With the vaccination campaign against COVID-19 meeting or exceeding the initially set targets in quite a few Western, Southern, and Northern European countries, at least prior to the highly contagious Delta variant establishing itself as the globally dominant strain and compromising the pursuit of a COVID-Zero strategy, the prediction that COVID-19 will be relegated to the status of a mild disease by the spring of 2022 appears quite likely to materialize. However, in the eastern region of the continent vaccine hesitancy has picked up the baton from the supply-related challenges during the first months of the vaccination drives in creating a major obstacle to the return of a semblance of normality.
Vaccine skepticism, especially in the context of the vaccines developed to provide protection against the coronavirus disease, can be attributed to a multitude of causes, with the differences between various demographics within rather than between populations also in need of being taken into account. In particular, it has become par for the course in two countries in Eastern Europe: Bulgaria and Romania. As of October 2021, these two states have been the laggards in the EU in terms of both first and second vaccine doses administered.
From a historical standpoint, both Bulgaria and Romania have seen quite a few periods of compromised sovereignty, notably those during which the countries found themselves under Ottoman tutelage, which has played a part in fostering a deep-seated distrust of the state. The reservations displayed toward the political leadership on the part of the general populace may spill over into the medical realm, reducing the likelihood of certain medical interventions gaining widespread acceptance. In 2016, Romania was significantly below the World Health Organization’s targets with regard to its vaccination rate for measles while levels of trust in the medical providers in Bulgaria are consistently quite low. Thus, with the COVID-19 vaccines being novel types of preventive medications and the tendency for vaccination campaigns to be perceived as top-down and state-driven endeavors, turning skeptics into believers appears to be an unusually daunting challenge.
The slump in the COVID-19 vaccinations is perhaps also to be imputed to the lack of a sufficiently strong fear factor, with a June 2021 YouGov survey revealing that Romania and Bulgaria occupy the top two spots among the EU countries when it comes to the number of citizens who express an agreement with the sentiment that the COVID-19 risk is overstated. This is in spite of the rather high per capita rates of fatal outcomes, notably among young people as well (who are somewhat more likely to underestimate the threat of the virus) in the two states. There does not necessarily appear to be a strong relationship between the actual health impacts of COVID-19 and the vaccine uptake of the population, as evidenced by success story New Zealand’s high degree of enthusiasm for vaccinations and the example of Germany where COVID-19 vaccination rates have actually been the lowest in provinces in the East, such as Thuringia and Saxony, which were among the most seriously affected during the previous waves of the pandemic. From a psychological standpoint, as pointed out by political scientist Ivan Krastev, Bulgaria and Romania’s ability to emerge relatively unscathed from the first wave in the spring of 2020 in comparison to countries such as Italy and Spain where the pandemic quickly became a shocking reality on the ground may have contributed to the lukewarm reactions to the vaccinations. Furthermore, in the case of these two Balkan countries, some of the concerns about the virus are arguably being ameliorated by the often mistaken belief among many people that they have already had an asymptomatic or mildly symptomatic case of the disease and made a recovery from it. The significant number of undetected (not officially registered with the authorities) COVID-19 cases in Bulgaria and the issues experienced in Romania when it comes to the accurate reporting of crucial numbers pertaining to mortality are probably an additional explanatory factor as to why regular citizens may unwittingly obtain a distorted picture with respect to the epidemiological situations in their countries, causing them to overestimate the speed with which their states are approaching the “herd immunity” threshold.
Another less frequently mentioned facet potentially hampering vaccination efforts concerns the political uncertainty and the effects of a rapidly emerging protest culture, which has been a feature of Bulgaria and Romania’s political landscapes since the early 2010s.
Romania’s culture of street movements is believed to have started establishing a foothold since the early 2010s. In each of the three years prior to the emergence of COVID-19, Romania experienced massive protests, frequently triggered by corruption issues and specific concerns regarding the judiciary, as in the case of those erupting against the Dăncilă Cabinet in the summer of 2019. During the COVID-19 pandemic, Romania has grappled with political gridlock and seen numerous participants protesting against the pandemic-related restrictions. After a promising start to the country’s vaccination campaign, the vaccination rate significantly slowed down during the summer, with the active involvement of political figures in advocating for the vaccines notably regarded by some analysts such as Costin Ciobanu as having a negative rather than a positive effect, which could be a reflection of the polarized political climate in Romania.
In the last ten years, Bulgaria has also seen a rise in citizen activism, with the country experiencing two major protest waves (in 2013-14 and 2020). The latter one began in July 2020 and was largely political in its scope, reflecting long-standing grievances with the policies of the third Borisov government. While the protests were organic in nature and drew support from many segments of society that were far from inclined to peddle conspiracy theories regarding the virus, in the autumn of 2021 there was a spillover in the direction of vocal opposition to the pandemic control measures. This was evidenced by the burning of face masks during some demonstrations – an action which was criticized by cultural anthropologist Ivaylo Ditchev for threatening the idea of national solidarity in the face of the pandemic. Some sources also lambasted the protesters for going one step further by creating a dividing line between themselves and those supporting compliance with the COVID-19 measures, implicitly labeling the latter as encouragers for the Borisov government. In the spring of 2020 there was a high degree of support for the first lockdown in Bulgaria, but by the third quarter of the year the government’s legitimacy had largely eroded, to an extent due to the tense political climate in the country, which inevitably had a negative impact on the public perceptions of the vaccination campaign that began during the Borisov administration.
When a nation finds itself in the throes of a global pandemic, an inclination to take part in major demonstrations, even if for perfectly legitimate causes, may cause the social fabric to begin to unravel and pave the way for the adoption of a discordant tone among the public institutions. Mixed messaging, resulting from a government’s desire to placate as many competing interest groups as possible may actually further reduce the levels of public trust, an essential ingredient for a successful public health response (a major component of which is the administering of vaccines) to a respiratory virus. The pressure from the street may also make political parties less inclined to compromise in order not to be perceived as sell-outs, worsening the prospects for stable governance, as evidenced by Bulgaria’s experience with three different governments (two of them caretaker ones) in 2021. A provisional government with a restricted mandate, especially if it is perceived to be favorable to a particular part of the political spectrum, as in the case of Bulgaria, may find it more difficult to strike the right chord with the electorate in terms of popularizing a vaccination campaign.
Vaccine hesitancy is a concerning phenomenon, especially due to the extremely serious physical and mental toll that COVID-19 exerts on populations, the lack of a truly reliable and accessible treatment, as well as the possibility of more infectious vaccine-resistant variants cropping up. Still, it is by no means an immutable state of affairs that does not render itself to change. For instance, during the initial stages of the COVID-19 vaccination campaign France was frequently cited as a paragon of vaccine skepticism in Western Europe, but has as of September 2021 one of the highest proportions of people on the continent with a completed vaccination regimen against the coronavirus. Thus, with a fourth COVID-19 wave pushing health systems to the brink, there is hope that countries such as Bulgaria and Romania will muster up a spirit of national unity that transcends the political cleavages, which is likely to significantly reduce the potency of vaccine skepticism.
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