Despite being one of the European Union's poorest countries, Romania started its coronavirus vaccination campaign faster and stronger than its richer neighbours.
In the first months of the year, it regularly featured among the bloc's top three nations in terms of the percentage of the population that received at least one vaccine dose.
Since launching its inoculation drive in late December, Romania has injected over 8 million vaccine doses to its population of more than 19 million.
But in recent weeks, the number of administered daily vaccine doses in the eastern European nation has declined.
"The situation is quite worrying," said political analyst Costin Ciobanu, noting that only about 17,000 people got vaccinated with a first dose on Monday and 32,000 with a second one.
By early June, only about 25% of the eligible population (4.4 million people) had received at least one shot, placing Romania at the bottom of the EU's ranking, with only Bulgaria faring worse. About 20% of the population, making up 3.8 million people, have so far been fully inoculated.
"Nobody knows precisely why but we hit a ceiling very early in the game," said Sorin Ionita, a policy analyst at Expert Forum, a think tank.
"At this time, most people who are convinced by the vaccination benefits have already been vaccinated," said Valeriu Gheorghita, head of Romania's national COVID-19 vaccination campaign in a written statement sent to Euronews.
Why did Romania's vaccination campaign slip from its early success to the current hurdles? And how can it reach out to the hesitant segments of its population?
Euronews explores the reasons behind the vaccine slowdown in a country where the pandemic has claimed more than 30,000 lives.
Starting at 'full speed'
Romania's vaccination campaign started at "full speed" Ionita told Euronews.
In the initial months, the dominant narrative in the country was about prioritisation and people trying to skip the line.
"It seemed like a lot of people wanted to get the vaccine and then they couldn't get it quicker. And at some point, the balance tipped, it was probably around early April when they opened it up for the whole population."
For about two weeks after registrations opened to the general public, "people were falling over themselves to actually get registered on the platform and even travel long distances in Romania to get the vaccine, because in Bucharest the lists were full very quickly," Ionita said.
"Then we hit this 20% rate of vaccination and everything stopped."
Ionita also nuanced this figure, noting that "the Romanian government prioritised full vaccination," over massively injecting first doses. The rate of people who are fully vaccinated in Romania remains in line with the current EU average of 21%.
The country heavily relied on its military and intelligence services to set up quickly the infrastructure needed to roll out the coronavirus shots throughout the country.
"Romania has probably one of the most militarised vaccine campaigns," Ionita told Euronews, noting that the online platform used for vaccine registration is "administered by one of our numerous intelligence services, the Special Transmission Service."
A 'high tech' campaign in a rural country
Catalin Augustin Stoica, an associate professor of sociology at the National University of Political Studies and Public Administration (SNSPA), told Euronews that this government website where people can register to get their jabs was a pillar of the country's vaccination strategy.
"The problem is that Romania has the largest percentage of people leaving in rural areas in the EU, so it's around 44%. To this figure, we should add 10% of people who live in small cities, which are practically semi-rural settlements," the expert said.
"Rural areas and small cities have huge infrastructural problems, they don't have access to running water, they don't have access to medical services, internet use and access is also a problem. So it was kind of weird that the powers that be thought of a high-tech solution to get people vaccinated in rural areas," Stoica said. "We're talking about an ageing population. People don't have access or don't know how to use the internet."
"Plus, there are not enough vaccination centres in rural areas, that's a fact," Stoica added.
Ionita emphasised the need to take into account the diversity of Romania's rural population. "People living in rural settlements are not all the same and there is no 'Romanian Village', so to speak. Villages are very different." He noted that some of them had become suburban areas with middle-class workers commuting daily to town. "Actually, the highest rates of vaccination are in some rural settlements," Ionita added.
"And then you have traditional villages with physical, geographical isolation and elderly people (...) so you reach out to them in very different ways. And the government was a bit unprepared to do that. They just put out campaigns on TV, targeting everybody with the same message," Ionita told Euronews.
Lack of infrastructure and personnel
The lack of medical infrastructure and personnel, especially in rural areas, has plagued the country's vaccination campaign, Stoica told Euronews.
Romania’s health care system ranks as the EU’s worst, according to the latest Euro Health Consumer Index. The country only spends about 5.6% of its GDP on health, according to the World Bank, which is the lowest rate in the bloc.
The country's medical system has also suffered from the emigration of skilled workers. After Romania joined the bloc in 2007, thousands of doctors left the country in search of jobs with better pay in other European nations. According to the European Commission, over 85,000 medical doctors trained in Romania had their qualifications recognised in other EU countries between 2007 and 2020.
Two deadly hospital fires in COVID-19 units in recent months shed light on the critical state of the country's health infrastructure. At least five people died when a fire broke out in a Bucharest hospital in January, while another 10 patients were killed in a separate blaze in a Piatra Neamt hospital in November last year, reportedly due to electric problems.
Political management and transparency issues
"Problems that are related to the poor infrastructure were amplified by the Romanian state's low administrative capacity to handle the critical situation," Stoica told Euronews. "Practically, independent experts and academics have been largely ignored by those who have overseen this campaign," the professor said.
But according to Ionita, the country's vaccination campaign, with the military in charge, "didn't use much the public administration, including the healthcare sector. So the ministry of health doesn't have much attribution."
