The doctor is desperate. For months she has been trying to convince her neighbours in this northwest Bulgarian town to get vaccinated to prevent the rapid spread of Covid-19. But it is a losing battle and on one recent grey Wednesday afternoon, only a trickle of patients shows up to get vaccinated.
There are abundant supplies and a choice of either the Pfizer, Moderna or Janssen vaccine, yet only 12 per cent of those in Vidin, a town of 63,000 inhabitants near the Romanian border, have been double jabbed.
“The cases have increased,” said Pepa Tsvetanova, a physician and public health official administering vaccines to residents of this crumbling Danube River port town, where dozens of new cases show up at hospitals every day.
The nation hit a pandemic record of more than 6,000 Covid-19 infections per day last month, while daily deaths also hit new highs this month.
“We are trying to convince the people that the only thing to limit the disease is vaccination, and it’s our duty to do everything we can to stop it,” Tsvetanova added.
“We’re trying to communicate the message. But the most common thing I hear is that they read something somewhere and don’t want to expose themselves to the vaccine.”
Bulgaria has the lowest Covid-19 vaccination rate and highest death rate in the European Union. The pandemic has so far killed more than 27,000 people in the nation of seven million.
Although authorities have tried to encourage the jab with media campaigns and visits to schools, businesses and healthcare facilities by vaccine advocates, less than one in four Bulgarians has been fully inoculated.
This is despite Bulgaria having such ample vaccine stocks that more than 170,000 unused vaccines were donated to Bhutan in July before they were to expire.
Bulgaria is not an outlier; scepticism about the vaccine pervades eastern Europe. In neighbouring Romania, only 37 per cent have been vaccinated. Only about one in five residents of Bosnia has been inoculated.
And in Ukraine, where just 21 per cent of people have been jabbed, hospitals are overflowing with Covid-19 patients, forcing medical facilities to set up makeshift tents to tend to the sick and dying.
Actual inoculation rates in eastern European and Balkan nations might even be lower than official statistics. Health workers are issuing so many fake digital Covid-19 certificates that authorities are considering installing cameras in vaccination centres. Poorly paid physicians may also be seeking to profit off vaccine sceptics who are willing to pay up to $300 (£223) for a bogus certificate that will allow them to work and travel.
“In order to appear in the database, a doctor has to type it in,” said Hristov Ivanov, an leader of the opposition Yes Party and a staunch vaccine advocate. “You go to the doctor, they go through all the administrative steps, and then throw the vaccine into the trash bin instead of jabbing you.”
The low vaccination rates have alarmed EU and WHO officials, who have been urging Bulgaria and the Balkan region, including Bosnia and Moldova, to speed up inoculations, for their own sakes but also for the rest of the world.
“The first risk is of course for the Bulgarian population but also to generate a new variant, which would be more resistant than the other ones,” Thierry Breton, the EU official in charge of vaccine rollout, told reporters in Sofia last week. “If we do not do anything we may see a Bulgarian variant because there’s too many people not being vaccinated.”
To encourage vaccinations, authorities in eastern Europe have used a mix of carrots and sticks. Ukraine’s government handed each recipient the equivalent of about $40 in cash to get vaccinated. Bulgarian authorities have sought to compel employers to make jabs mandatory but have also removed a requirement for recipients to sign a liability waiver which fuelled conspiracy theories that the vaccination was unsafe.
The measures have resulted in small successes, especially among educated professionals in cities such as Sofia, the Bulgarian capital, where about a quarter of people have been vaccinated.
At an inoculation centre in a metro station in a busy, well-to-do district of the city, administrators said the numbers have jumped from about 30 a day to 150 since new rules forced businesses to make vaccines mandatory.
But public health officials warn that overall figures aren’t rising nearly fast enough to counteract a potential winter surge. Unlike in France, where one tough speech by President Emmanuel Macron in July prompted a dramatic spike in vaccination numbers, scepticism about the jab in eastern Europe runs deep.
It is rooted in longstanding mistrust of authorities dating back to the era of communist rule.
