Balkan’s vaccine hesitancy: why is Bulgaria last in the vaccine roll-out?

After more than three million COVID deaths worldwide, catastrophic economic consequences, numerous lockdowns, and severe social-distancing restrictions, you would think that people will see in vaccines what Israelites saw in Moses – the hero to finally set them free and lead them to the promised land.

Thousands of years later, our Canaan is the COVID-free world, but vaccines and their ticket to the promised land are not that tempting for some EU countries.  Contrary to expectations, parts of Europe, and specifically the Balkans, do not seem eager to roll up their sleeves and accelerate the vaccination process, trailing countries like Britain and the United States. But why?

The vaccination rate is indeed slow in Europe where it was deeply affected by the delays in deliveries, including the recent tension with Britain over exports of the AstraZeneca vaccine. The figures are relatively low in the Balkans, and more specifically in Bulgaria. Data published by Statista show that Bulgaria has the slowest inoculation rate among all EU member states with its 10 doses administered to a hundred people compared with 65 for the UK.

The slow authorisation of the vaccines further added to the problem. The European Commission secured its first vaccine contract 105 days after former EU member Britain. December 8 became a key date for the UK as the day of the first vaccination, whereas the first jab in Bulgaria was secured 19 days later.

But no technical obstacle compares with the fear Bulgarians feel from getting the jab. Bulgarians are not only scared, they are also sceptical. COVID-19 might be one of the worst pandemics, but it is also the greatest “infodemics” the country has seen. Misinformation about vaccines spreads faster than truth, scientists contradict each other, conspiracy theories thrive on social media and voalá: the confidence in vaccines is undoubtedly undermined. 

And while most sources of misinformation tend to lead their origins from social media, the mainstream media in Bulgaria has played the lead role in spreading fear, confusion and negligence about the pandemic. One of the most shocking examples was from Alfa TV, which published a video claiming that the Pfizer vaccine was causing people in the UK to go blind and deaf. Reporters Without Borders ranked Bulgaria 112th globally for freedom of expression, calling it “the black sheep of the European Union” which could somehow justify the low quality of reporting.

Bulgaria is last for freedom of expression in the EU

But the problem is not only the media. The journalists just amplified the contradicting model the Bulgarian government chose to tackle the COVID crisis by giving it the platform to spread confusion.

Let’s take a trip down memory lane to prove it. Back in February 2020, the PM Boyko Borisov set up the National Operational Headquarters (NOH) to deal with the pandemic. Unlike the UK where televised press conferences were held by PM Boris Johnson only when there were significant announcements to be made, the NOH held daily briefings from March to May, all of which were broadcast in full across different TV channels. Instead of giving Bulgarians reassurance at the times they mostly needed it, the televised briefings gave a sense of a military situation and turned into a weapon for spreading fear and confusion, exposing the nation to constant coverage of the virus, figures of deaths and infections.

The fear from the virus got even worse when a month later the government established the Medical Expert Council (MEC) as an alternative to the NOH. The team was made of doctors specialising in infectious deceases whose aim was to help their colleagues effectively fight the COVID outbreak and inform the public. The result, however, was two separate teams of experts sending mixed signals to people on TV. While the head of NOH General Ventsislav Mutafchiyski supported strict measures and lockdowns, the MEC and its doctor Atanas Mangarov undermined the seriousness of COVID, claiming that a “herd community” through exposure to the virus was the only way to overcome the pandemic. 

The National Operational Headquarters was set up to deal with the pandemic

As time went by, doctor Mangarov became the most controversial expert featured on almost every Bulgarian channel. Not only was he contradicting scientists from around the world, but he was also inconsistent with his own medical advice. The interviews Mangarov gave across different mainstream channels were so incoherent that the moral conflict in the Bulgarian COVID narrative became between the protagonist doctor Mangarov and the anti-hero doctor Mangarov. 