The country has had no less than four different ministers of health since the pandemic began.
In the latest episode, Vlad Voiculescu was fired from his role as health minister in April after reportedly changing the government's criteria on whether to impose virus-control restrictions on local areas without informing the prime minister.
One factor in the sacking, according to Ionita, was because Voiculescu "crossed the military guys." "It was a very bizarre episode anyway, which tells you who calls the shots," the expert said.
Another issue was that "politicians were too present" in promoting the country's vaccination campaign, said Ciobanu. "And as we know, it is not only the case of Romania but also in other countries, politicians are not really trusted by the population. So you need more key opinion leaders that have the trust of the population to get involved. And this has happened in the last couple of months, but probably not enough to overcome this barrier of mistrust that exists in the Romanian population," the expert told Euronews.
While the intention to get vaccinated in the EU is on average at 64% of the population, the rate is lower in Romania at 59%, according to a recent Eurofound survey.
"Sociological data have shown that in Romania, at the beginning of the vaccination campaign, the intention of the population to get vaccinated was around 31-35% and it has progressively increased to over 50%, along with the progress of the vaccination campaign. However, one-third of the population is estimated to still be hesitant and the rest of the population is against it," said Gheorghita.
The military doctor who leads Romania's national inoculation campaign noted that the hectic rollout of the AstraZeneca vaccine did not help to build trust in the Romanian population.
"The safety signal triggered by AstraZeneca had a major impact on the vaccination campaign, as it has considerably reduced the population's trust in the safety of using this vaccine in particular and somehow this affected the credibility of the other approved vaccines," Gheorghita told Euronews.
"In addition, the lack of a unitary approach in EU member states regarding the indication of the usage for AstraZeneca vaccine, by establishing different age limits as precaution measures, have increased the mistrust in public health policies," he added.
Stoica told Euronews that the mass media was sending "mixed messages" about coronavirus vaccination, fueling vaccine hesitancy in the country.
"There are some influential TV news channels which on a daily basis promote on their talk shows various public figures such as actors, actresses, singers, even medical doctors who embrace conspiracy theories about COVID or vaccination."
"What is strange is that during the commercial breaks, the same TV networks broadcast the pro-vaccine messages paid for by the Romanian government. So people are confused by this double talk," Stoica told Euronews.
The expert also pointed the role of the Romanian Orthodox Church in a country where religious authorities are still highly influential.
"According to the last census, which was more than 10 years ago, about 92% or so of Romania's population declared itself religious. Out of that 92%, 86% are Orthodox but the Romanian Orthodox Church wasn't fairly supportive of the vaccination campaign. Actually, some of its bishops and influential priests have sent mixed messages, questioning the reality of the pandemic and the need to get vaccinated," the professor told Euronews.
Like in other parts of the world, social media has also played a role in disseminating conspiracy theories about COVID-19 vaccination.
"You have a certain kind of permeability of the population to fake news and disinformation campaign wise. What is striking is that more than half of the Romanian population believes that the virus was created in a lab," Ciobanu noted, adding that the country had a strong anti-vaccination movement even before the pandemic.
"Misinformation and fake news have had a higher negative impact in rural areas, probably due to several factors, such as poor education, low social and economic status and poverty, thus the low trust in the benefits of vaccination," Gheorghita told Euronews.
Bridging the gaps
In light of the current hurdles, the government has revised its vaccination ambitions downwards. The government initially wanted to have 5 million people vaccinated by June 1 but it has missed that target.
Prime Minister Florin Citu last spring foresaw 10 million vaccinations by September 1. The government is now hoping to have 7 million inoculated by August.
To achieve that goal, authorities are boosting their vaccination logistics, especially in rural areas.
"The planning concept is based on the idea of bringing the vaccine as close as possible to the end-user, so we developed the following concepts: vaccination in the general practitioner's cabinet; door to door vaccination teams; marathon vaccination events organised in public locations that meet all sanitary criteria; deploying mobile vaccination centres in areas that have no medical personnel, nor appropriate spaces for the vaccination process," Gheorghita told Euronews.
Vaccination is also offered to staff in private companies, drive-through centres, airports and terrestrial border crossing points, the official said.
Romanians can even get their jabs at Dracula’s castle in Transylvania without an appointment.
Authorities are furthermore sharpening their communication strategy.
"Communication measures have been taken, based on feelings, such as what we all missed, especially on a personal level during the COVID- 19 pandemic, 'l miss together' and what the vaccine contains for each and everyone of us: it might be a hug, a family get-together, a trip, a vacation with friends, etc," Gheorghita said.
"We also tried to get the local authorities involved in the vaccination process, as well as important community vectors, such as mayors, doctors, priests, teachers, etc."
Whether the measures will be enough to get the vaccination campaign back on track, however, is another story.
"I think it will be very hard to get 7 million people vaccinated by August 1 or 10 million people by September. But maybe the government will surprise us and come up with better communication tools," said Ciobanu.
"Seven million vaccinated by August is science-fiction. We won't be able to do it," Stoica told Euronews.
Among other measures, the expert thought that it would help to condition the relaxation of rules to vaccination, "involve experts to try to combat the conspiratorial views on these issues" and "obviously, allocate more money to do this. It's also a matter of money."
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