Vaccine Refusal, Floods Impact Polio Drive in Pakistan

By Ashfaq Yusufzai

PESHAWAR, Nov 29 2022 (IPS) - Vaccine refusal is impacting the eradication of polio in Pakistan.

Pakistan has vaccinated about 35 million children during its door-to-door campaign, but about 500,000 remained unvaccinated due to refusal by their parents, Jawad Khan Polio officer in Khyber Pakhtunkhwa, recorded in 2022 so far.

Khyber Pakhtunkhwa, one of Pakistan’s four provinces, has reported all 20 polio cases. North Waziristan has detected 17 infections, Lakki Marwat 2 and South Waziristan 1.

Khan says that hesitancy against vaccination is not a new trend, as Pakistan has been facing this problem since the start of the polio-eradication campaign in the 90s.

Of the 17 cases reported in militancy-riddled North Waziristan, 12 were not vaccinated, while five were partially immunized.

Muhammad Shah, whose son was diagnosed with the polio virus in August, told IPS that he had been opposing vaccination because this wasn’t allowed in Islam.

“Our religion Islam says that no medication is permissible before the occurrence of any ailment; therefore, our people defy vaccination to fulfill their religious obligations,” he said. Shah, a religious preacher, says his son will soon recover from the paralysis.

He says he was unrepentant in refusing vaccination of his child and would continue to thwart efforts by vaccinators to inoculate the toddler.

North Waziristan district, located near Afghanistan’s border, has many militants who staunchly oppose vaccination.

“It was the hub of the polio virus till 2014 when militants ruled the area illegitimately as there was a complete ban on all sorts of immunization. The Taliban militants were evicted through a military operation in 2014, and parents started vaccinating their kids,” Sajjad Ahmed, a senior health worker, said.

According to him, polio vaccinations have decreased with the emergence of militancy in the area.

“In the last three months, three persons, including two policemen and one health worker, have been killed by unknown assailants during a polio drive in North Waziristan,” he said.

People are afraid to take part in the campaign due to fear of reprisals by Taliban militants, he said.

Dr Rafiq Khan, associated with polio immunization in the region, told IPS that parents refuse vaccination, arguing that it was a US and Western plot to render recipients impotent and cut the population of Muslims – a baseless argument.

“Alleged Taliban have killed about 70 vaccinators and policemen since 2012. Government deploys 25,000 policemen in each three-day campaign to ensure the safety of workers,” he said.

Khan said that militants are pressuring the people against vaccination, due to which parents weren’t willing to administer jabs to their kids below five years.

“We are also facing fake finger marking of kids. As a standard procedure, our vaccinators mark the thumb of the vaccine recipients with indelible ink so that we know how many children have been immunized,” he said.

However, the parents ask the vaccinators to mark their kids’ fingers without vaccination, he said. In this way, parents deceive the government.

“Now, we have started convincing the parents through community elders and religious scholars to create demand for vaccination,” he said.

The government has enlisted the services of religious scholars to do away with refusals against poliomyelitis.

Maulana Amir Haq, a pro-vaccination cleric, told IPS that they had been holding awareness sessions with people telling them vaccination is allowed in Islam.

“It is the responsibility of the parents to safeguard their kids against diseases and vaccination aimed to prevent the crippling ailments. There, parents should fulfill their religious duty and inoculate their sons and daughters,” he said.

He said that laboratory reports confirm vaccines given to Pakistan’s children are safe and don’t contain any ingredient to sterilize the recipients. The situation is changing because we now reach hardcore refusal cases and vaccinate them.

Federal Health Minister Abdul Qadir Patel said that it is crucial to understand that the only protection from polio is vaccination, and parents should protect their children against disability through free immunization.

“We want to wipe out the virus and safeguard not only our own kids but all around the world,” he told IPS.

Polio will keep haunting us until we interrupt transmission, Federal Health Secretary Dr. Muhammad Fakhre Alam said.

On August 31, a 16-year-old boy was diagnosed positive for polio in Waziristan, which shows how robust Pakistan’s virus detection network is because it highlights that we can identify polio cases in children outside the usually expected age, he said.

National Emergency Operations Centre Coordinator for polio, Dr Shahzad Baig, expressed concerns about the spread of wild poliovirus as millions of people in the country are displaced by recent floods.

“The scale of the current calamity is absolutely devastating. As part of the polio program, our network of health workers is here to support in every way we can, but I am deeply concerned about the virus gaining a foothold as millions of people leave their homes and look for refuge elsewhere,” he said.

The province of Balochistan and parts of southern Punjab, and 23 districts of Sindh were unable to hold a vaccination drive as floods swept away homes and villages around the country. Despite the extreme climatic conditions, polio teams reached children in all accessible areas, he said.

Neighboring Afghanistan is facing the same problems; however, it has detected only two cases this year.

Source: Inter-Press Service (IPS).

Link: https://www.ipsnews.net/2022/11/vaccine-refusal-floods-impact-polio-drive-pakistan/.

Putin's COVID-19 vaccination to be kept out of public eye

March 23, 2021

MOSCOW (AP) — Russian President Vladimir Putin will be getting his first vaccination against COVID-19 on Tuesday, but out of sight of the cameras, his spokesman said, prompting questions about whether the gesture will boost comparatively low immunization rates in Russia.

