever when you return home, it’s important to get medical advice as soon as possible. You should seek medical help even if it’s up to 1 month after you’ve been travelling.

Always make sure you tell the health professional that you’ve recently travelled abroad. This is especially important if you have been to a country where malaria is a risk.

Donating blood after travelling abroad

Travel outside the UK can affect whether you can give blood donations. This is because some infections may be caught abroad. This is usually through mosquito or other insect bites.

There are conditions for donating blood if you’ve been to certain countries. This can depend on your length of stay and some other factors.

Further information on donating blood after travelling abroad

Source: Public Health Scotland - Opens in new browser window

Last updated: 01 March 2024

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• Travel vaccinations

Yellow fever vaccine

Peer reviewed by Dr Colin Tidy, MRCGP Last updated by Dr Toni Hazell Last updated 10 Feb 2023

Meets Patient’s editorial guidelines

In this series: Travel vaccinations Hepatitis A vaccine Hepatitis B vaccine Rabies vaccine Tick-borne encephalitis vaccine Typhoid vaccine

Yellow fever is a serious disease. You should be immunised against yellow fever before you travel to certain countries.

In this article :

What is yellow fever, what country requires the yellow fever vaccine, who should have the yellow fever vaccine, where can i get the yellow fever vaccine, how does the yellow fever vaccine work, when should you get the yellow fever vaccine, what are the side-effects of yellow fever vaccine, who should not receive the yellow fever vaccine.

You may need an International Certificate of Vaccination to prove you have been immunised, as some countries will not allow you entry unless you can produce one. Check with your practice nurse several months before you travel to see if you need the yellow fever vaccine. You will only be able to get it from your GP if they are a designated yellow fever centre - if not then you will have to see a private travel clinic. Since 2020 there have been some shortages of this vaccine, so allow plenty of time before you travel to get it sorted out.

Continue reading below

Yellow fever is a serious disease caused by the yellow fever virus which is transmitted by infected mosquitoes and which infects humans and other primates (for example, monkeys).

For some people it can cause a flu-like illness from which they recover completely. However, for other people it causes symptoms of high temperature (fever), being sick (vomiting), yellowing of the skin or the whites of the eyes (jaundice) and bleeding. This is fatal in about 1 in 12 cases. There is no medicine that can destroy the virus, so treatment is to support the person medically whilst they fight the infection themself.

Yellow fever is passed to humans and other primates such as monkeys by mosquitoe bites from a type which tend to bite during daylight hours. (These are different to the type of mosquitoes which carry malaria, which tend to bite from dusk to dawn.)

Yellow fever occurs in certain countries of Africa and South and Central America. In the distant past it has been present in Europe and Asia but these parts of the world are currently free of yellow fever.

Yellow fever is not transmitted directly from person to person; the mosquito is needed to carry the infection from one human to another. Therefore, whilst vaccination offers high protection against yellow fever infection, taking steps to avoid being bitten is also an important part of avoiding the disease.

Travellers over the age of 9 months to countries where yellow fever is a risk. Some countries require an International Certificate of Vaccination against yellow fever before they will let you into the country. Yellow fever is the only disease which routinely requires proof of vaccination:

In some countries, vaccination is compulsory for all incoming visitors.

In some countries, vaccination is compulsory for those who have travelled from a 'yellow fever' area or country.

Your doctor or practice nurse may be able to advise if you should be immunised for your travel destination and whether you need this certificate of vaccination. Not all practices have the resources to do this - if yours doesn't then you'll need to go to a private travel clinic.

Workers who handle material that may be infected by the yellow fever virus - for example, laboratory workers.

People who are resident in areas where yellow fever is present.

The purpose of vaccination for travellers is two-fold:

Firstly it is to protect you from catching yellow fever.

Secondly it is to protect local populations from catching yellow fever from you, leading to an epidemic. Some countries are theoretically in danger of epidemics, as they have the right mosquitoes to transmit the virus, and have the kinds of monkeys who could become infected and act as a store or reservoir for the virus. They therefore require visitors to be immunised.

