The COVID-19 vaccination in Bulgaria is an immunization campaign currently taking place against SARS-CoV-2, the virus that is the cause of the COVID-19 disease. It began on 27 December 2020, in line with most other countries in the EU, and is in response to the ongoing pandemic in Bulgaria. The vaccination drive was affected by organizational and supply-related issues during the initial months while since the spring of 2021 vaccine hesitancy has contributed significantly to the country having the lowest rate of inoculations in the EU, with 35% of Bulgaria's adult citizens, and 30% of its eligible population, fully vaccinated by May 2022.
Background After being one of the first countries in Europe to enter a lockdown, which came into effect on 13 March 2020, five days after the first case was confirmed and when there were 23 people with positive tests, Bulgaria had mostly cluster-based transmission and a relatively low rate of infection compared to many other sovereign states on the continent up until mid June 2020 (when the vast majority of restrictions were lifted), managing to a large extent to be spared from a first wave, with the timely lockdown saving 15,000 to 19,000 lives according to one assessment. However, it was heavily affected during the autumn months, over the course of which the health system came under severe strain, reaching a state of near collapse, resulting in a very high death toll per capita, especially for the month of November and early December 2020.
The authorities' handling of the pandemic has been criticized for insufficient levels of testing for the virus, the nature of the policies in relation to the quarantining of foreign arrivals and the lax enforcement, especially outside the capital city, an absence of an adequate exit strategy after the first lockdown, contributing to rather loose general measures against the spread of the virus during the summer of 2020, poor preparedness of the country's health system for the second wave of the pandemic, contradictory and inconsistent messaging, downplaying the gravity of the epidemiological situation as well as not following some of the recommendations of health experts due to concerns that the imposition of tight measures, purportedly not resonating with the wishes of most of the population, could pile on public pressure on the government, which faced political protests from July 2020 to April 2021. Medical professionals and politicians have expressed the view that the second partial lockdown that entered into force just before midnight of 28 November 2020 should have come earlier, at least three to four weeks before it was imposed and with stricter restrictions. Infection rates soared during March 2021, approaching the autumn levels and causing an even sharper rise in hospitalizations than in the preceding months, which prompted the government to impose a third lockdown from 22 to 31 March, though this once again garnered criticism for being a reactive measure that was long overdue and followed the almost complete reopening of the economy in the previous weeks, with medical professionals expressing concerns that its length was insufficient. Prime Minister Boyko Borisov has been accused of populism, with some analysts drawing comparisons with Donald Trump's approach to the pandemic, by prioritizing the interests of lobbies in the entertainment business and hospitality industries over those of health care establishments as well as allowing political considerations relating to the spring elections to influence the nature of the policy decisions. Some of the lockdown-related measures implemented during the spring of 2020, such as the closures of public parks, have been subject to criticism due to being regarded as overly harsh in terms of the fines levied and not being justifiable on epidemiological grounds, as well as reflective of what some sources have denounced as a panic-inducing general approach of the authorities in the early stages of the pandemic.
The caretaker government's policies in relation to the pandemic have invited disapproval due to being plagued by many of the same shortcomings as the ones implemented by Borisov's administration with some analysts characterizing its performance as worse than that of its predecessor government, in part for not implementing sufficiently strict measures and not attaching enough priority to the prioritization and popularization of the vaccination campaign, which has been a major contributing factor to the very serious fourth pandemic wave experienced in the autumn of 2021 that saw health systems struggling to deal with the patient flow as early as October 2021, Bulgaria activating the EU civil protection mechanism, requesting medical supplies and equipment, and the country being included by the European Centre for Disease Control among the 10 EU states facing a COVID-19 situation of "very high concern".
The Petkov government has also attracted multiple criticisms, especially due to what has been regarded as a failure to boost support for the vaccination campaign.
Molecular biologist Georgi Marinov from Stanford University, a proponent of the COVID-Zero strategy who has characterized "living with COVID" as having blurred the distinction between developed and developing countries, with the former's tolerant attitude to the virus causing them to descend into Third World status from an epidemiological standpoint, and is supportive of the Chinese approach (in place until December 2022) of tight border controls, strict lockdowns and contact tracing, has expressed a belief that since May 2020 the governing bodies in Bulgaria have essentially abdicated from controlling the pandemic, also cautioning that while vaccination is quite important, it should not be an excuse for the premature abolishment of non-pharmaceutical interventions, as such a course of action would be morally impermissible due to inevitably leading to preventable deaths, including among the fully vaccinated. In a December 2021 interview, former COVID-19 taskforce head Ventsislav Mutafchiyski confirmed that Bulgaria had subscribed to a COVID-Zero philosophy until 13 May 2020 when the state of national emergency was lifted. From 1 April 2022, based on a prior decision of the Council of Ministers of Bulgaria, almost all non-pharmaceutical interventions such as capacity limits and mask mandates were abolished. From 17 November 2022, all compulsory public health measures related to COVID-19 were removed.