Asked whether the Kremlin will release any photos or footage of Putin getting his coronavirus vaccine shot, Dmitry Peskov told reporters during a conference call that they would have to "take (our) word for it.”

“When it comes to getting vaccinated on camera, he has never supported that, he doesn't like that,” Peskov said. Peskov wouldn't reveal whether Putin will go to a vaccination facility or the shot will be brought to him in his office or residence, saying only that “it will done in a way that would the least affect” Putin's working schedule.

Putin announced that he would get vaccinated at a government meeting the day before. The statement came several months after widespread immunization against COVID-19 kicked off in Russia. Kremlin critics have argued that Putin's reluctance to get vaccinated was contributing to the already existing hesitancy about the vaccine.

Only 6.3 million people, or 4.3% of Russia's 146-million population, have received at least one dose of a vaccine. It lags behind a number of other countries in terms of the vaccination rate. Surveys by Russia’s top independent pollster, Levada Center, have shown that the number of Russians reluctant to get vaccinated with the domestically developed Sputnik V shot has grown in recent months — to 62% in February from 58% in December.

Pressed by reporters over whether Putin should get vaccinated on camera in order to boost slow vaccination rates, Peskov argued that Russians “will hear” about the president's vaccination and that Putin is already doing “a lot" for promoting the vaccination campaign.

“The president ... dedicates a rather significant time in his working hours to events, discussions, meetings related to vaccination, production of vaccines and so on. So the president does a lot for propaganda of the vaccines,” Peskov said.

The Kremlin spokesman refused to reveal which one of the three vaccines authorized for use in Russia Putin will receive, saying only that all three are “absolutely good, reliable, effective.” Russian authorities have given regulatory approval to three domestically developed shots — Sputnik V, EpiVacCorona and CoviVac. All three received the authorization before completing advanced trials experts say are necessary to ensure their safety and effectiveness in line with established scientific protocol.

However, a recent study in the British medical journal the Lancet showed that Sputnik V is 91% effective and appears to prevent inoculated individuals from becoming severely ill with COVID-19, although it’s still unclear if the vaccine can prevent the spread of the disease. No data on efficacy of the two other vaccines have been released.

Russia scores points with vaccine diplomacy, but snags arise

March 07, 2021

MOSCOW (AP) — Russia's boast in August that it was the first country to authorize a coronavirus vaccine led to skepticism at the time because of its insufficient testing. Six months later, as demand for the Sputnik V vaccine grows, experts are raising questions again — this time, over whether Moscow can keep up with all the orders from the countries that want it.

Slovakia got 200,000 doses on March 1, even though the European Medicines Agency, the European Union's pharmaceutical regulator, only began reviewing its use on Thursday in an expedited process. The president of the hard-hit Czech Republic said he wrote directly to Russian President Vladimir Putin to get a supply. Millions of doses are expected by countries in Latin America, Africa, the former Soviet Union and the Middle East in a wave of Russian vaccine diplomacy.

“Sputnik V continues to confidently conquer Europe,” anchor Olga Skabeyeva declared on the Russia-1 state TV channel. Dmitry Kiselev, the network's top pro-Kremlin anchor, heaped on the hyperbole last month, blustering: “The Russian coronavirus vaccine, Sputnik V, is the best in the world.”

State TV channels have covered vaccine exports extensively, citing praise from abroad for Russia and running segments about the difficulties countries are having with Western vaccines. The early criticism of Sputnik V has been blunted by a report in the prestigious British medical journal The Lancet that said large-scale testing showed it to be safe, with an efficacy rate of 91% against the virus.

That could help revamp Russia's image to one of a scientific, technological and benevolent power, especially as other countries encounter shortages of COVID-19 vaccines because richer nations are scooping up the Western-made versions or manufacturers struggle with limited production capacity.

“The fact that Russia is among five countries that were able to quickly develop a vaccine … allows Moscow to present itself as a high-tech power of knowledge rather than a petrol pump in decline,” said foreign affairs analyst Vladimir Frolov.

Some experts say boosting the use of vaccines from China and Russia — which have not been as popular as those from the West — could offer a quicker way to increase the global supply. Others note that Russia wants to score geopolitical points.

“Putin is using (the vaccine) to bolster a very tarnished image of Russia’s scientific and technological prowess,” said Lawrence Gostin, a Georgetown University professor and director of the World Health Organization Collaborating Center on National and Global Health Law. “He’s using it for geostrategic purposes in areas where Russia would like to have spheres of influence.”

Whether Russia can deliver is another question. China has supplied millions of doses to other countries, but the output of Sputnik V appears for now to be far lower than the demand. “They succeeded beyond their wildest dreams in terms of this vaccine actually being a viable, marketable product," said Judy Twigg, a political science professor specializing in global health at Virginia Commonwealth University. "They’ve made all of these explicit and implicit promises to people inside and outside Russia about access to this product that now is unexpectedly great. And now they’re stuck trying, scrambling, trying to figure out how to deliver on all those promises.”