The doctor was so successful in creating public confusion that he went from “mass testing should be introduced” in March to “testing is a waste of money” in October. He completely disregarded the possibility of a second or third wave in Bulgaria, and was later proven wrong by the rising number of cases. The famous doctor has fiercely criticised all the safety precautions used to fight the pandemic and has boycotted the wearing of masks many times.  It is important to note that how effective masks are in curbing the spread of the virus is still a grey area for scientists around the world, but both the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) recommend it as a safety measure, especially indoors.  This was partly the reason why Facebook deleted one of Mangarov’s posts claiming there was no scientific evidence that masks worked.

The Bulgarian expert was even filmed in public transport without a mask (which was also breach of the law), days after he was in contact with a COVID positive TV reporter. When challenged by a BTV presenter, Mangarov said he hasn’t tested for COVID because no one asked him to, proudly saying that he only wears a mask when he thinks is “necessary”. 

Doctor Mangarov was filmed in public transport without a mask

No wonder why he went from the most commonly featured expert on TV to the anti-hero in the COVID narrative. And what the mainstream media did was to amplify the misinformation he spread by uncritically reproducing his contradictory opinion on TV. The result from everyone undermining the seriousness of the pandemic was the record number of 5176 infections a day at the end of March, the highest infections rate Bulgaria has ever seen.

So, how could we expect people to vaccinate when they have lost faith in institutions and the experts who never stopped giving them mixed signals?

The answer is we can’t. In a poll of 1,000 Bulgarians conducted by Alpha Research, 52% of those surveys said they did not intend to be immediately vaccinated. And those who are not willing to vaccinate are supported by doctor Mangarov who claims that “there is no point in vaccinating” and the natural immunity is stronger than the one obtained by the vaccine. According to the WHO, however,  ‘herd immunity’ could be achieved through mass vaccination only and a natural approach is “scientifically problematic and unethical” and will only result in   “unnecessary infections, suffering and death.”  

Unfortunately, the large amount of misinformation and incoherent health guidelines does not end with TV interviews featuring contradicting experts. Social media is constantly flooded with fake news about vaccines, the most shocking case of which was the story of a teacher who was reported to have died after vaccination. The teacher was actually alive and well, and wasn’t even vaccinated in the first place. The website that broke the news even published a picture of the victim causing massive distress to the teacher and her family. 

The sad news is cases like this occur on a daily basis. Websites use carefully constructed headlines which serve as clickbaits, claiming people die after vaccination. These headlines are the proof anti-vaxxers need to uphold their perceptions of the “deadly vaccines”, which makes them less likely to look for flaws or do some quick fact-checking with other sources. Instead, these articles are instantly shared on Facebook, they reach more and more people and the number of anti-vaxxers just grows bigger. But if someone were to do some fact-checking or simply open the website and read the article, they would find there was no link between the vaccination and the cause of death, but only a misleading headline that sparked their fear of vaccination. 

Websites use carefully constructed headlines which serve as clickbaits, claiming people die after vaccination

The truth is people can get sick after vaccination, but that does not imply it is the vaccine that made them ill. The explanation is rather simple.  According to the CDC, it typically takes a few weeks for the body to build immunity after vaccination. This means a person could still be infected with COVID-19 just before or after vaccination, because the vaccine has not had enough time to provide protection. Despite all that, Bulgarian websites are unstoppable from spreading fear and crossing lines, the most unacceptable of which was the report claiming a whole family died as a result of vaccination.

Although this kind of reports is enough to undermine the trust in vaccines, misinformation on the web is just one of the nails in the coffin of vaccines. The trust in vaccines was further shaken by concerns over blood clots caused by the AstraZeneca shot. The limited use of the jab, including in Bulgaria, just sparked wider concerns about its safety. As a result, a YouGov survey found that between one in four and one in five people would refuse the AstraZeneca vaccine in Europe.

The blood clots concerns, along with fears over the long-term effects are causing understandable but unnecessary tension in Bulgaria. There have been more than 750 million doses administered worldwide and the WHO assures that severe side-effects would have been reported by now. What’s more, the vaccines undergo rigorous phase checks before approval and they continue to be monitored, but this is still not enough to win Bulgarians over.