Yellow fever vaccine can only be given at accredited centres. Many GP practices (but not all) are accredited. If your local GP practice is not accredited you can find a list of the nearest available centres from NaTHNaC (see 'Further Reading and References', below). You will then be issued with a vaccination certificate which gives the date your vaccine will become effective.

The vaccine stimulates your body to make antibodies against the yellow fever virus. These antibodies protect you from illness should you become infected with this virus. The yellow fever vaccine is a live vaccine which can be given at the same time as other vaccines.

You should have an injection of vaccine at least ten days before the date of travel to countries with yellow fever to allow immunity to develop.

A single dose of vaccine was previously considered to provide immunity for at least 10 years. In 2013 the World Health Organization (WHO) declared that a single injection can be considered to give lifelong immunity. The International Health Regulations have not yet been altered to reflect this and so the certificate is only valid for 10 years, after which a booster is needed.

Some countries now accept it as being valid for life, so it is important to check the regulations for the countries you are visiting. You can do this on the WHO or National Travel Health Network and Centre (NatHNaC) websites or at your GP surgery.

Severe reactions after receiving the yellow fever vaccine are very rare but mild reactions can last for up to 14 days. Common side-effects of the vaccine may include feeling generally unwell, headaches, muscle aches, joint pain, mild fever or soreness at the injection site. Always contact a doctor if you have any concerns. A more serious, but rare, side-effect is encephalitis or infection in the brain. Most people recover fully from this side-effect which presents between 2 and 56 days after the vaccine with a fever or headache which may progress to confusion and a coma. This serious side-effect is more common in those aged over 60, who should therefore only have the vaccine if there is a serious and unavoidable risk of catching yellow fever.

The yellow fever vaccine is not usually given under the following circumstances, although advice should be taken from your doctor or practice nurse:

If you have reduced immunity (immunosuppression) - for example, people with HIV, people taking high-dose long-term steroids, people receiving chemotherapy, etc.

If you are ill with a fever you should ideally postpone the injection until you are better.

As a rule, pregnant women should not be immunised with this vaccine, although if travel is unavoidable then the woman and her doctor will need to make an assessment of the risks versus the benefits of having the vaccine - a private travel specialist would need to be approached for this, rather than your GP.

This vaccine may be given if you are breastfeeding and cannot avoid being at high risk of catching yellow fever, but expert advice should be sought before doing so.

You should not have the yellow fever vaccine if you have had a severe (anaphylactic) reaction in the past to egg. (This is because the vaccine contains small amounts of egg. A severe reaction to egg is very rare and it does not mean an upset stomach eating eggs or disliking eggs.)

Children under 9 months old should not receive the yellow fever vaccine. (Babies aged 6-9 months may occasionally receive the vaccine if the risk of yellow fever during travel is unavoidable.)

Older travellers (those aged over 60 years) who have not previously been vaccinated against yellow fever are at a higher risk of side-effects with the yellow fever vaccine and should therefore only have it if there is a serious and unavoidable risk of catching yellow fever. .

If you have had a severe reaction to the yellow fever vaccine in the past.

If you have a thymus disorder.

Dr Mary Lowth is an author or the original author of this leaflet.

Further reading and references

• Travel Health Pro ; National Travel Health Network and Centre (NaTHNaC)
• Travelling if you have a medical condition ; British Airways (includes downloadable MEDIF forms)
• Immunisation against infectious disease - the Green Book (latest edition) ; UK Health Security Agency.
• Travellers' Health ; US Centers for Disease Control and Prevention
• MHRA updated guidance on use of yellow fever vaccine in patients with immunosuppression, with thymus dysfunction, and in those aged over 60 ; Medicines and Healthcare products Regulatory Agency, April 2019

Article History

The information on this page is written and peer reviewed by qualified clinicians.

Next review due: 6 Jan 2028

10 feb 2023 | latest version.