Russia also must take care of its own. Authorities have announced plans to vaccinate 60% of adults, or roughly 68 million people, by the end of June. The domestic rollout in Russia has been slow, compared with other nations, with about 4 million people, or less than 3% of the population, vaccinated as of late February. Some of that could also be due to widespread reluctance among Russians to trust vaccines.

The Russian Direct Investment Fund, which bankrolled and markets the vaccine abroad, has not responded to a request for comment on how many doses are going to other countries. It said earlier that it has received requests for 2.4 billion doses from over 50 nations.

Airfinity, a London-based science analytics company, estimates that Russia agreed to supply about 392 million doses abroad, and there are talks with countries for at least another 356 million. Judging by production and exports so far, “Russia is very far from being able to deliver this,” said Airfinity CEO and founder Rasmus Hansen.

Russia manufactured just over 2 million doses last year amid reports of local producers having problems with buying equipment and making the second component of the two-shot vaccine. Russian Prime Minister Mikhail Mishustin said Feb. 20 that over 10 million doses of Sputnik V have been produced.

Sputnik V is a viral vector vaccine, which uses a harmless virus that carries genetic material to stimulate the immune system. Producing it is a complicated process, said Elena Subbotina, a consultant with the pharma consultancy CBPartners’ Central and Eastern Europe Team. Producers can’t guarantee stable output because working with biological ingredients involves a lot of variability in terms of the quality of the finished product.

Some countries that have been offered large batches of Sputnik V have yet to approve it for use. In India, which has been pledged 125 million doses, the vaccine is undergoing studies to determine if it produces a comparable immune response. Brazil’s health ministry said it is negotiating to purchase 10 million doses, but the nation’s regulatory agency has yet to authorize its use. Nepal, which has been offered 25 million doses, also hasn’t given its approval.

Other countries have had delays in receiving Sputnik V shipments. Argentina got nearly 2.5 million doses by March 1, even though at one point the government was expecting 5 million in January and over 14 million more in February. Officials in Hungary, who agreed to buy 2 million doses over three months, said Jan. 22 they were expecting 600,000 doses in the first 30 days, but got only 325,600 by early March. Mexico signed a deal for 24 million doses and was hoping to receive 400,000 in February but got only 200,000.

The Russian Direct Investment Fund has agreements with manufacturers in countries including Brazil, South Korea and India to boost production, but there are few indications that manufacturers abroad have made any large amounts of the vaccine so far.

The Brazilian company Uniao Quimica is in the pilot testing phase, the results of which will be shared with Russia before the company can produce it for sale. Indian drugmaker Hetero Biopharma, with a deal to make 100 million doses, was to begin production at the start of 2021, but it isn’t clear if it has actually started.

South Korean company GL Rapha, which expects to make 150 million doses this year, will be manufacturing finished products by sometime in March, said company official Kim Gi-young. Russia so far hasn't faced any criticism for delaying supplies of Sputnik V to other countries, with foreign officials optimistic about the deals.

Hungary is still awaiting large shipments, but expressed optimism about receiving them. “The Russian side, with minimal delay, will meet the 600,000 doses agreed to in the first phase, and then the additional 1.4 million doses,” Hungary's State Secretary Tamas Menczer said last month. Prime Minister Viktor Orban added Friday: “The Russians are pretty much keeping their promises.”

Promising more than can be delivered appears to be a universal problem with coronavirus vaccines, and it is a real risk for Russia as well, said Theresa Fallon, director of the Brussels-based Centre for Russia Europe Asia Studies.

“They have won the gold medal for creating this very effective vaccine," she said. "But the problem is, how are they going to implement it?”

Associated Press writers Aniruddha Ghosal in New Delhi, India; David Biller in Rio de Janeiro; Almudena Calatrava in Buenos Aires, Argentina; Justin Spike and Bela Szandelszky in Budapest, Hungary; and Tong-hyung Kim in Seoul, South Korea, contributed.

As virus cases rise, so do pleas for Russians to get vaccine

October 22, 2021

NIZHNY NOVGOROD, Russia (AP) — As she stood in the courtyard of the morgue holding the body of her grandmother who died of COVID-19, Ramilya Shigalturina had a message for anyone still resisting vaccinations.

“I'm begging all Russians: Please get vaccinated, because it's really dreadful and dangerous,” said the resident of Nizhny Novgorod, the country's fifth-largest city. Shigalturina said her 83-year-old grandmother “died right away after catching it. She wasn't vaccinated.”

When Russia last year became the first country to launch a coronavirus vaccine, called Sputnik V, it was hailed as a matter of national pride and a sign of its scientific know-how. But since the free immunization program began in December 2020, only about a third of the country's 146 million people have gotten fully vaccinated.

The low vaccine acceptance is of increasing concern as Russia suffers a sharp rise in cases, setting records for infections and deaths nearly every day this month. On Friday, the national coronavirus task force reported 1,064 deaths and more than 37,000 new infections over the past 24 hours, another pandemic high.

“I can't understand what's going on,” President Vladimir Putin said, a rare admission of bewilderment from the steely leader. “We have a reliable and efficient vaccine. The vaccine really reduces the risks of illness, grave complications and death.”

