COVID-19 vaccination in Romania
COVID-19 vaccination in Romania started on 27 December 2020. It was announced that the process would be divided into three phases. Medical personnel would be vaccinated first (first phase), followed by the population at risk (second phase), and finally by the rest of the population (third phase).[2] Vaccination was declared free and non-mandatory.[2] As of March 2022, five types of vaccines (Pfizer/BioNTech, Moderna, Oxford/AstraZeneca, Janssen and Novavax) were authorized to be used in Romania.[3] This is the largest vaccination campaign in the modern history of Romania.[4]
Date
27 December 2020–present
Nationwide
Former PNL Prime Minister and self-appointed coordinator of the vaccination campaign Florin Cîțu aimed to have 10.4 million people (or 70% of the country's population) vaccinated by the end of September 2021.[5] However, by the end of September 2021, Romania had the second lowest vaccination rate in the European Union, 33%, just before Bulgaria,[6] and sold part of its expiring vaccine stock to Denmark,[7] Ireland,[8] and South Korea.[9] The low vaccination rate had exposed entrenched distrust in state institutions, misinformation campaigns, poor rural infrastructure, and weak vaccine education.[10][11]
Background[edit]
Responsibility for COVID-19 vaccine deployment[edit]
The National Coordinating Committee for COVID-19 Vaccination Activities (Romanian: Comitetul Național de Coordonare a Activităților privind Vaccinarea împotriva COVID-19; abbreviated CNCAV) is the inter-ministerial body responsible for developing the national vaccination strategy. It was established on 20 November 2020 by Prime Minister's decree and is under the direct subordination of the General Secretariat of the Government and the coordination of the Prime Minister.[12] The first president of the committee is Valeriu Gheorghiță, doctor at the Central Military Hospital in Bucharest.[13]
Romania heavily relied on its military and intelligence services to set up quickly the infrastructure needed to roll out the shots throughout the country. The Romanian Army and structures from the Ministry of Interior are involved in the distribution and transport of vaccines.[14] The online platform used for vaccine registration is also administered by an agency with military status, the Special Telecommunication Service.[11]
Vaccines on order[edit]
Romania has ordered 120 million doses of vaccine or 7.5 doses for each person who can be vaccinated.[15] As of 10 February 2022, it received 31.8 million doses, of which it used only about 16 million.[16] Amid disinterest in vaccination, Romania sold or donated almost 5 million doses to countries such as Argentina,[17] Denmark,[17] Egypt,[18] Ireland,[19] Moldova,[17] Serbia,[17] South Korea,[20] and Ukraine.[17]
Vaccination centers[edit]
Before the official start of the vaccination campaign, the Ministry of Health identified 899 vaccination centers throughout the country: 302 in health units for the immunization of medical staff and 597 in other spaces for phases II and III.[85] 583 of them were operational by 30 January 2021.[86] As of 9 March 2021, before the start of the largest phase of the vaccination campaign, 678 vaccination centers with 990 flows were active in the country; according to Valeriu Gheorghiță, the total number of vaccination centers would be 1,137.[87] Vaccination centers have a fairly good distribution in the national territory of Romania.[88]
Adverse reaction reporting[edit]
As of 4 February 2022, adverse reactions were reported in 19,918 vaccinated people (0.121% or 1.21 reactions at 1,000 doses administered).[89] Most of them were general reactions (fever, headache, myalgia, asthenia, urticaria, etc.).[89] Only six severe allergic reactions were reported as of 4 February 2022.[90] The median age of people who reported adverse reactions was 37; 63% of them were female.[91] By manufacturer, most adverse reactions have been reported in people vaccinated with Oxford/AstraZeneca (0.72% of the total number of doses administered), followed by Moderna (0.23%), Pfizer/BioNTech (0.08%) and Johnson & Johnson (0.06%).[90]
Between 21 December 2020 and 19 March 2021, CNCAV received five reports of death among people who received a COVID-19 vaccine.[92] However, the National Institute of Public Health (INSP) classified them as "coincidences", ruling out any direct link between vaccination and deaths.[93] Moreover, between 1 January and 14 March 2021, INSP recorded 89 deaths (a fatality rate of 0.002% of the people who completed the vaccination scheme)[94] among COVID-19-positive people who previously got vaccinated; 12 of them received both doses.[93]
Efficacy[edit]
According to the National Center for Surveillance and Control of Communicable Diseases, between 27 December 2020 and 30 September 2021, 28,929 people (or 0.52% of all people vaccinated with the first dose) tested positive for SARS-CoV-2 after being administered the first dose of vaccine.[98] The median time from the first dose to the date of confirmation was 14 days.[98] During the same period, 38,604 people (or 0.84% of all people vaccinated with both doses) became infected with SARS-CoV-2 after the second dose; most were asymptomatic or mild cases.[98] The median time from the second dose to the date of confirmation was 146 days.[98]
A preliminary analysis of the effectiveness of vaccination against COVID-19 in February–May 2021 showed that full-dose vaccination reduces the risk of death from COVID-19 by 14 times, the risk of hospitalization and ICU admission by 12 times and the risk of SARS-CoV-2 infection by 10 times.[99]
Opinion polls and vaccine hesitancy[edit]
Similar to neighboring countries, a significant portion of the Romanian population is reluctant to get vaccinated. A recent study among Europeans aged 50+ showed that vaccine hesitant individuals are mainly adults aged 50–65 years, with lower education, and residing in Central and Eastern European countries.[100] The most commonly cited reasons are fear of adverse reactions and distrust of the vaccine's effectiveness.[101][102] In September 2020, before the launch of the first anti-COVID-19 vaccine, only 29% of Romanians in urban areas were determined to get vaccinated, but by February 2021, 51% of them said they intended to schedule a vaccination.[103] The vaccination intention was higher among men, people over 45, people with higher education and people with high incomes in urban areas.[102]
For a short time, in the first weeks of 2021, Romania was among the most vaccinated countries of EU. But Romania was also the first EU country to open the vaccination campaign towards the general population over 18 years and the public was immediately bombarded with some highly mediatised cases of young or middle-aged people that unexpectedly died after vaccination. Among them the most notorious cases were those of the young wife of a handball player from Dinamo Bucharest and the case of Bogdan Berki, a young student (both cases registered in May 2021).[104] Such early unfortunate events, and many other, were instrumental in establishing a highly distrust in vaccines among the general public, despite the fact that the authorities always denied any link between such unfortunate events and the vaccines. Beside that, the coming of Omicron and the very mild Omicron waves during the winter of 2021-2022 (much milder than in the Western European countries that sported very high rates of vaccination) blocked once for all any intention regarding the vaccination and the vaccination rates abysmally plummeted by the month of March 2022.