Last updated by

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NHS booking system to open for spring Covid-19 vaccinations

• Vaccination

The NHS national booking system will open for spring Covid-19 vaccination bookings on Monday (15 April), with those eligible able to book appointments from the following week .

People at increased risk from severe illness can get the vaccine, including those aged 75 or over (on 30 June 2024), people with a weakened immune system or who live in an older adult care home.

Spring vaccinations will be available until 30 June 2024.

Anyone eligible can book a vaccine appointment via the NHS.UK website  or by calling 119 for free, with parents or carers able to book a Covid-19 vaccination for children under 16 on their behalf. Eligible people aged 16 and over can also use the NHS App to book an appointment.

The NHS is sending texts, emails, NHS App messages or letters to those who are eligible, but they do not have to wait for the invite to book.

Monday will also see the start of visits to older adult care homes and eligible household patients. For those that receive all their care at home, a home visit should be arranged via their GP.

Eligibility for a spring vaccination is similar to previous years but those with a weakened immune system are now eligible from 6 months instead of 5 years.

Following JCVI advice, this spring’s eligible cohorts include:

• Adults aged 75 years and over by 30 June 2024
• Residents in care homes for older adults
• Individuals aged 6 months and over who are immunosuppressed.

This year there are thousands of appointments available every day across the country including at pharmacies and GP practices. Some areas also offer convenient walk-in options, with a list of available walk-in sites online .

Covid-19 can still be very dangerous and even life-threatening, particularly for older people and those with a weakened immune system. The vaccine gives good protection and helps reduce the risk of serious illness or death, needing to go to hospital, catching and spreading the virus, and protects against different variants.

UKHSA surveillance data on last year’s spring Covid-19 vaccination programme showed that those who received a vaccine were around 50% less likely to be admitted to hospital with COVID-19 for three to four months after vaccination, compared to those who did not receive one.

Anyone eligible who has not received any previous doses should get vaccinated during this year’s spring offer, to help protect against serious illness.

The NHS is also encouraging those eligible to get the shingles vaccine, which is recommended for all adults turning 65, those aged 70 to 79, and those aged 50 and over with a severely weakened immune system. Anyone eligible should be contacted by their GP surgery to book an appointment.

Steve Russell, NHS national director for vaccinations and screening, said : “This spring, the NHS is offering the Covid-19 vaccine to those that are at highest risk of getting seriously unwell if they catch the virus.

“Covid-19 can still be very dangerous, particularly for older people and those with a weakened immune system, and over time immunity – either from having the virus or from a previous vaccination – can fade, so it is vital that those who are at higher risk top up their protection.

“If you are aged 75 or over or if you or your child have a weakened immune system, then it is vital that you get your vaccine as soon as possible – you can book quickly and easily through the NHS App, by calling 119, or visiting the NHS website, which also lists walk-in sites across the country that you can visit without an appointment.

Dr Mary Ramsay, Director of Immunisations at UK Health Security Agency, said : “With COVID-19 still circulating, it’s important those at highest risk who are eligible for the spring vaccine get their jab to help top up their immunity.

“We are still seeing COVID-19 causing hospitalisations and severe illness particularly among older people and those with weakened immune systems and the vaccine provides the best protection – so don’t put it off, if you’re eligible book your appointment as soon as you’re invited by the NHS.”

Health Minister Maria Caulfield said: “We are committed to protecting the most vulnerable from Covid and this spring programme will give those most at risk of serious illness the protection they need.

“Getting vaccinated is quicker and more convenient than ever, with thousands of sites open across the country including local pharmacies and GP practices.

“I urge anyone eligible to book their appointment as soon as possible.”

A summary of the health conditions, treatments and medications that can cause a weakened immune system is available on the NHS.UK website , and a full definition of immunosuppression can be found in Chapter 14a (table 3) of the Green Book .

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• Vaccinations for COVID-19

What your NHS COVID Pass letter tells you (easy read)

Easy-read version of the non-personal information in your NHS COVID Pass letter about your COVID-19 status.

