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World of Genomics: Belarus

Sometimes referred to as the “Lungs of Europe,” Belarus is a country famous for the breathtaking forests that make up 40% of its landscape. The country boasts five UNESCO heritage sites, including the Belovezhskaya Pushcha National Park, which is home to over 13,000 species of flora and fauna.  

The country has a modern healthcare system and reported one of the lowest death rates in Europe during the COVID-19 pandemic. In this article, we delve into the intricacies of Belarus’ healthcare system, examining its strengths, weaknesses and ongoing efforts to address pressing health concerns. Additionally, we explore the nation’s capabilities in genomic medicine and projects to advance research in the field.  

Population of Belarus

Belarus is a landlocked country in Eastern Europe, bordering five countries: Poland in the west, Lithuania in the northwest, Ukraine in the south and Russia in the north and east. It is divided into six regions (or oblasts): Brest Oblast, Vitebsk Oblast, Gomel Oblast, Grodno Oblast, Minsk Oblast and Mogilev Oblast. Minsk Oblast is the central region of Belarus, home to its capital city, Minsk.  

Figure 1 | Map of Belarus. Source: Canva.  

Belarus has a rich history that dates back thousands of years and has been inhabited by many East Slavic tribes. From the 14th to 16th centuries, Belarus was part of one of the most powerful states in Europe, The Grand Duchy of Lithuania, which later entered a union with the Kingdom of Poland to form the Polish-Lithuanian Commonwealth. From the 18th century to the early 20th century, the majority of Belarus was under Russian control. It briefly gained independence in 1918 but was soon occupied by Soviet forces. During World War II, Belarus was invaded by Nazi Germany and suffered heavily from destruction and loss of life. Belarus was a founding republic of the Soviet Union, remaining under Soviet control until the USSR dissolved in 1991, when it became the Republic of Belarus.  

Geographic and demographic information  

Summary statistics  

  • Land area: 207,600 km²  
  • Gross domestic product (GDP):  
    • Total: 72.2 billion USD (2022)  
    • Per capita: 7904.0 USD (2022)  

Population statistics  

  • Population size: 9,208,701 (2022)  
  • Birth rate: 10.898 births per 1000 people (2023)  
  • Death rate: 12.568 deaths per 1000 people (2023)  
  • Infant mortality rate: 2.462 deaths per 1000 live births (2023)  
  • Average life expectancy: 75.2 years (2023)  
    • Male: 67.3 (2021)  
    • Female: 77.7 (2021)  
  • Ethnicity: Belarusians 84.9%, Russians 7.5%, Poles 3.1%, Ukrainians 1.7%, Jews 0.1%, Armenians 0.1%, Lipka Tatars 0.1%, Ruska Roma 0.1%, Lithuanians 0.1%, Azerbaijanis 0.1%, others 2.2% (2019 census).    

Healthcare system  

Belarus has a universal healthcare system that is mainly funded through taxation, as well as some out-of-pocket (OOP) payments for services such as dental care and pharmaceuticals, the latter of which accounts for 73% of OOP payments. All Belarusian citizens are entitled to free health care and the country’s Human Development Index (HDI) has been categorized as “very high.” Public health insurance has not been introduced.  

Belarus’ healthcare system uses a highly centralised, hierarchal structure and is divided across the Oblasts. The Ministry of Health (MOH) sets national health priorities, which are managed by regional leaders that organise and fund primary and secondary care at the local level. The MOH only directly funds tertiary healthcare services (those that require highly specialised expertise and equipment). This results in significant inequalities between economic regions. In 2018, there were approximately 41 practitioners per 10,000 people in Belarus; slightly higher than the EU average of 38 per 10,000 in the same year. There were 108 hospital beds per 10,000 people in 2014, compared to the EU average of 56 per 10,000 in the same year.  

Out-of-pocket payments are a significant problem in the healthcare system. The MOH tries to counter this by allowing reimbursement of pharmaceutical charges. However, this only applies if bought at one of a few state-owned pharmacies. A national survey conducted in 2011 found that over 14% of the population could not obtain pharmaceuticals and other medical goods that they needed, and 62% of respondents said this was because they couldn’t afford them. This issue is persistent, with 2016 data indicating that 30% of Belarusian citizens spent almost a third of their income on healthcare. 

Health priorities  

Following the dissolution of the USSR in 1991, the Republic of Belarus had a highly centralised healthcare system. Unfortunately, minimal changes have been implemented since, with poor lifestyle choices and non-communicable diseases still being prominent causes of death.  

