Why do Bulgarians refuse to get the Covid vaccine?

One in five responses is linked to misinformation or conspiracy theories - that the vaccine could harm reproductive functions, that it was a manipulation by politicians and pharmaceutical companies, or a global conspiracy to control the population through "chipping" - inserting a microchip that would somehow put individuals under surveillance or control by unknown entities. About 10 percent believe the vaccine does not protect against infection, more than 6 percent say they have a disease that prevents them from getting vaccinated, and another 2.6 percent cite their General Practitioner's (GPs) advice as a reason not to get immunized.

These answers reveal a variety of problems

Objective information about the safety, effectiveness and benefits of vaccines - including for those who have already had them - has clearly either not reached the public, or filtered through in a convincing way.

Misinformation is widespread and has affected at least 20 percent of the population.

GPs are in some cases hindering rather than helping immunization. Although fewer than 3 percent of respondents indicated that they had been advised by their GP not to vaccinate, this phenomenon appears to be more widespread in reality than these figures suggest. It is much discussed in social media groups, and is also commented on by experts as an unacceptable but highly prevalent practice.

The proportion of those citing a chronic illness as a reason for not vaccinating is also too big to be taken at face value. This also points to their doctors' ignorance and general passivity. Very few conditions can be adversely affected by the Covid-19 jab, the exceptions being severe allergies and a very rare type of thrombosis.

More than 7 percent of respondents shared the classic anti-vaccine postulate: it is better to get the disease than a vaccine.

What is the profile of the anti-vaxxer?

According to a Eurobarometer survey from the end of August, the typical "anti-vaxxer" in Bulgaria is usually a young, urban-based woman aged between 25 and 39, with secondary education and two children. Other surveys by Bulgarian agencies throughout the last year, however, show that the highest proportion of vaccine opponents are young men in smaller towns, with primary or secondary education and relatively low income.

Both statements are probably true. A Europe-wide survey conducted in the summer paints the typical European profile of a vaccine sceptic according to several arbiters - education, age, income, occupation and information habits. It found that the most negative attitudes towards vaccines were among the unemployed, housewives, small town dwellers and, especially, people who derive their information mainly from social media.

All this clearly shows the correlations between vaccine scepticism and, generally speaking, low income.

Hence it will be quite a challenge to convince poorer Bulgarians to vaccinate. Yet there is no alternative to vaccinations because this is the only sustainable solution to the health crisis. Without mass vaccinations, Bulgaria will drift from crisis to crisis, risk tens of thousands more deaths, continue to see its health system overloaded for months on end, and businesses will sustain massive losses. And hopes of "collective immunity" will be continually dashed despite the human tragedies and high costs wrought by each wave.

Bulgaria remains prone to new infection surges

Regional data on the number of administered vaccines, Covid-"recoverees", and deaths across the country reveal substantial inter-regional differences, but strongly suggest that no region is close to collective immunity. Nor are there any groups in society that we can assume are protected, except doctors - to a certain extent.

Unsurprisingly, the share of vaccinated people is the highest in Sofia - almost 32 percent, while in Montana it is only 14 percent. The highest share of people who have had the shot is in the age groups between 60 and 80 years (35 percent) - these are also the most vulnerable to severe disease and the ones likely to fill hospitals. But this level is nearly three times lower than the European average for these age groups. Vaccination rates for under-18s lag at 1 percent, compared to an EU average of over 16 percent. Only 40 percent of teachers are immunized, despite schools being one of the biggest spreaders of the infection. Only doctors have managed to achieve a 70 percent immunization rate, and the rest of the medical staff stands at about 50 percent.

Data on the number of recovered Covid patients also varies widely across regions. The highest percentage of infected people is registered in Sofia - almost 12 percent, and the lowest is in Kardzhali - fewer than 4 percent. Clearly, these differences are not objective. In large cities, where there are more laboratories and the population is better educated, the proportion of cases is higher simply because people bother to get tested. Meanwhile, in poorer and economically more backward regions, there is a significantly higher hidden incidence. Thus, the higher prevalence rate in Sofia should be seen as a more realistic representation than that of Kardzhali.

Information on Covid-19 fatalities in each district completes the picture. In Sofia-city, where treatment options are best, the casualties amount to about 2 percent of registered cases, the same as the European average. At the other extreme is Smolyan with a 7 percent mortality rate. The national average mortality rate stands at about 5 percent of those officially infected. Thus, to judge from the high proportion of deaths, the number of cases in many districts is underestimated by a factor of two or three and in some places the share of people who contracted the disease and recovered could be as high as 16-18 percent.

Even so, the number of people who recovered and/or got vaccinated is unlikely to exceed half of the population in any region of the country, and so at least half the population remains vulnerable to the disease - enough for several more Covid-waves.