Mathematician Lachezar Tomov has pointed out that the outcome in Bulgaria may have been worse if the levels of travel within the country and the inter-connectedness of its regions were comparable to those of Western European countries such as the United Kingdom.
In November 2021, cardiologist Ivo Petrov characterized Bulgaria as an extremely negative example in the handling of the COVID-19 crisis and as being part of an experiment, in which it is the control group representing the unvaccinated in comparison to the developed countries, pleading with the people to get themselves vaccinated in order to turn the tide in the demographic catastrophe. The mortality rate from COVID-19 in the country has been significantly above the EU average and among the highest in the world, with substantial excess deaths for the years 2020 and 2021.
According to the COVID-19 Stringency Index, the country reached a peak of 73.15 (out of 100) during the first lockdown, with the second one being the least strict (having an apogee of 57.41) while the third one saw 61.11 as the highest value.
The Lowy Institute ranked Bulgaria 67th out of 98 countries in terms of its performance in tackling COVID-19, awarding it a score of 37.4 (the maximum being 100) on 9 January 2021. On 13 March 2021, in a second Lowy Institute assessment, Bulgaria had retained the 67th spot (this time out of 102 countries), accumulating 38.2 points.
In the early months of the pandemic, there was speculation that the BCG vaccine, of which the country is a major producer and which has been part of the mandatory vaccination package for newborns in Bulgaria since 1951, offers some degree of protection against COVID-19, with studies in the Netherlands suggesting that it serves as a powerful immune stimulator. However, this has not been corroborated by most scientific sources and the WHO maintains that there is so far a lack of evidence that the vaccine demonstrates effectiveness against COVID-19.
Even though two thirds of Bulgarian citizens reported being in good health in the years prior to the pandemic, which was only slightly below the EU average, the overall health status of the population has been characterized as being of high concern due to factors connected to lifestyle choices and a tendency for many people to neglect their annual medical check-ups.
Bulgaria had been one of the countries in Europe the most strongly affected by the 1918 influenza pandemic, losing approximately 2% of its then population to the virus.
In January 2006, a National Pandemic Preparedness Plan was approved, which had a particular focus on a future outbreak of a flu pandemic. In December 2020, Kostadin Angelov, the then Health Minister, stated that the document in question had been updated to reflect the new realities. However, some figures from the medical community claim that the plan was virtually forgotten and never consulted by the authorities when deciding on their response to COVID-19.
Vaccines
Pre-orders of vaccines and procedural matters European Union vaccine negotiations Bulgaria eventually agreed to purchase all seven vaccines included in the European portfolio - Moderna, Pfizer-BioNTech, Oxford–AstraZeneca, Sanofi, CureVac, Novavax, and Janssen, even though it had some reservations regarding its participation in the contract with Janssen Pharmaceutica. On 14 October 2020 Bulgaria explicitly refused to pre-order the latter's vaccine candidate as part of the EU-wide deal, but reversed course in November and ratified a separate agreement for 2 million doses in December, aided by Sweden's cooperation, with the change of heart partly attributed to concerns pertaining to the progress made by Oxford-AstraZeneca at the time. Some Bulgarian experts reportedly considered the European vaccine portfolio to be overly diverse. After major delays due to trial issues of Sanofi and GlaxoSmithKline's vaccine candidate, for 2021 the country was in the initial months mostly reliant on the Oxford–AstraZeneca COVID-19 vaccine, expecting to receive enough doses for vaccinating 2.5 million citizens. After at first ordering 1 million doses from Pfizer-BioNTech, on 13 January 2021 when the European Commission announced that it had concluded an agreement for extra 300 million doses with this vaccine producer, Bulgaria requested additional 2.9 million Pfizer-BioNTech vaccines, with a later agreement resulting in the quantity of pre-ordered doses of this vaccine for 2021 rising to 5.4 million.
In total, the amount of vaccine pre-ordered or set to be ordered by the country is expected to be equivalent to 18 million doses, able to cover 9 million citizens.
In May 2021, Bulgaria made a pre-order for 14 million Pfizer vaccine doses for 2022 and 2023, with 8,354,768 expected for the latter year.
In August 2021, it was revealed that Bulgaria had pre-ordered a new type of attenuated vaccine, developed by Valneva Austria. In September 2021, it was confirmed that Bulgaria will buy only 10,000 out of the pre-arranged doses from the one-shot Sanofi Pasteur SA/Glaxosmithkline Biologicals SA vaccine, which are to be delivered in 2022.
In August 2023, it was confirmed that Bulgaria will receive 1,3 million doses from the adapted Pfizer-BioNTech vaccine, which targets the XBB.1.5 Omicron variant.
Vaccine availability issues, further deals and new approach to the ordering of vaccines