At Nizhny Novgorod's Infectious Hospital No. 23, where the seriously ill patients lie in wards with little space between their beds, Dr. Natalia Soloshenko is battered by the onslaught. “I can tell you that out of every 50 admitted, only one or two of them are vaccinated," the chief doctor told The Associated Press. “The whole ICU is full of highly critical patients; all of those patients are unvaccinated.”

“To be honest, we're not even outraged anymore; we just feel sorry for these people,” she said. Nina Pugacheva is still in the hospital, but is one of the lucky ones — she is recovering. “Tell everyone to get vaccinated,” she said.

Soloshenko said widespread misinformation appears to be driving the vaccine hesitancy. “It's a very sensitive issue, a burning issue for all health care workers. We read what's on social media and see the most negative information coming from the citizens of our country regarding vaccination,” she said.

Many Russians are suspicious of vaccines as a whole because of a distrust of authorities dating to the Soviet era. With Sputnik V, there was widespread concern that it was approved for use before the completion of full clinical trials.

Some critics also have blamed conflicting signals from authorities. While extolling Sputnik V and three other domestic vaccines, state-controlled media often criticized Western-made shots, a message that many saw as feeding doubts about vaccines in general.

The vaccination rate in the Nizhny Novgorod region, about 400 kilometers (250 miles) east of Moscow, is 44% higher than the national average, but it is seeing a high death rate. The coronavirus task force reported 40 new deaths in the past day — about twice the death rate recorded in Moscow.

As deaths spiked, regional Gov. Gleb Nikitin said new measures would be taken to curb the spread of the infections, but they haven't been announced yet. Putin on Wednesday ordered Russians to stay away from work from Oct. 30 to Nov. 7, a period that includes a four-day national holiday.

Moscow and St. Petersburg, the two most populous Russian cities and the country's key political, business and cultural centers, have gone further, announcing new restrictions following months of inaction.

In Moscow, gyms, cinemas, entertainment venues and most stores are to be closed from Oct. 28 to Nov. 7; and restaurants will be open only for takeout or delivery. The authorities in St. Petersburg on Monday introduced digital codes for proving vaccination that must be shown beginning Nov. 1 to enter conferences and sports events. Starting on Nov. 15, those codes will be required at movies, theaters, museums and gyms, and on Dec. 1 they will be mandatory at restaurants, cafes and some stores.

A similar code system was tried in Moscow over the summer but was abandoned after a few weeks amid complaints from restaurant owners about tanking revenue.

Associated Press writers Vladimir Isachenkov and Jim Heintz in Moscow contributed.

French vaccine rollout slowed by focus on elderly, red tape

January 09, 2021

PARIS (AP) — The few hours it took to give the first coronavirus vaccine shots to 14 residents of the John XXIII nursing home — named after a pope and not far from the birthplace in eastern France of vaccine pioneer Louis Pasteur — took weeks of preparation.

The home's director, Samuel Robbe, first had to chew his way through a dense 61-page vaccination protocol, one of several hefty guides from the French government that exhaustively detail how to proceed, down to the number of times (10) that each flask of vaccine should be turned upside down to mix its contents.

“Delicately,” the booklet stipulates. “Do not shake." As France tries to figure out why its vaccination campaign launched so slowly, the answer lies partly in forests of red tape and the decision to prioritize vulnerable older people in nursing homes. They are perhaps the toughest group to start with, because of the need for informed consent and difficulties explaining the complex science of fast-tracked vaccines.

Claude Fouet, still full of vim and good humor at age 89 but with memory problems, was among the first in his Paris care home to agree to a vaccination. But in conversation, it quickly becomes apparent that his understanding of the pandemic is spotty. Eve Guillaume, the home's director, had to remind Fouet that in April he survived his own brush with the virus that has killed more than 66,000 people in France.

“I was in hospital,” Fouet slowly recalled, “with a dead person next to me.” Guillaume says that getting consent from her 64 residents — or their guardians and families when they are not fit enough to agree themselves — is proving to be the most labor-intensive part of her preparations to start inoculations later this month. Some families have said no, and some want to wait a few months to see how vaccinations unfold before deciding.

“You can’t count on medicalized care homes to go quickly,” she says. “It means, each time, starting a conversation with families, talking with guardians, taking collegial steps to reach the right decision. And that takes time.”

At the John XXIII home, between the fortified town of Besancon and Pasteur's birthplace in Dole, Robbe has had a similar experience. After the European Union green-lighted use of the BioNTech-Pfizer vaccine in December, Robbe says it took two weeks to put together all the pieces to this week vaccinate 14 residents, just a fraction of his total of more than 100.

Getting consent was the biggest hurdle for a doctor and a psychologist who went from room to room to discuss vaccinations, he says. The families of residents were given a week over the December holidays to approve or refuse, a decision that had to be unanimous from immediate family members.

When one woman's daughter said yes but her son said no, a shot wasn't given because “they can turn against us and say, ‘I never agreed to that,’” Robbe explained. “No consensus, we don't vaccinate.” Only by cutting corners and perfunctorily getting residents to agree could the process go quicker, he says.

“My friends are saying, ‘What is this circus? The Germans have already vaccinated 80,000 people and we’ve vaccinated no one,'" he says. "But we don’t share the same histories. When you propose a vaccine to Germans, they all want to get inoculated. In France, there is a lot of reticence about the history of vaccinations. People are more skeptical. They need to understand. They need explications and to be reassured.”