“Because we lived under totalitarian regimes, we believe that truth does not reside with those in power,” says Ilian Vassilev, an analyst and former diplomat in Sofia.
But the hesitancy is also the result of a new wave of effective disinformation campaigns by passionate anti-vaccination activists promulgated through social media, which has been happening across much of the world.
“The problem with these first-generation vaccinations is they are not mature enough,” said Tihomir Bezlov, a researcher at the Centre for the Study of Democracy, a think-tank, referring to the relative novelty of the Covid vaccines compared to other inoculations that are tested for years before they are used en masse.
“And that gives anti-vaxxers an opening and an opportunity. ”
Analysts also cited the persistent influence of religion as a factor.
During a recent visit to rural Romania, an Orthodox Christian priest said he opposed any public discussion of the vaccine or vaccination statuses, calling it a private decision. In Romania, two priests are also under investigation after allegedly turning away vaccinated members from their congregations.
Russia’s Orthodox Church publicly urged the faithful to get jabbed last summer but critics have accused Bulgaria’s Orthodox church of subtly promoting an anti-vaccination message by declining to endorse mass inoculations and speaking instead about the sacredness of the body of Christ.
In all of these countries, healthcare systems have been depleted by immigration and decimated by lack of investment, fuelling mistrust in authorities. In recent weeks, deadly fires erupted in Covid wards in both Romania and Bulgaria, killing a total of 12 people.
Like much of eastern Europe and the Balkans, huge stretches of rural Bulgaria and Romania have been hurt by depopulation.
Bulgaria’s rural northwest feels like a wasteland. Hundreds of homes appear abandoned, with broken windows, boarded-up doors and overrun with weeds. Massive warehouses and hollowed-out factory complexes are covered in rust and graffiti. Few businesses operate.
Those residents who mill about towns and villages have little faith in the future of their country, much less the vaccine.
“I doubt the vaccine they give to rich people is the same thing that the poor people get,” said one teenager in Vidin’s main square.
Polarised, fractured politics also hurt public trust. Romania has been without a government for months. Ukraine remains locked in a state of perpetual crisis, with pro-Russian forces occupying the country’s east. Bosnia is said to be near implosion, with Serbian nationalists challenging the country’s 25-year peace accord.
Bulgaria has held three inconclusive elections this year and has yet to form a governing coalition.
Critics blame the machinations of the country’s political elite, including both former longstanding prime minister Boyko Borisov and his opponents. He first acted quickly regarding the pandemic, imposing sensible lockdown measures. However, he then sought to shield himself from any political fallout by creating two bodies overseeing healthcare, each giving contradictory messages.
“He would wake up in the morning and say, ‘Today, I’m going to meet this group and support their message… another day, the other group’,” said opposition leader Ivanov.
When Borisov’s popularity seemed to increase last year as the nation rallied around his Covid-19 measures, the opposition pounced, questioning the lockdown, mask mandates and eventually, vaccinations as a way to bring about his demise.
One far-right political party with little more than a strident anti-vaccination message entered parliament for the first time in a vote this month. Surveys suggest up to 70 per cent of Bulgarians oppose the vaccine. In interviews, their reasons vary. Some question the effectiveness of the vaccine. Others cited unfounded concerns about side-effects and there are those who worry about conspiratorial agendas.
“I’m a healthy person and I don’t need a vaccination,” said Karamfil Kamenov, a 52-year-old lorry driver.
“Generally speaking, I trust doctors but the vaccine, I don’t trust.”
The prevalence of anti-vaccination sentiment makes those who choose to get jabbed a quiet minority.
Valentin Tsenov, a 47-year-old Bulgarian who works in agriculture in the UK was getting his first jab during a trip back home to visit his family in Vidin. He said that watching life slowly return to normal near Canterbury where he lived had convinced him the vaccine was safe and effective.
However, he refuses to serve as a vaccine advocate to his friends and family in Bulgaria.
He said: “I prefer not to quarrel with them, because I fear they will try to convince me not to get vaccinated.”
Milena Hristova contributed to this report.
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