The leading causes of death in Belarus include ischaemic heart disease, stroke, Alzheimer’s disease and other dementias, cancers, alcohol use disorders and chronic obstructive pulmonary disease. In men, self-harm also sits in the top five causes of death. Ischaemic heart disease contributes significantly to mortality in Belarus, responsible for over 550 deaths per 100,000 people in 2019, in comparison to the second highest cause of death, stroke, at less than 200 per 100,000. These numbers are significantly higher than the EU average, with all circulatory diseases (which includes both ischaemic heart disease and stroke) responsible for only 344 deaths per 100,000 people.  

As a country, Belarus has a very high alcohol intake. In 2010, the country had the highest alcohol consumption levels in the world, which prompted action from its government to curb alcohol-related deaths. Several initiatives were put in place, such as measures to raise the price of alcohol, but were not adequately implemented. Furthermore, excise taxes promoted the manufacturing of cheap fortified fruit wines. From 2011-2015, Belarus launched its first successful anti-alcohol campaign, which included limiting alcohol production and increasing penalties for drunk driving. Alcohol consumption and alcohol-related mortality have since been reduced but remain in the top five causes of death in adults.  

Tobacco consumption is another problem: in 2016, 48.6% of Belarusian men were smokers, a stark comparison to just 9.7% of Belarusian women. No indoor public spaces in Belarus are smoke-free, including health-care facilities. The WHO Framework Convention on Tobacco Control (WHO FCTC), implemented in 2017, aims to reduce smoking prevalence within 15 years through a range of initiatives, including increasing excise cigarette taxes from 34.48% to 75%, requiring strong graphic health warnings on tobacco products and banning the advertisement of cigarettes. 

Despite a hesitance to enforce lockdowns, Belarus had one of the lowest death rates during the COVID-19 pandemic. This is likely due to the country’s large hospital capacity and large number of medical practitioners. Mass testing started early, initially using kits from Russia and China before the country developed its own rapid-testing kits between April and May. However, a 2021 article published in Communications Medicine suggests that the number of COVID-19 cases was over four times higher than reported, meaning many related deaths could also have gone undetected.  

Genomic medicine capabilities   

There are several large research institutions in Belarus involved in genetics and genomics, such as the Belarusian State University and The National Academy of Science of Belarus.   

In late 2018, the MOH and Belarusian State University presented and launched the HELP course on “Key Human Rights Principles in Biomedicine” for medical and legal professionals, which became available via an online platform in 2019. This course consists of eight modules, notably “Medical Confidentiality and Protection of Health-Related Data” and “Genetic Testing”. 

The number of licensed genetic counsellors in Belarus is unclear. Online resources on genetic testing and counselling in Belarus are scarce but several international companies (e.g., in Canada, the United States, Spain and Italy) offer these services electronically to those living in Belarus. Most of these services are paid, presenting a significant barrier to access. However, a few international companies offer genetic services in Belarus free of charge. 

In February 2023, The World Health Organisation Country Office in Belarus obtained equipment for the Republican Research and Practical Centre for Epidemiology and Microbiology. This will enable the country to research genomes of infectious diseases, as well as monitor mutations in the genome of HIV, hepatitis B and C, and SARS-CoV-19 viruses. Belarus has just one newborn screening laboratory that only screens for two conditions: Congenital hypothyroidism and Phenylketonuria (compared to 25 different conditions/genes in its neighbouring country, Poland).   

Notable projects  

  • Belarus Health System Modernization Project: This project is run by the Republic of Belarus MOH, utilising 125 million USD to improve select aspects of health care delivery in the country. This project was approved in November 2016 and will conclude in December 2023.  
  • Healthy Lifestyle Promotion in Belarus (BELMED): Project run by the Republic of Belarus MOH from May 2015 to December 2020 to “Prevent non-communicable diseases, promoting healthy lifestyle and support to the modernisation of the health system in Belarus”. This project cost over 2 million USD, which was contributed to by the Government of Poland, the United Nations and the Republic of Belarus.  