The quick development of the vaccines was also a cause for concern. The rapid creation of the vaccines was possible thanks to previous research on similar coronaviruses such as SARS and MERS, so scientist simply built on the data already available to them. But the fact that Pfizer-BioNTech and Moderna vaccines use the mRNA technology just added to the list of fears of Bulgarians. These concerns are largely unjustified as mRNA vaccines are not unknown and they have been studied before for flu, rabies, Zika and cytomegalovirus. This type of vaccines works by triggering an immune response inside our bodies when injected and they never enter the nucleus of the cell, which makes conspiracy theories such as “vaccines alter our DNA” completely invalid and untrue. Then why are Bulgarians not rushing to get the jabs?

The claim that mRna vaccines alter DNA was one of the most widely shared conspiracies

The mRNK conspiracy was just one of the false theories that undermined the credibility of vaccines and that Bulgarians fell into. In case you wonder why these conspiracy theories are so appealing, it’s because they have the three-act structure archetype on which so much of the storytelling is built. We instinctively organize our thinking around a set-up scene and a climax and wait to see what the resolution of the conspiracy is.  Take the Bill Gates narrative for example. The exposition of the story was embodied by the outbreak of the pandemic and the vast amount of deaths worldwide. The conflict took the form of the dilemma whether to let Bill Gates use vaccines as a weapon to microchip us and control us through the 5G network. The resolution then is either a vaccinated world controlled by the Microsoft giant or a public boycott that will ruin Bill Gates’ carefully constructed evil plan.

Most of these conspiracy theories thrive on social media and within closed Facebook groups, which unite people with the same stand against vaccines.The fact that most of the conspiracy posts published in Bulgaria have Bulgarian captions makes it even harder for Facebook to flag them as false information. To make matters worse, Bulgaria is not included in FaceBook’s world map which features countries the social platform works with to review the accuracy of stories, so misinformation and fake news spread even easier. The Judi Mikovits’ clips are a case in point. 

Mikovits is a former chronic fatigue researcher who claims the federal government is behind “plague of corruption” to gain profits from vaccines. She appeared in a 25-minute clip on YouTube, called “The Plandemic”, claiming that vaccines will “kill millions”. The video was taken down from the platform for spreading misinformation, but different clips with Judy Mikovitz continue to exist in Bulgarian. Similar videos are also shared, like this one, which features a German doctor claiming vaccines have foreign DNA in them. 

The truth is Bulgarians choose a different narrative of vaccines according to the situation the end up being in. Before vaccines turned into the monster that alters DNA and Bill Gates uses to microchip the nation, they were seen as the heroes that helped the low mortality in the country.   

After a scientific study found a possible correlation between countries with mandatory tuberculosis vaccines, also called BCG, and the low impact of coronavirus, Bulgarians took the pride in being vaccinated. The BCG vaccine has been mandatory in the country since 1951 and Bulgaria is its major producer, exporting it to 140 countries. According to the report, the BCG vaccination was thought to be offering broad protection to respiratory infections, which explained why Italy for example, who never universally applied the tuberculosis vaccination, had the second biggest number of deaths. The UK ended its routine tuberculosis programme in 2005 and saw the highest COVID mortality rate. Bulgaria, on the other hand, has mandatory BCG vaccination policy. During the first peak of the pandemic in 2020, it recorded the mere 10 deaths by the begging of April and scientists were putting this to the tuberculosis jabs. This clearly shows how vaccines played the lead role in two contrasting narratives before and after the pandemic.

Nevertheless, the Bulgarian government is still trying to fight the hesitancy and speed up the inoculation process . Unlike the UK, anyone in Bulgaria is entitled to choose a COVID jab and get vaccinated without being in a priority group. But will the “green corridors” put the country ahead of the vaccination game? Only time will tell. Yet vaccines are the safest choice we have so far and it would be foolish to blow it away because of conspiracies, bad politics, contradicting experts… and microchips.

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