France prioritized nursing homes because they have seen nearly one-third of its deaths. But its first vaccination on Dec. 27, of a 78-year-old woman in a long-term care facility, quickly proved to have been only the symbolic launch of a rollout that the government never intended to get properly underway before this week.

Only on Monday, as scheduled, did authorities launch an online platform where health workers must log all vaccinations and show that those inoculated got an obligatory consultation with a doctor, adding to the red tape.

In some countries that are moving faster than France, the bureaucracy is leaner. In Britain, where nearly 1.5 million have been inoculated and plans are to offer jabs to all nursing home residents by the end of January, those capable of consenting need only sign a one-page form that gives basic information about the benefits and possible side effects.

No doctor interviews are needed in Spain. It started vaccinating the same day as France but administered 82,000 doses in the first nine days, whereas France managed just a couple of thousand. Germany, like France, also mandates a meeting with a doctor and is prioritizing shots for care home residents, but it is getting to them quicker, using mobile teams. At its current rate of nearly 30,000 vaccinations per day, Germany would need at least six years to inoculate its 69 million adults. But while the German government is facing criticism for the perceived slow rollout, France made an even more leisurely start, at least in numerical terms, but has pledged to reach 1 million people by the end of January.

Other countries have racked up bigger numbers by offering shots to broader cross-sections of people who are easier to reach and can get themselves to appointments. The large majority of the more than 400,000 doses administered in Italy have gone to health-care workers.

Lucile Grillon, who manages three nursing homes in eastern France, says the many hours invested to prepare vaccinations for 50 residents and staff who got jabs on Friday was time well spent. She worked through the holidays to get ready.

“We can’t wait until we have the doses in our fridge to realize that we’re not ready to vaccinate and then have to throw doses away and say, ‘Rats! I didn’t think of that,’” she adds. “The doses are too precious.”

“It takes us two months to prepare for flu shots. Here, we have been asked to set records, to vaccinate against COVID in under 15 days," she says. “I don’t see how we could have gone any quicker.”

Associated Press writers Pan Pylas in London, Nicole Winfield in Rome, Ciaran Giles in Madrid and Kirsten Grieshaber in Berlin contributed.

France's go-slow coronavirus vaccination strategy backfires

January 04, 2021

PARIS (AP) — France’s cautious approach to rolling out a coronavirus vaccination program appears to have backfired, leaving barely 500 people inoculated in the first week and rekindling anger over the government’s handling of the pandemic.

Amid public outcry, the health minister vowed Monday to step up the pace, and made a belated public plea on behalf of the vaccine, saying it offers a “chance” for France and the world to vanquish a pandemic that has killed more than 1.8 million people. President Emmanuel Macron was holding a special meeting with top government officials Monday to address the vaccine strategy and other virus developments.

The slow rollout of the vaccine made by Pfizer and the German firm BioNTech was blamed on mismanagement, staffing shortages during holiday vacations and a complex French consent policy designed to accommodate unusually broad vaccine skepticism among the French public.

Doctors, mayors and opposition politicians pleaded Monday for speedier access to vaccines. “It’s a state scandal,” said Jean Rottner, president of the Grand-Est region of eastern France, where infections are surging and some hospitals are over capacity.

“Getting vaccinated is becoming more complicated than buying a car,” he said on France-2 television. In France, a country of 67 million people, only 516 people were vaccinated in the first six days, according to the French Health Ministry. Health Minister Olivier Veran promised that by the end of Monday, “several thousand” people will have been vaccinated, with the tempo picking up through the week — but that still leaves France well behind its neighbors.

Germany’s first-week total surpassed 200,000 and Italy’s was over 100,000 — and even those countries are under fire for being too slow to protect the public from a pandemic that has killed more than 1.8 million people worldwide.

The U.S. and China, meanwhile, have vaccinated millions. Britain on Monday became the first nation in the world to start giving people shots of the Oxford-AstraZeneca vaccine, so the U.K. now has two approved vaccines to use.

France started its vaccination campaign on Dec. 27 in nursing homes, because so many elderly people have died with the virus. But facing fears that people with cognitive problems would be vaccinated against their will, the government devised a time-consuming screening process before the vaccines can be ordered and administered.

Macron's government is also keen not to appear that it is forcing vaccines on anyone. Though France has lost more lives to the virus than most countries — over 65,000 — polls suggest the French are unusually wary of vaccines. They remember past French drug scandals, worry about how quickly these new vaccines were developed and their long-term impact, and wonder about the profits they bring to big pharmaceutical companies.

But many other French people are eager to vaccinated and have been frustrated by the surprisingly slow rollout. “We are doing anything we can to motivate people to get vaccinated,” said Frederic Leyret, director of the St. Vincent Hospital in the eastern French city of Strasbourg, whose geriatric rehabilitation facility started vaccinations Monday.

He lamented a mixed message from leading French officials, which he sums up as: “Go get vaccinated, but we will go slowly because it could be dangerous.” Now that millions of people in multiple countries are getting injected, he said attitudes are starting to shift. The French government adjusted its policies over the weekend to allow immediate vaccinations for medical workers over 50, alongside nursing home residents. Vaccines will gradually be made available to others.

