Delivery delays, vaccine skepticism and poor management have left the country with the lowest rate of jabs in the bloc.
SOFIA — As vaccination campaigns across the European Union gather speed, one member state continues to lag far behind the rest: Bulgaria.
Plagued by delivery delays, vaccine skepticism and poor management, the country has the lowest vaccination rate in the bloc. As of mid-May, just over one in ten Bulgarians have received a first dose.
While most EU members are on track to meet the European Commission’s goal of inoculating 70 percent of the population by this summer, Bulgaria currently is set to reach that in February 2022. Even the other stragglers, like Romania and Latvia, have administered a first dose to nearly twice as many people as Bulgaria.
At the same time, Bulgaria has suffered one of Europe’s highest death rates during the third wave. Although cases have recently declined, experts fear that the slow pace of vaccination means the end of the pandemic will remain out of reach for a long time.
“If we don’t speed up our vaccination push, we would continue to witness new waves of the coronavirus and deaths among vulnerable groups,” said Dafina Dobreva, a Bulgarian public health specialist based in Spain.
All eggs in one basket
Among the factors that slowed Bulgaria down was the government’s decision to bet heavily on the Oxford/AstraZeneca vaccine, which was more affordable and easier to store than the mRNA shots on offer. As a result, Sofia did not order the full share of BioNTech/Pfizer jabs it had access to under the EU’s joint procurement scheme.
“At the time it was not necessarily a bad decision,” said Alexander Simidchiev, a pulmonologist and a former member of parliament from the opposition Democratic Bulgaria coalition. “However, relying predominantly on one vaccine without ordering sufficient amounts of the other ones proved to be the wrong approach in the long term.”
That quickly became apparent when AstraZeneca vastly under-delivered to the EU. But the lack of available doses was not the only obstacle hampering Sofia’s vaccination efforts.
Initially, Bulgaria prioritized doctors, nurses, front-line workers including teachers as well as residents and staff of nursing homes. But even among that first group, vaccine hesitancy held back the campaign, with authorities reporting no-shows early in the year.
In an attempt to speed things up, Bulgaria introduced so-called green corridors — a walk-in scheme allowing everyone to get a vaccine regardless of whether they fell into priority groups — in February. Thousands of people lined up in front of vaccination centers in big cities and 30,000 Bulgarians received a shot over the course of just three days.
Yet the program’s initial success was short-lived; the green corridors were suspended only days later due to vaccine shortages. Meanwhile, news that the AstraZeneca vaccine was linked to extremely rare cases of blood clotting further dented confidence in the shot.
“No one wants to get vaccinated with AstraZeneca now,” said Georgi Mindov, head of the association of general practitioners in Sofia.
Petar Petrov, a 55-year old telecommunication engineer from Sofia, was among those who delayed vaccination until his preferred jab was offered to him.
“I preferred a mRNA shot, so I waited for a while until those became available,” he said. “I finally got an appointment on April 15 but when I got to the hospital it turned out that nothing else is available but AstraZeneca.”
He eventually got his mRNA shot in early May, but his wife is still hesitant, he added. “She has some concerns about the vaccines and is taking her time.”
While most EU citizens want to get vaccinated as soon as possible, in Bulgaria only 19 percent said so, according to a Eurobarometer survey conducted earlier this year. Just 21 percent wanted to be vaccinated “some time in 2021.” Another 32 percent wanted to receive a shot “later,” while 22 percent said that they never want to get inoculated.
At the same time, many Bulgarians still do not take the coronavirus seriously. More than half of Bulgarians think the virus has been artificially created, according to a poll last year; another 17 percent believe the virus does not exist.
Critics say that state did little to sway those hesitant to get the shot. “We failed to develop an integrated communication strategy which targets vulnerable groups and clearly explains the benefits of getting the COVID-19 vaccine,” said Simidchiev.
A series of management missteps, distribution delays and a patchy health infrastructure also thwarted the country’s efforts to get vaccines into arms.
In a health care system where outpatient care is heavily reliant on family doctors, authorities were also slow to involve general physicians in the vaccination drive.
Last month, family doctors in Sofia had to queue for hours, cooler bags in hand, to receive vaccine vials. Three weeks ago, attempts to jump the line even led to heated arguments and an altercation between doctors.
“It’s a total lack of organization,” said Mindov. “We never know what vaccine is available and how many vials we would be given.”
Last week, he said, his car was towed away while he was waiting to receive two vials. “This is quite insufficient, so I need to get vaccines almost every day.”
On Monday, in an attempt to streamline the process, the country’s new health minister, Stoycho Katsarov — who serves as a member a caretaker government that took over last week ahead of elections in July — said that health authorities should designate logistics sites to provide vaccines to general practitioners upon their request on a weekly basis.
Bulgaria’s attempt to speed up vaccinations by opening appointments to everyone early has meant those with priority status — such as the elderly and people with chronic illnesses — had difficulties accessing jabs.
Many EU member states have administered at least one shot to the majority of their senior citizens. Yet Bulgaria is lagging drastically behind, having inoculated just 10.6 percent of Bulgarians aged 80 or older, 17.2 percent of those aged 70-79, and 16.5 percent among the 60-69 age group.
Dobreva finds the figures worrisome. “Research shows that this age group is more likely to develop a severe illness and is at greater risk of dying, so vaccinating seniors is key,” she said.
On Monday, Katsarov announced new vaccination guidelines that appeared designed to address this concern. Starting Tuesday, all vaccination centers in the country will inoculate only people aged 60 years and older and those suffering from chronic diseases, and will operate from Monday to Thursday. Others can take appointments on the remaining days of the week.
“We are amending vaccination guidelines because the majority of deaths occurred among people who are above 60 years of age,” he told reporters in Sofia on Monday.
Dobreva welcomed the changes as a step in the right direction.
“It could have a positive impact if supported by good logistical planning and an informational campaign, targeting the most vulnerable groups,” he said. She said that giving precedence to seniors could reduce mortality and hospitalizations.
However, the two months’ deadline that the government set might limit the scope and impact of the vaccination efforts, she cautioned.
Meanwhile, in a separate video statement, Katsarov — who last year at times downplayed the danger posed by the coronavirus dangers — urged Bulgarians to get vaccinated.
“Like it or not, vaccination is the only way which is currently proven to slow the virus’ spread and death toll,” he said. “Our success or failure depends on each and every citizen.”
This story has been updated.
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