On February 24, 2022, the world watched in horror as Russia invaded neighboring Ukraine without provocation or justification. In 2019, Volodymyr Zelenskyy, an actor and comedian who played the part of a Ukrainian president in the show Servant of the People (available on Netflix, in case you were wondering), beat a pro-Russian incumbent on a platform of ending the war with Russia and rooting out corruption in the government. In 2021, he cracked down on pro-Russian Ukrainian oligarchs, leading to Vladimir Putin deploying troops to the Ukrainian border.

The invasion of Ukraine is a watershed moment in world history. Unexpectedly, the invasion led to an overwhelmingly unified response from the West, including a reversal of centuries of neutrality by Switzerland. Using economic shock and awe, the West imposed sweeping sanctions, removing Russian banks from the SWIFT global bank payment system, freezing $300 billion in assets of the Central Bank of Russia, removing Russia from the G8, and likely removing Russia’s favored nation status in the World Trade Organization. Essentially, Russia has been removed from the global economy, causing the ruble to freefall, emptying stores, and rapidly causing a return to Soviet-era living standards. No one wishes harm on the Russian people, but short of assisting in the war, this is the best the West could do to help repel the invasion and stop the war.

A few years ago, I visited Russia and spoke at the White Nights meeting in St. Petersburg about different anti-VEGF medications. This beautiful city facing the Gulf of Finland on the Baltic Sea, with its UNESCO European Enlightenment architecture, was the former capital of Russia under the tsars before the capital was moved to Moscow after the October Revolution in 1917. I was scheduled to speak virtually at the same meeting this year, but I am not sure if it is even taking place. Like many multinational companies that have ceased operations in Russia, pharmaceutical companies have also joined the flight. Novartis, Eli Lilly, Abbvie, Bayer, and others have halted marketing activities and all scientific events organized by the companies or external parties in Russia and Belarus.

But what about the anti-VEGF medications themselves? Are they going to be sold in Russia and how will the drug supplies reach the country and be paid for? Current sanctions do not cover medicines. Bayer has stated that it would maintain humanitarian supplies of medicines to Russia. However, Russia has banned Russian firms from paying overseas shareholders, so will medicines keep flowing when companies are not being paid? Numerous studies have shown vision loss resulting from missed injections during the COVID-19 pandemic, so an epidemic of vision loss is a very real possibility in Russia. Similarly, what about patients in the Ukraine? It is worrisome and very sad to think of all the patients who will lose vision due to a senseless war. Here’s to hoping a rational and quick end can be negotiated, but I am not optimistic. RP