“I realized that covid is an actual problem, and I wanted to get protected in some way,” said Iliev, an 18-year-old who is starting college this fall. “I wanted to do my part in it.”
On that day, the government-sponsored mobile vaccination unit immunized about 15 people at the market, a local hub where vendors sell still-flopping fish, fresh produce and secondhand clothing. After about four hours, the crew moved on to the other villages on its route, hoping to administer another couple dozen doses.
It’s a painfully slow process — especially in the European Union’s least-vaccinated country.
Fewer than 1 in 5 Bulgarians are fully vaccinated against the coronavirus, a number that lags far behind the bloc’s median rate and marks the most profound example of the E.U.’s increasingly unequal pandemic recovery.
The 27-member club took a collective approach to vaccine purchasing and distribution. Early on, E.U. leaders sought to balance the demands of rich members such as Germany, which wanted to stockpile expensive mRNA vaccines, with poorer countries like Bulgaria, which preferred AstraZeneca’s cheaper version. When the first vaccines were authorized, the bloc launched a coordinated rollout, with each country receiving the same per capita supply. And when that rollout stumbled, E.U. leaders received heavy criticism for prioritizing equity over speed.
They have been somewhat vindicated. As supply increased, vaccinations accelerated, and in July the E.U. surpassed the United States in immunizations. For all the emphasis on equity, though, a gulf has opened between Western and Eastern European countries.
In Portugal and Belgium, for example, about 84 and 73 percent of residents are fully vaccinated. In Bulgaria and Romania, meanwhile, the rates stand at 19 and 27 percent. The E.U. gap now far outstrips the difference between highly vaccinated U.S. states like Connecticut and Massachusetts, and stragglers like West Virginia and Alabama.
Seven E.U. countries have vaccinated less than half of their populations, a disparity that will continue to complicate the bloc’s rebound, allowing infections and possibly new virus variants to circulate and spread across borders, especially as movement by workers and tourists increases. One particular worry: Many of the workers who staff the farms of Western Europe travel seasonally from Bulgaria and Romania. But the consequences stand to be most dire within the sparsely-protected countries themselves.
The European Commission, the bloc’s executive arm, can’t do much beyond procure the vaccines for its members, experts say, because national governments still have power over their vaccination campaigns.
“It’s really just a national problem,” said Matteo Villa, a researcher at the Italian Institute for International Political Studies who has tracked the vaccination disparity. “Given they are the economic laggards of the E.U., it is compounding poverty and inequality within the European Union.”
In Bulgaria, it’s an especially urgent time. The covid-19 death rate here is by far the highest in the European Union, and the number of new cases has also begun to climb. Doctors expect the infection rate to soar in the coming weeks — yet another wave in a country that has stubbornly refused the most effective protection against the virus.
‘Fertile soil for conspiracy theories’
Bulgaria, a Balkan country of about 7 million people, is one of the E.U.’s newest members, and one of its poorest. The region where Krushovitsa sits — in the country’s northwest, between the Danube River and a low mountain range that glows yellow and red in autumn — regularly tops the list of the bloc’s most impoverished sections.
But even in Sofia, the country’s capital and its largest city, vaccine hesitancy is a long-standing problem, exacerbated during the pandemic.
Numerous studies have found a connection between mistrust in institutions and an unwillingness to be vaccinated, and Bulgarians consistently show some of the E.U.’s lowest levels of trust in democracy, the government, health care and the news media. The country in turn has a low level of public confidence in a range of vaccines, and its family doctors are the most vaccine skeptical in the E.U.
“There’s no real trust in institutions, no real trust in our society, and because of that, it’s very fertile soil for conspiracy theories,” said Alexander Simidchiev, a former member of parliament and a physician who specializes in lung disease.
Hoaxes involving Microsoft founder Bill Gates or microchips, for example, have gained particular traction in Bulgaria, along with a barrage of fake news that still circulates online and in traditional media outlets.
Doctors espousing anti-vaccine views are often invited on to popular national TV shows, which rarely correct falsehoods and instead juxtapose their opinions with those of experts calling for stricter public health measures.
The government has conveyed similarly conflicted messages. Last year, authorities established two competing covid-19 task forces, which offered contradictory advice. Then-Prime Minister Boyko Borisov said he looked to both sets of advisers for guidance.
The coronavirus has also collided with a full-blown political crisis. After repeatedly failing to form a coalition government, Bulgaria’s parliament was dissolved this month and a caretaker government appointed while the country awaits its third election in less than a year.
“This is a compounding reason why things aren’t going well,” Simidchiev said. “During times of political instability, people tend to be very populist, going with the flow of fake news.”
The instability has made even the most basic logistics of government more challenging. The Ministry of Health, which oversees the vaccine drive, has only about $6,000 available for an immunization information campaign. Before parliament was disbanded, Simidchiev proposed expanding the budget to nearly $6 million, but the measure was voted down.
“What we’re left with now is there’s no central campaign to speak of,” he said.
In its place, falsehoods have continued to flourish, bringing even more pain to those who have lost friends and relatives to the virus.