On Monday, French authorities reported 378 new deaths from the virus and said numbers of COVID-19 patients hospitalized in intensive care units — more than 2,600 people — remained stable. Similar troubles have surfaced around Europe.

Spain saw vaccinations move slowly over the New Year holiday, blamed on shortages of medical personnel and of freezers for the vaccine, after a batch of them were caught in a bottleneck of trucks trying to enter the European mainland from Britain.

Spain has received in total 718,535 vaccine doses from Pfizer and BioNTech, but had only administered 82,334 by Monday, Health Minister Salvador Illa said. He added authorities that are confident that vaccination levels will reach “cruising speed” by next week, once the holiday period is over.

In Germany, where nearly 265,000 coronavirus vaccinations had been reported by Monday, impatience is growing with what is seen as a slow start. Chancellor Angela Merkel’s spokesman Steffen Seibert promised that “some things can and will improve.”

Amid the criticism, a European Commission spokesman defended the European Union’s collective vaccine strategy, saying Monday that the main problem is a shortage of production capacity. The European Medicines Agency, the medical regulator for the 27-nation bloc, was meeting Monday to discuss approval of Moderna's coronavirus vaccine.

Samuel Petrequin in Brussels, Aritz Parra in Madrid, and Geir Moulson in Berlin, contributed to this report.

As deaths rise, Russian doctors despair at low vaccine rate

October 19, 2021

MOSCOW (AP) — Dr. Georgy Arbolishvili doesn’t need to see government statistics or hear about the records being broken every day for infections and deaths to know that Russia is struggling through a particularly alarming phase of the coronavirus pandemic.

He simply looks around his filled-to-capacity intensive care unit at Moscow’s Hospital No. 52. With only about a third of Russia's 146 million people vaccinated against COVID-19, the country has hovered near 1,000 reported deaths per day for weeks and surpassed it on Saturday — a situation that Arbolishvili says “causes despair.”

“The majority of ICU patients in grave condition are unvaccinated," he told The Associated Press. These illnesses “could have been very easily avoided if a person had been vaccinated.” With a record 1,015 fatalities reported Tuesday, the country's death toll is now 225,325 — by far the highest in Europe, even though most experts agree even that figure is an undercount.

Those statistics “are directly linked to vaccinations,” Arbolishvili said. "The countries with a high share of those vaccinated don't have such bad mortality numbers.” Even though vaccines are plentiful, Russians have shown hesitancy and skepticism when it comes to getting vaccinated, which has been blamed on conflicting signals sent by authorities since the pandemic began last year.

Even as ICUs have filled in recent weeks, life in Moscow has continued as usual, with restaurants and movie theaters brimming with people, crowds swarming nightclubs and karaoke bars and commuters widely ignoring mask mandates on public transportation.

That makes medical workers like Dr. Natavan Ibragimova shudder. “I think about sleepless nights when we get a huge number of patients who didn't even bother to use banal protective means,” the internist at Hospital No. 52 said.

Patients who have gotten the vaccine usually don't have serious symptoms, Ibragimova added, while the unvaccinated come to regret it. “Patients who survive after a grave course of illness tell us when they are discharged, 'Doctor, you were right and I will tell everyone that it's necessary to get the vaccine,'" she said.

Until now, the Kremlin has ruled out a new nationwide lockdown like the one imposed early in the pandemic that dealt a heavy blow to the economy and sapped President Vladimir Putin’s popularity. The surging infections have raised the pressure on Russia's health care system and prompted Cabinet officials to suggest that most public sector workers take a week off.

Deputy Prime Minister Tatyana Golikova, who heads the coronavirus task force, suggested Tuesday that such a nonworking period start Oct. 30 and last through the following week, when four of seven days already are state holidays. The Cabinet will ask Putin to authorize the move, which would still keep many businesses in the service sector open.

Authorities also have raised the pressure on medical workers, teachers and public servants to get vaccinated, but the pace has stayed sluggish. Putin has underlined the importance of vaccinations but has emphasized that it should be voluntary.

Kremlin spokesman Dmitry Peskov admitted that while the government has done everything to make vaccinations easily available, it should have been more proactive in encouraging them. “Obviously, more should have been done to explain the lack of alternative to vaccination,” Peskov told reporters.

Authorities have set up vaccination sites in shopping malls and other facilities at clinics where shots are offered without any advance booking. They also have used lotteries, bonuses and other incentives to encourage people to get vaccinated, without much success.

Russia is the only place “where you can easily come and get the shot while passing by,” said Dr. Irina Beloglazova, a pulmonary specialist at Hospital No. 52. “A vaccine offers a clear chance to survive. I wonder why people don’t take that chance.”

In August 2020, Russia boasted of being the first country in the world to authorize a coronavirus vaccine even though it was only tested on a few dozen people at the time, proudly naming the shot Sputnik V in honor of its pioneering space program.

While extolling Sputnik V and three other domestic vaccines developed later, state-controlled media derided Western-made vaccine shots, a controversial message that many saw as feeding public doubts about vaccines in general.

Asked if authorizing imports of foreign vaccines would help, Peskov said the skepticism isn't limited to domestic shots. So far, the World Health Organization and the European Union have not authorized the use of Sputnik V, and Peskov emphasized that the issue should be resolved on an equal basis.

