Why does Bulgaria have the EU’s lowest vaccination rates?

With more than 5,000 COVID-19 cases and 100 deaths a day, Bulgaria is fast approaching another peak in infections.

But as the death toll mounts and the healthcare system becomes overstrained, most Bulgarians are still refusing COVID-19 vaccines.

Bulgaria has the lowest rate of vaccinations in the 27-nation European Union, with just 21.8 percent of its population inoculated amid an abundant supply of vaccines.

One of the millions of Bulgarians who do not want to get the jab is Dimo Indzhov, a 30-year-old sales representative living in Sofia.

“I’m not worried about side effects; every medicine has side effects. Rather, it’s the fact that the vaccines are very new and their trials on humans have been rushed through,” he told Al Jazeera.

Indzhov said he is not against vaccines in general but does not see a need to get the COVID-19 jab at this point, given that he has been exposed to the virus several times but not fallen ill.

The health ministry’s campaign to encourage vaccination, including a raffle for a smartwatch, which he called “a joke”, has failed to convince him.

Vaccine hesitancy has cost Bulgaria thousands of lives.

Since the mass vaccination campaign started in March, about 11,000 coronavirus-related deaths have been registered.

Experts told Al Jazeera that misinformation, poorly organised vaccination campaigns and conflicting messaging from politicians and health authorities are some of the reasons why vaccine uptake is so low.

‘Showered with vaccines’

Young and healthy people like Indzhov are most likely to be hesitant about vaccines, according to a September survey by Gallup International. They constituted a significant proportion of the 45 percent of respondents who said they are not vaccinated and do not want to be.

Another poll conducted by Trend in November last year showed conspiracy theories and misinformation shaped public attitudes towards COVID-19.

In that study, 52 percent said that COVID-19 is an artificially created virus; 40 percent believed it is part of a conspiracy by pharmaceutical companies to increase profits; 33 percent were convinced that the coronavirus was not worse than the flu; and16 percent believed that COVID-19 vaccines contain microchips that can control people.

According to Dr Miroslav Spasov, a Sofia-based general practitioner, the spread of misinformation on social media platforms hurts doctors’ vaccination efforts. Of his 3,000 patients, only 700 are inoculated.

“We are currently showered with vaccines, but we either have to throw them away or give them away to other countries because people do not want to get vaccinated,” he told Al Jazeera.

He said the government and medical community have played a role in the failure, claiming that high-risk groups were not targeted or prioritised for vaccination while authorities failed to launch a cohesive information campaign.

Officials were also too late to involve general practitioners in the vaccine drive, he said.

Vaccine scepticism among doctors

Dr Spasov alleged that some doctors even discourage patients from getting vaccines, despite overwhelming evidence of their efficacy.

“I’ve had patients with chronic disease who I’ve managed to convince to get vaccinated. I’d then send them to a specialist for a second opinion and they’d come back saying, ‘The doctor said, don’t listen to your GP, don’t put this trash in your body,” he said.

Some Bulgarian doctors have publicly spoken out against the vaccine.

Dr Atanas Mangarov, a regular guest on TV talk shows and a proponent of herd immunity, has falsely claimed that people who have been infected with COVID-19 develop immunity that protects them against reinfection, while vaccines do not.

Vaccine scepticism among medical workers has also been reflected in relatively high rates of unvaccinated hospital staff. According to the Bulgarian Doctors’ Union, about 30 percent of doctors are not vaccinated against COVID-19. In some hospitals in Sofia, up to half of the personnel has not been inoculated.

Deputy Health Minister Dr Toma Tomov, who used to lead the COVID-19 ward in one of the main hospitals in the capital, acknowledged that negative attitudes towards the vaccination campaign among medical workers is a problem.

When asked by Al Jazeera whether the ministry was taking measures to tackle it, he responded, “There is a lot of information [about vaccines] available from verified sources that provide evidence. Anyone who wants to check it can do that and can also reach out to the ministry.”

He blamed a lack of funding for the ministry’s inability to push a comprehensive information campaign targeting the general population.

Fake vaccine certificates

Another challenge is the spread of fake vaccine certificates.

Bulgaria, like other EU countries, uses a centralised data system to register citizens who have received a vaccine.

But in recent months, illegal schemes have emerged in which doctors charge people who refuse to be jabbed between $170 and $300 to issue them “proof” of vaccination.

Official statistics show that about 5.8 percent of weekly deaths are people who have been vaccinated, but medical experts believe that some may have had fake certificates.

Dr Tomov said that would be difficult to verify.

He said the ministry receives dozens of reports about fake certificates each week, which it forwards to law enforcement agencies.

“I don’t think the people with fake certificates are such a big number, but they do distort the official statistics,” he said.

He hopes that the rate of inoculation will soon rise after the government imposed mandatory vaccine certificate requirements for people who want to enter public spaces.

Since mid-October, when the government started talking about this measure, 236,412 doses were administered, compared to 218,139 for the whole of September.

‘Politicians are afraid of losing votes’

In parallel to the COVID-19 crisis, Bulgaria has also been shaken by political instability.

Two parliamentary elections this year have resulted in a hung parliament and the country heads to a third on November 14, which will be combined with a presidential vote.

The vaccination drive has become a political football.

Former Prime Minister Boyko Borisov, for example, blamed the interim government appointed by his opponent President Rumen Radev for the low vaccination rate, and said the health ministry has allowed the use of expired vaccines.

But Health Minister Dr Stoyko Katsarov said Borisov’s last cabinet is responsible for the failed vaccine campaign.

According to Petar Cholakov, associate professor of sociology at the Institute for the Study of Societies and Knowledge at the Bulgarian Academy of Sciences, there has been a lack of will across the political spectrum to encourage vaccinations, which has severely undermined public trust in the campaign.

“Here lies the responsibility of the politicians. They were supposed to come out and say clearly that the vaccines help save lives, but they didn’t,” he said, pointing out that leading political figures also failed to lead by example early on.

Borisov took the jab only in July, while Radev told the media he was inoculated in August.

“In an election year, the politicians are afraid of losing votes given how divided society is on this topic and how much scepticism there is [towards vaccines],” Cholakov said.

He explained that a large-scale, systematic information campaign with cohesive messaging from health authorities – and the political elite – can give the vaccination drive the necessary push.