Notable organisations and companies   

Notable individuals   

  • Yury Bandazhevsky (1957-present): Bandazhevsky is a Belarusian scientist and the founder of Gomel State Medical Institute in Belarus, which is specially dedicated to scientific work on the 1986 Chernobyl disaster. Since 2013, Bandazhevsky has been leading the research and health protection project, “Chernobyl: Ecology and Health” near Chernobyl in Ivankiv District in Ukraine, supported by the European Commission.  
  • Sophia Getzowa (1872-1946): Getzowa was a Belarus-born pathologist who is known for her work on the thyroid, identifying solid cell nests (SCN) in 1907.  

The future genomics landscape  

Belarus possesses a modern and largely tax-funded healthcare system, providing free services to its citizens. However, out-of-pocket payments remain a significant concern. The system’s centralized structure, managed by regional leaders, has led to economic disparities in healthcare access. Non-communicable diseases, notably alcohol-related disorders, are major health challenges in the country, but Belarus has made successful efforts to combat these issues in recent years.  

The nation’s genomic research capabilities are advancing, with new equipment coming into the country and wider access to education.  

Currently, Belarusian citizens have few options for genetic testing and newborn screening. With out-of-pocket payments already a significant challenge, it is unlikely that citizens will be able to afford the electronic testing and counselling that is offered abroad. Introducing these vital services as part of the free healthcare system would be a promising first step for the MOH.  

Belarus continues to grapple with evolving political, social and healthcare challenges, with both strengths and areas for improvement in its healthcare system. The large number of initiatives that have been launched in the last decade, such as the Belarus Health System Modernization Project, indicate that the country is moving in the right direction to improve its citizen’s healthcare.  

References   

  • Grigoriev, P. and Andreev, E.M. (2015). The Huge Reduction in Adult Male Mortality in Belarus and Russia: Is It Attributable to Anti-Alcohol Measures? PLOS ONE, 10(9), p.e0138021. doi:https://doi.org/10.1371/journal.pone.0138021. 
  • Grigoriev, P. and Bobrova, A. (2020). Alcohol control policies and mortality trends in Belarus. Drug and Alcohol Review. doi:https://doi.org/10.1111/dar.13032. 
  • Human Rights Education for Legal Professionals. (n.d.). The HELP course on Bioethics presented and launched in Belarus. [online] Available at: https://www.coe.int/en/web/help/-/the-help-course-on-bioethics-presented-and-launched-in-belarus [Accessed 1 Nov. 2023]. 
  • Loeber, J.G., Platis, D., Zetterström, R.H., Almashanu, S., Boemer, F., Bonham, J.R., Borde, P., Brincat, I., Cheillan, D., Dekkers, E., Dimitrov, D., Fingerhut, R., Franzson, L., Groselj, U., Hougaard, D., Knapkova, M., Kocova, M., Kotori, V., Kozich, V. and Kremezna, A. (2021). Neonatal Screening in Europe Revisited: An ISNS Perspective on the Current State and Developments Since 2010. International Journal of Neonatal Screening, [online] 7(1), p.15. doi:https://doi.org/10.3390/ijns7010015. 
  • Modern and Studies (2018). HEALTH CARE SYSTEM IN BELARUS: PATH OF LEAST RESISTANCE. [online] 1(1), pp.18–27. Available at: http://repec.kse.org.ua/pdf/mes/n4_Chebanova_Chernoknyzhna_Sinichenko_ENG.pdf [Accessed 4 Nov. 2020]. 
  • Nemira, A., Adeniyi, A.E., Gasich, E.L., Bulda, K.Y., Valentovich, L.N., Krasko, A.G., Glebova, O., Kirpich, A. and Skums, P. (2021). SARS-CoV-2 transmission dynamics in Belarus in 2020 revealed by genomic and incidence data analysis. Communications Medicine, [online] 1(1), pp.1–9. doi:https://doi.org/10.1038/s43856-021-00031-1. 
  • president.gov.by. (n.d.). Healthcare of the Republic of Belarus | Official Internet Portal of the President of the Republic of Belarus. [online] Available at: https://president.gov.by/en/belarus/social/healthcare
  • Richardson, E., Malakhova, I., Novik, I. and Famenka, A. (n.d.). Belarus Health system review Health Systems in Transition. [online] Available at: https://iris.who.int/bitstream/handle/10665/330303/HiT-15-5-2013-eng.pdf?isAllowed=y&sequence=5 [Accessed 1 Nov. 2023]. 
  • World Bank. (n.d.). Development Projects : Belarus Health System Modernization Project – P156778. [online] Available at: https://projects.worldbank.org/en/projects-operations/project-detail/P156778 [Accessed 1 Nov. 2023].