This publication was withdrawn on 27 March 2024

This guidance was withdrawn on 8 December 2023 

The NHS COVID Pass service has now closed. There are no longer any domestic requirements to demonstrate your vaccination status in England. 

The NHS COVID Pass is no longer required to travel abroad to any countries. 

If you are travelling abroad, you should review  travel entry requirements  for the countries you will visit or travel through. 

The NHS COVID Pass was developed at the height of the pandemic to let you share your COVID-19 vaccination status in a secure way. It was mainly used for international travel, as well as for some domestic purposes, such as entry to venues or events. 

See information about COVID certificates in  Guernsey ,  Jersey  and the  Isle of Man .

Applies to England

What your nhs covid pass letter for travel tells you (easy read).

PDF , 2.36 MB , 6 pages

Your NHS COVID Pass letter is used for travel abroad and to show others that you have had a full course of the COVID-19 vaccine (including a booster vaccination if you have received one).

You should get the letter within 7 working days of requesting one.

If you do not have access to a smartphone, computer or tablet, you can request a letter by calling 119 from within the UK. Select the ‘NHS COVID Pass service’ and ask for an NHS COVID Pass letter to be posted to you.

Find out more about using your NHS COVID Pass for travel abroad .

Updated information about the NHS COVID Pass letter.

Added easy-read version of 'What your NHS COVID Pass letter for domestic use tells you'.

Updated to include information about single dose and 2-dose letters.

Changing title of guidance to reflect that from 21 June 2021, the NHS service to demonstrate your COVID-19 vaccination status is now called the NHS COVID Pass.

First published.

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Russia Is Slow to Administer Virus Vaccine Despite Kremlin’s Approval

After announcing the first government clearance for a coronavirus vaccine, Russia delayed distributing it. It remains unclear how many people have received it.

• Share full article

By Andrew E. Kramer

MOSCOW — More than a month after becoming the first country to approve a coronavirus vaccine, Russia has yet to administer it to a large population outside a clinical trial, health officials and outside experts say.

The approval , which came with much fanfare , occurred before Russia had tested the vaccine in late-stage trials for possible side effects and for its disease-fighting ability. It was seen as a political gesture by President Vladimir V. Putin to assert victory in the global race for a vaccine.

It is not clear whether the slow start to the vaccination campaign is a result of limited production capacity or second thoughts about inoculating the population with an unproven product.

The Russian vaccine is one of nine candidates around the world now in the late-stage clinical trials that are the only sure means to determine whether a vaccine is effective and find possible side effects.

A vaccine is considered the only way to halt the spread of the coronavirus, which has sickened more than 30 million people globally and slowed economies around the world since it first appeared in China late last year.

In one example of the limited scope of distribution, the company financing the vaccine pointed to a shipment sent this past week to the Crimean Peninsula. The delivery contained doses for 21 people in a region with two million.

The Russian Ministry of Health has not said how many people have been vaccinated in all of Russia. The minister, Mikhail Murashko, said last weekend that the first small shipments was being delivered this past week to the Russian provinces.

He did not say how many doses were shipped, describing the shipments only as “small amounts,” and also did not say when they would become available. He said the area around St. Petersburg, the Leningrad region, would be among the first to receive what he called “samples” of the vaccine.

Mr. Putin has said that one of his two adult daughters took the vaccine.

“Unfortunately, we have very little information,” said Dr. Vasily V. Vlassov, a professor of epidemiology and vice president of the Russian Association for Evidence-Based Medicine. His organization had opposed approval of the vaccine before testing it.

“We cannot understand how much is P.R. and how much is a violation of medical ethics,” he said of the announcement that the vaccine had been approved for use outside a clinical trial. If few Russians are receiving the vaccine, the early approval appears less troubling, he said.

“Maybe nothing scary is happening in reality and only the announcement was scary,” he said.