Luba Kassova’s father, Georgi Kassov, returned to Bulgaria last year, after spending the beginning of the pandemic under a strict lockdown in Britain. Kassova didn’t want him to go home — she knew the health care there would not be as good — but the isolation in the U.K. had been difficult for him, an 85-year-old former diplomat, to manage.
When Bulgaria began administering its first vaccine doses, Kassova tried from afar to get her father a shot, but because the government prioritized health professionals and other front-line workers, he was not yet eligible. Then, in late February, authorities scrapped the priority list altogether, leading to more competition for vaccinations and making the jabs hard for elderly people to access.
In April, the month Kassova — a healthy woman in her 40s — was able to get vaccinated in London, Kassov contracted covid-19 and died.
“It was so unfair,” Kassova said. “I felt very helpless.”
Then came the conspiracy theorists, who told Kassova that her father couldn’t have died of covid-19 because the virus is fake, or that he “would’ve died anyway” because of his underlying conditions.
“That made me feel like someone was pulling the rug from under my feet and I was falling,” Kassova said. “It undermines my whole notion of reality and grieving for my dad.”
Preparing for another surge
Lozenetz University Hospital in Sofia is one of the best-equipped medical facilities in Bulgaria, but even there, staff struggled to deal with the influx of virus patients during the winter peak.
“I can never forget this: At some point, the mortality rate was so high that we didn’t have enough bags for all the dead bodies,” said Milena Peruhova, a gastroenterologist at the hospital.
Peruhova and her colleague Petar Iliev, a cardiologist, were two of many doctors reassigned to Lozenetz’s four-floor covid-19 unit, and during the worst of the surge, they watched the virus sicken their co-workers and kill at least one. Like health workers around the world, they became exhausted. The facility lost roughly 10 percent of its covid-19 patients from October to April, they said, a staggering mortality rate that was likely higher in hospitals with fewer resources.
“We start talking about patients in the context of prognosis,” Iliev said. “‘This is Ivan and he’s not going to make — probably not going to make it, going to make it.’ That’s how we envision the patients. We’ve seen so many.”
Last weekend, the covid-19 ward was about half full. But the doctors are girding for another upswing that will match or top last year’s winter wave, with the virus likely to tear through the substantial swaths of unvaccinated residents.
The doctors say their country’s leaders need to set and promote ambitious vaccination goals, like in the United States and France.
“Politicians are adapting to public opinion,” Peruhova said. “Public health and people’s lives are not prioritized.”
Bulgaria’s caretaker health minister, Stoycho Katsarov, has recently been among the government’s most vocal proponents of vaccination, calling inoculations “the most effective means of avoiding severe coronavirus and death” and condemning an anti-vaccine group that harassed medical staff at a vaccine clinic.
The country has a mask mandate in place, but many ignore it, and in early September the government imposed tighter restrictions on restaurants and night clubs, leading to protests in several cities.
“The low vaccination rate forces us to impose these measures,” Katsarov said.
‘They tell me I’m crazy'
In rural areas such as Krushovitsa, the skepticism is entrenched.
At the Sunday market, vendors and patrons eyed the mobile vaccination clinic warily, telling Post journalists they didn’t trust coronavirus vaccines and doubted the severity of covid-19, which has so far killed at least 20,000 Bulgarians and infected at least 480,000.
“I won’t get vaccinated, because I think all of that with the covid is propaganda,” said Martin Petrov, a 22-year-old strolling through the market with a friend. “They’re just using it to scare people. I’m pretty sure it’s not as bad as they show it.”
The only way he’d get the shot, he said, was if he were forced to before traveling abroad.
Kapka Georgieva, a member of the country’s Roma minority — who overall are even less willing to be vaccinated — recently received the Johnson & Johnson shot. Her unvaccinated friends and neighbors told her it might cause her to lose a leg, or her life.
Georgieva was so anxious about side effects she might still encounter that she left the post where she was selling clothes and knickknacks at the market to seek assurance from the vaccine clinic staffers.
“The people in my community don’t want to get vaccinated,” she said. “They are afraid and hearing on television and other sources that they might die. There is panic. I can’t convince anyone to get the vaccine. They tell me I’m crazy for doing it.”
At the mobile vaccine unit, the staff are hoping for more people like Georgieva, who are willing to resist immense social pressure. But they know it will be a long road.
“I am mostly concerned that in the rural communities not everyone understands the need to get themselves vaccinated,” said Albena Dimitrova, a nurse with the unit. “People are still hesitant and the rates are low. The goal is to build a collective immunity so we can overcome this pandemic together and live a normal life.”
Boyan Ivanov has driven the clinic’s van of vaccine supplies more than 3,000 kilometers in three months, going from village to village to deliver the lifesaving doses.
“I am proud of my job,” he said. “In short, I’m fighting against the anti-vaxxer campaign.”
On that day, the anti-vaxxers still seemed to be winning. The unvaccinated likely far outnumbered the immunized at the Krushovitsa market. But the clinic will be back, each weekend, to try again.
Peter Georgiev contributed to this report.