Turning to Russia, San Marino gave its vaccination campaign a jump start.

San Marino, a tiny, independent republic within northern Italy, is perhaps best known — to the extent it is known at all — as one of the smallest countries on earth.

But the pandemic has given it a new, tragic distinction: a place with one of the world’s highest death rates from the coronavirus.

Just six weeks ago, San Marino risked becoming the last country in Europe to start inoculating its people. It had counted on an agreement with Italy to furnish it with vaccines, but they never materialized. With tensions rising and doctors threatening to stop working, the desperate government turned to Russia and found a warm embrace.

San Marino has long had close ties to Russia, and readily accepted more than 7,000 doses of the Sputnik V vaccine, which has not been authorized by European or Italian drug regulators.

Russians have been drawn for years to this nation of just 33,000 people, often flying directly from Moscow to the Italian beach town of Rimini only 10 miles away. More than 100,000 Russian tourists visit San Marino in a typical year.

Sputnik is just the latest tool Moscow has used to gain influence in Europe, exploiting rifts between the European Union, which has had a disastrously slow vaccine rollout, and some member states.

Roberto Ciavatta, San Marino’s health minister, said that for his nation, the issue was not geopolitics but something simpler.

“The only vaccine in that moment available on the market was Sputnik,” he said.

Just as San Marino is within Italy but not part of it, it is ensconced in the heart of the European Union but not a member of the club or its vaccine-buying program. As Europe’s vaccination efforts stumbled, San Marino risked falling ever farther behind.

The positions are now reversed. San Marino has given at least one vaccine shot to 26 percent of its people, more than double the E.U. average. Officials say hundreds of Italians have tried to make vaccination appointments here, and some even showed up, hoping in vain to get vaccinated by the foreign state next door.

“We asked Italy for help and didn’t get any,” Denisa Grassi, a 42-year-old teacher, said after receiving her shot. “Now it’s the Italians who ask us.”

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