Svetlana Zavidova, the director of a pharmaceutical trade group, the Association of Clinical Trial Organizations, which also opposed the hasty approval, said the limited use was encouraging news, even as its reasons are unclear.

“Is it a question of limited production or more of a political decision?” she said. Either way, “of course from my point of view it is better they limit their activity to only clinical trials, as we said from the beginning.”

The trial in Russia began on Sept. 9, and Russian officials have said they expect early results before the end of the year, though the Gamaleya Institute, the scientific body that developed the vaccine, has scheduled the trial to continue until May.

That timeline is similar to the testing schedules announced by the three pharmaceutical companies testing potential vaccines in the United States, AstraZeneca, Moderna and Pfizer.

AstraZeneca paused its trial this month after a test subject experienced symptoms of a neurological disease, transverse myelitis, as a possible side effect. The trial has since resumed in Britain but not the United States.

Mr. Putin and senior health officials announced the approval of the Russian vaccine, called Sputnik V in reference to the satellite that won the space race, for emergency use on Aug. 11. China had earlier begun vaccinations outside trials starting with members of its army , and has approved four vaccines for limited use.

On Sept. 14, the United Arab Emirates gave emergency approval for one Chinese vaccine, made by Sinopharm , for use on health workers.

Russia’s health minister said on Aug. 11 that people at high risk of infection, like doctors and teachers, would be vaccinated, and the Russian financial company sponsoring the vaccine said doses would be available in August.

But the rollout proved slower.

Mr. Murashko, the minister, said the delays were partly because of a need to test the distribution system for a vaccine that must be stored in a deep freeze, and also to train medical personnel. The delays have persisted even as the virus infects more than 5,000 people a day in Russia.

The Russian late-stage, or Phase 3, clinical trial is being carried out entirely in Moscow, where 30,000 people will receive the vaccine and 10,000 will get a placebo.

Yevgenia Zubova, a spokeswoman for the Moscow city health department, said in an interview that the vaccine was available only to trial participants. The Health Ministry did not reply to written questions about the use of the Sputnik V vaccine outside clinical trials.

Nonetheless, Kirill Dmitriev, the director of the Russian Direct Investment Fund, the company sponsoring the vaccine, has been cheering on officials in other countries who advocate early vaccine approvals.

“It has now been accepted that Russia’s approach is the correct one,” he said in a statement after reports emerged that the U.S. Food and Drug Administration might provide an emergency use approval for a vaccine, an idea promoted by President Trump.

Russia’s health authorities have a history of approving medicines after limited testing. It is a legacy of the Soviet-era regulatory system, in which an oversight committee often deferred to the judgment of drug researchers, who were not motivated by profit, said Dr. Vlassov with the Association for Evidence-Based Medicine.

Regulators have, for example, approved a best-selling cold medicine in Russia, Arbidol, though the clinical trial to prove its efficacy was canceled.

But when medicines are tested, Russia has an exceptionally good track record on managing clinical trials, according to a database of U.S. Food and Drug Administration inspections of clinical trials around the world. The F.D.A. found a lower percentage of trials with problems in Russia than in any other European country or the United States.

Andrew E. Kramer is a reporter based in the Moscow bureau. He was part of a team that won the 2017 Pulitzer Prize in International Reporting for a series on Russia’s covert projection of power. More about Andrew E. Kramer

Russia registered the first Covid vaccine. Now it's struggling to vaccinate its population.

MOSCOW — In August 2020, Russia became the first country in the world to register a Covid-19 vaccine. President Vladimir Putin announced the news on national television and said one of his daughters had already been vaccinated.

At the time, Russia was set to race ahead of other countries in its efforts to vaccinate its population.

Instead, 10 months after Sputnik V’s approval, Russia's vaccination rate is one of the lowest in countries where vaccines are widely available.

Just 14 percent of Russia’s 146 million people have been vaccinated with at least one dose, compared to 53.5 percent of Americans, according to Our World in Data, a monitoring project based at the University of Oxford.

