Bulgaria has the lowest vaccination rate in the European Union: just 27 per cent of its total population has been fully vaccinated, according to figures collected by the European Centre for Disease Prevention and Control.
It also has the EU’s highest Covid-19 death rate, with 327 deaths per million people over a fortnight. To put it in perspective, it suggests that if Croke Park had been packed to capacity with Bulgarians for an event two weeks ago, 27 of them would have died of Covid-19 since.
That's 20 times Ireland's death rate. The data from across Europe clearly show that the higher the vaccination rate in a country, the lower its rate of deaths. So why has such a large majority of people in Bulgaria declined to take a vaccine, despite the jabs being available?
The story began last year. Back then, each EU country was offered vaccines from AstraZeneca, Pfizer, and Moderna, under the EU joint purchase scheme. Bulgaria's government under-ordered Pfizer and Moderna, betting the house on AstraZeneca, which was cheaper and easier to store.
"We didn't manage to diversify the risk," says Petar Vitanov, an MEP with the Bulgarian Socialist Party. "We ordered 75 per cent from AstraZeneca only."
It was a poor wager. Bulgaria was hit hard by early supply problems as the company failed to deliver the promised quantities of vaccines. On top of this, data from the vaccine trials was messy, and initial trials did not involve many older people. This led cautious governments to recommend the vaccine only for younger groups at first, pending more data.
Side effects
This is why reports of side effects emerged early in the EU: this particular vaccine was initially predominantly given to health workers, who are working-age and majority female. While extremely rare, its side effects seem to occur more frequently in younger women. Confusingly, it meant governments then switched, restricting AstraZeneca to older groups instead.
The European Medicines Agency never wavered that the benefits of AstraZeneca outweigh the risks for adults. But to Bulgarians, it seemed like negative news about this vaccine just didn't stop.
Meanwhile, national politics was in a state of chaos. Prime minister Boyko Borissov was forced to resign following weeks of street protests over alleged corruption and abuse of power. Political deadlock prevented parties from forming a new coalition: the country held three elections in eight months.
Amid the tumult, public opinion of the authorities reached a low. There wasn’t enough stability to enforce strong health measures, and public communication about the vaccines was shoddy.
“We were in constant elections,” Vitanov recalls. “There were some concerns about adopting certain measures, in order not to lose popularity.”
Into the vacuum, bad actors moved. Conspiracy theories, disinformation and rumour abounded on social media. And for some, the fear and uncertainty of the pandemic provided an opportunity.
Anti-vaxxer movement
“Fake news was a huge, huge problem in Bulgaria,” Vitanov says. “In social media, the anti-vaxxer movement is really flourishing here.” A far-right party used an anti-vaccination platform to get into parliament for the first time.
Vitanov rejects the commonly-aired theories that there is an older cultural or historical reason for scepticism, such as the legacy of communism resulting in distrust of authorities. He points out that Bulgaria has traditionally had high vaccination rates: measles vaccine coverage in 2019 stood at a respectable 93 per cent, rivalling or surpassing the rates of older democracies.
The country has had measles break-outs, a sign of insufficient vaccine coverage for a disease that can be particularly deadly to babies and toddlers. But these have tended to be in marginalised Roma communities, rather than in the broader Bulgarian population.
Survey data does indicate that vaccine scepticism had begun to take root prior to the Covid-19 pandemic. It has inroads among the highly educated – including doctors – and younger groups, suggesting that this may be more like the “lifestyle choice” avoidance of vaccines that has been growing in wealthy countries over the last two decades.
In October, Bulgaria introduced the Covid-19 digital certificate system to access services like bars and restaurants. It was controversial, but daily vaccinations rose by a factor of 10 as a result, Vitanov says. This informs his view that the incoming government needs to take a “strong hands” approach.
“I’m definitely in favour of mandatory, obligatory vaccination. Maybe not for all the population, but at least for some people that are higher risk, or some professions that are dealing with a lot of people,” he says.
“It’s not very popular. I know that it can affect negatively on your public image. But this is the only way that you can save human lives.”