While resisting a nationwide lockdown, the Kremlin empowered regional authorities across the country to decide on local restrictions, depending on their situation. Many of Russia’s 85 regions already have restricted attendance at large public events and limited access to theaters, restaurants and other venues. Some have made vaccinations compulsory for certain public servants and people over 60.

Golikova urged the regions to move quickly on using digital codes for access to public areas. Russia's second-largest city of St. Petersburg joined others Monday in ordering digital codes so people can prove their vaccination or their recovery from infection to access conferences and sports events beginning Nov. 1. As of Nov. 15, those codes will also be required at movies, theaters, museums and gyms, and on Dec. 1, they will be mandatory at restaurants, cafes and some stores.

The city reported the second-largest number of new infections after Moscow, where authorities so far have refrained from tightening restrictions despite the mounting caseload. Moscow this week moved to tighten mask mandates on public transportation.

On Tuesday, Moscow Mayor Sergei Sobyanin said unvaccinated people over 60 will be required to stay home. He also told businesses to keep at least a third of their employees working remotely for three months starting Oct. 25.

Michael Head, a senior research fellow in global health at Britain’s University of Southampton, said the almost daily record-breaking virus numbers in Russia are hardly surprising, given the lack of restrictions and the highly contagious delta variant.

“We have seen time and again that if you let susceptible people mix, the delta variant is very, very adept at spreading in communities,” he said. Experts at the WHO and elsewhere estimate that might require more than 80% of a population to be immunized.

The government's task force has registered more than 8 million infections and ranks Russia as having the fifth-most COVID-19 deaths in the world after the United States, Brazil, India and Mexico. However, state statistics agency Rosstat, which also counts deaths in which the virus wasn’t considered the main cause, has reported a much higher death toll — about 418,000 as of August. Based on that number, Russia would be the fourth hardest-hit nation.

Martin McKee, a professor of European public health at the London School of Hygiene and Tropical Medicine, said the situation was extremely worrying for Russia and the rest of the world. Even high rates of vaccination elsewhere in Europe won't prevent the virus from being reimported from Russia, particularly if worrisome new variants emerge, he said.

“Until we have control of the virus everywhere, there’s a risk of importation and the pandemic will not be under control,” he said.

AP Medical Writer Maria Cheng in London contributed.

Russians flock to Serbia for Western-made COVID-19 vaccines

October 09, 2021

BELGRADE, Serbia (AP) — When Russian regulators approved the country's own coronavirus vaccine, it was a moment of national pride, and the Pavlov family was among those who rushed to take the injection. But international health authorities have not yet given their blessing to the Sputnik V shot.

So when the family from Rostov-on-Don wanted to visit the West, they looked for a vaccine that would allow them to travel freely — a quest that brought them to Serbia, where hundreds of Russian citizens have flocked in recent weeks to receive Western-approved COVID-19 shots.

Serbia, which is not a member of the European Union, is a convenient choice for vaccine-seeking Russians because they can enter the allied Balkan nation without visas and because it offers a wide choice of Western-made shots. Organized tours for Russians have soared, and they can be spotted in the capital, Belgrade, at hotels, restaurants, bars and vaccination clinics.

“We took the Pfizer vaccine because we want to travel around the world,” Nadezhda Pavlova, 54, said after receiving the vaccine last weekend at a sprawling Belgrade vaccination center. Her husband, Vitaly Pavlov, 55, said he wanted “the whole world to be open to us rather than just a few countries.”

Vaccination tour packages for Russians seeking shots endorsed by the World Health Organization appeared on the market in mid-September, according to Russia’s Association of Tour Operators. Maya Lomidze, the group’s executive director, said prices start at $300 to $700, depending on what’s included.

Lauded by Russian President Vladimir Putin as world's first registered COVID-19 vaccine, Sputnik V emerged in August 2020 and has been approved in some 70 countries, including Serbia. But the WHO has said global approval is still under review after citing issues at a production plant a few months ago.

On Friday, a top World Health Organization official said legal issues holding up the review of Sputnik V were “about to be sorted out,” a step that could relaunch the process toward emergency use authorization.

Other hurdles remain for the Russian application, including a lack of full scientific information and inspections of manufacturing sites, said Dr. Mariangela Simao, a WHO assistant director-general. Apart from the WHO, Sputnik V is also still awaiting approval from the European Medicines Agency before all travel limitations can be lifted for people vaccinated with the Russian formula.

The long wait has frustrated many Russians, so when the WHO announced yet another delay in September, they started looking for solutions elsewhere. “People don’t want to wait; people need to be able to get into Europe for various personal reasons,” explained Anna Filatovskaya, Russky Express tour agency spokeswoman in Moscow. “Some have relatives. Some have business, some study, some work. Some simply want to go to Europe because they miss it.”

Serbia, a fellow-Orthodox Christian and Slavic nation, offers the Pfizer, AstraZeneca and Chinese Sinopharm shots. By popular demand, Russian tourist agencies are now also offering tours to Croatia, where tourists can receive the one-shot Johnson & Johnson vaccine, without the need to return for a second dose.