An ambitious plan to vaccinate 30 million Russians by June — which involved giving away cars and free groceries — has fallen short by a third.

There are three Russian-made vaccines approved for use in Russia and the country has sold Sputnik V to countries around the world, including Turkey and Brazil. Russian-made vaccines are the only ones available to most Russians and supplies are plentiful. Researchers have said that Russia’s Sputnik V vaccine is about 91 percent effective .

The Kremlin said in a statement on Friday that that there were shortages in some areas, such was the level of "growing demand." But many just don’t trust Russian-made shots.

Samyr Oynushev, a musician from Moscow, has no plans to get the vaccination, though he believes Covid vaccines are necessary.

“If I had a choice, I would rather take a non-Russian vaccine,” the 29-year-old said.

“I think that [low vaccination rates] are primarily the fault of the government, that people don't trust them so much.”

Others feel that after recovering from Covid-19, they don’t need to rush to get a vaccination. According to one study published in the journal Nature, around 45 percent of the adult population of Russia’s second city, St. Petersburg, have antibodies to the coronavirus.

Epidemiologist Vasily Vlassov, a professor at the Higher School of Economics in Moscow, hasn’t yet been vaccinated, and believes his antibodies still protect him from infection after he caught Covid-19 in January.

Although vaccinations in the former Soviet Union were widely accepted, hesitancy began rising in the 1990s after the fall of communism as people realized they could make choices for themselves, he said.

“Russians know German cars are better than Russia’s cars and they have a problem believing that a Russian vaccine is better,” he said.

Currently in Israel, Vlassov is considering getting the Pfizer vaccine that’s widely available there.

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Despite his initial excitement about the vaccine, Putin has offered no proof, other than a short government statement, that he received a Russian-made shot. Unlike other world leaders who have been photographed with their sleeves rolled up or even their chests bared while receiving their shot, no such picture of Putin was released.

Meanwhile, Covid-19 rates and deaths in Russia are rapidly rising. After a dip in infections, the country is now reporting numbers similar to those seen in February, largely as a result of the delta variant. In Moscow, nearly 90 percent of reported cases were linked to the variant, Mayor Sergey Sobyanin said last week.

The national coronavirus task force said Saturday that 619 people died over the past day, the most since Dec. 24. Russia also reported its highest daily Covid-19 death toll of the year, with 21,665 cases.

Those rising rates, along with the hesitancy to be vaccinated, has led officials to offer incentives to residents, including the chance to win new cars. In Moscow, city authorities have given employers in public services a month to ensure that 60 percent of their staff had been vaccinated or face a fine.

Sobyanin ordered bars and restaurants in the capital to serve people only if they have been vaccinated or have had an infection indicating immunity. And unvaccinated people may soon be refused nonemergency hospital treatment. This crackdown has led to a thriving black market for fake vaccination certificates.

Natalia Andreeva, a laboratory diagnostician in Moscow, has yet to be vaccinated but has accepted that she will need to be in the future.

“It inevitably needs to be done,” Andreeva, 63, said. “I think that many people are afraid to get vaccinated, because all this was done very quickly.”

There are signs that officials' incentives and threats seem to be working. In the last week, Moscow’s vaccination rate has increased four or five times, Vice Mayor Anastasia Rakova said on the state-owned news channel Russia-24.

However, epidemiologist Anton Barchuk, the researcher who ran the study on antibody prevalence in St. Petersburg, suggests that a more effective way to convince people to get a vaccination would be through a more open discussion on the pros and cons.

“The pandemic has highlighted the problems with vaccine hesitancy,” he said, adding that the take-up of other vaccines for adults is also low. “It’s a problem of trust, and a lack of information on the harms and benefits of vaccination.”

Tatyana Chistikova reported from Moscow, Rachel Elbaum reported from London. Reuters also contributed to this report.

Tatyana Chistikova is an NBC News producer based in Moscow, Russia.

Rachel Elbaum is a London-based editor, producer and writer.