The studies on correlation between religiosity and vaccine hesitancy are vast.[105] On October 19, 2022, a paper appeared in the scientific journal Vaccines analyzing the correlation of prayer frequency and COVID-19 vaccine hesitancy among older adults in Europe.[106] Though analyzing religion and spirituality is difficult, by analyzing how often people pray (prayer frequency) the authors found that "daily praying, as compared to praying 'weekly or less' or never, was mostly reported among those being vaccine-hesitant, being female, having a lower educational level, not having a partner in their household, having lower wealth, or having three diseases or more". It is a known fact that Romania is one of the most religious country in Europe, as 84% of the population considering that religion is important for them.[107]
The authors speculate that "people may be vaccine-hesitant because they believe that God will protect them (restful religious), or because they fear both the COVID-19 disease and the vaccine (crisis religious)". However, the authors also say that more studies are needed that include the role of trust in the government and in science, as those factor also strongly correlate with vaccine hesitancy. Though vaccine hesitancy appears to be stronger in central and eastern Europe compared to other European regions, it is present and positively correlated with religiosity all around the world, not just the regions analyzed, as other studies have found.[106]
Some people believe that the anti-vaccine movement is closer to the Orthodox Church, linking the people who manifest against vaccines to divine inspiration and grace. In November 2021, Suceava County had the lowest vaccination rate in the country, and the doctor who managed the county's main hospital reported religious influence against vaccination. "Very few [priests] are pro-vaccine, and I definitely know some who are anti-vax," the doctor said. In some cases, a person's "priest, or their pastor, has advised them to not get vaccinated, just like that."[108] One priest, during the religious service, recommended that parishioners not to be vaccinated because their tails or scales would grow, referring to the genetic changes that, he believes, are produced by the vaccine.[109] However, other priests and high-profile clergy had been actively promoting the vaccines. One of them, Gurie, the bishop of Deva, even died of Covid in October 2021 despite being vaccinated against it since the beginner of the summer.[110]
On February 9, 2022, a paper appeared on the scientific journal Vaccines describing the refusal of vaccination against COVID-19 in Romania as it was measurable in November 2021.[111] The analysis revealed that, although 81% of the respondents to the survey trust the mandatory vaccines under the national scheme and 94.9% of them are jabbed with the aforementioned vaccines, a large portion of them distrust the COVID-19 vaccines and showed a high degree of susceptibility to conspiracy theories. This "fear of the vaccine" is determined by conspiracy theories, lack of medical education and fear of novelty. Main reasons invoked by people arguing the non-vaccination decision are general distrust of COVID-19 vaccines (16%), the belief that these vaccines are an experiment (12.6%) and immediate side effect (8.1%). The percentages were higher in the rural environment. In addition, 74% of the respondents do not trust the medical system and 34.7% do not trust in doctors. Most worryingly, 47% of the participants believe there is a world occult organisation that controls the world and wants to reduce the population of the Earth (44.1%). From these percentages, it follows that almost 30% of the total population of Romania believes in a conspiracy scenario. In addition, 49.8% consider that vaccination does not want to eradicate COVID-19, 40.9% believe that COVID-19 vaccines lead to infertility or death, 38.1% say the vaccines were created to reduce the aging population, 34.4% question the existence of the COVID-19 pandemic, 33.2% believe that doctors are paid to inoculate a vaccine that would help reduce Earth's population, and 13% believe in the conspiracy theory that the vaccines are intended to implant a microchip in one's body.
Almost half of those who refuse to be vaccinated consider themselves a kind of heroic apostle of the human race fighting for its purity with a powerful, unnamed manipulative occult organisation, enriched by the sale to vaccines that will lead to genetic modifications of the species. The lack of an elementary medical culture of the people and a lack of a state-led vaccination campaign lead to such a scenario that creates a conspiratorial world to which more and more people adhere.[111]
The study also indicates that mistrust is more likely to be directed towards the new mRNA-based types of vaccine, showing that the reluctant people who finally got vaccinated opted for one of the "classical" vaccines (Oxford–AstraZeneca or Janssen).[111]