“For Serbia, the demand has been growing like an avalanche," Filatovskaya said. "It’s as if all our company is doing these days is selling tours for Serbia." The Balkan nation introduced vaccination for foreigners in August, when the vaccination drive inside the country slowed after reaching around 50% of the adult population. Official Serbian government data shows that nearly 160,000 foreign citizens so far have been vaccinated in the country, but it is unclear how many are Russians.

In Russia, the country's vaccination rate has been low. By this week, almost 33% of Russia’s 146 million people have received at least one shot of a coronavirus vaccine, and 29% were fully vaccinated. Apart from Sputnik V and a one-dose version known as Sputnik Light, Russia has also used two other domestically designed vaccines that have not been internationally approved.

Russian Health Minister Mikhail Murashko recently said administrative issues were among the main holdups in the WHO’s review process. Judy Twigg, a political science professor specializing in global health at Virginia Commonwealth University, expects Sputnik V to be approved eventually, but “maybe not by the end of this year.”

“The WHO has said that it needs more data, and it needs to go back and inspect some production lines where it saw issues early on. Those re-inspections are a multiweek process, with good reason. It’s not something that they just gloss over lightly."

Amid low vaccination rates and reluctance by the authorities to reimpose restrictive measures, both Russia and Serbia have seen COVID-19 infections and hospitalizations reach record levels in the past weeks.

The daily coronavirus death toll in Russia topped 900 for a second straight day on Thursday — a day after reaching a record 929. In Serbia, the daily death toll of 50 people is the highest in months in the country of 7 million that so far has confirmed nearly 1 million cases of infection.

Pavlova said the “double protection” offered by the Pfizer booster shots would allow the family "to not only travel around the world, but also to see our loved ones without fear.” Since the vaccine tours exploded in popularity about a month ago, they have provided welcome business for Serbian tour operators devastated by the pandemic in an already weak economy. The owner of BTS Kompas travel agency in Belgrade, Predrag Tesic, said they are booked well in advance.

“It started modestly at first, but day by day numbers have grown nicely,” Tesic said. He explained that his agency organizes everything, from airport transport to accommodations and translation and other help at vaccination points. When they return for another dose in three weeks, the Russian guests also are offered brief tours to some of popular sites in Serbia.

Back in Russia, some Moscow residents said they understood why many of their fellow Russians travel abroad for vaccines. But Tatiana Novikova said homegrown vaccines remain her choice. "I trust ours more, to be honest,” she said.

Associated Press writers Dusan Stojanovic and Ivana Bzganovic in Belgrade, Serbia, and Daria Litvinova and Daniel Kozin reported from Moscow.

Chinese vaccine arrives in Hungary, a first in the EU

February 16, 2021

BUDAPEST, Hungary (AP) — A shipment of COVID-19 vaccines produced in China arrived in Hungary on Tuesday, making it the first of the European Union's 27 nations to receive a Chinese vaccine. A jet carrying 550,000 vaccine doses developed by the Chinese state-owned company Sinopharm landed at Budapest’s international airport after flying in from Beijing. The shipment is enough to treat 275,000 people with the two-dose jab, Dr. Agnes Galgoczy of the National Public Health Center told a press conference.

“With this vaccine, five different types are now available in Hungary so that we may get as many people vaccinated as quickly as possible,” Galgoczy said, adding that vaccine shots won't begin until the shipment is evaluated by the National Public Health Center.

Hungarian health authorities were the first in the EU to approve the Sinopharm jab for emergency use on Jan. 29. That came after a government decree streamlined Hungary’s vaccine approval process by allowing any vaccine administered to at least 1 million people worldwide to be used without undergoing review by the country’s medicines regulator.

The country expects to receive 5 million total doses of the Sinopharm vaccine over the next four months, enough to treat 2.5 million people in the country of nearly 10 million. Hungarian officials, including Prime Minister Viktor Orban, have been critical of the EU's common vaccine procurement program, claiming the bloc's slow rollout of shots is costing lives.

“If vaccines aren’t coming from Brussels, we must obtain them from elsewhere ... One cannot allow Hungarians to die simply because Brussels is too slow in procuring vaccines,” Orban said last month. Hungary has also agreed to purchase 2 million doses of Russia’s Sputnik V coronavirus vaccine, which hospitals began administering in Budapest last week.

On Friday, Orban claimed these additional vaccines from Russia and China will enable Hungary to vaccinate millions more people by the end of May than other European countries with similar populations.

“As things stand now, (we can vaccinate) 6.8 million people by the end of May or beginning of June,” Orban said in a radio interview. “I think this is huge.” Orban earlier said he would personally choose to be inoculated with the Sinopharm vaccine since he trusts it the most.

“I think the Chinese have known this virus for the longest and they probably know it the best,” he said last month. The Sinopharm vaccine, which the developer says is nearly 80% effective, is already in use in Hungary’s non-EU neighbor Serbia, where around half a million people, including ethnic Hungarians, have already received the jab. The company has not yet released data on the results of the vaccine's Stage 3 trials.

The new vaccines shipment represents around 40% of all COVID-19 vaccine doses that Hungary has received so far, and makes Sinopharm nearly equally prevalent in Hungary as the Pfizer-BioNtech vaccine. But recent polling shows that some Hungarians are reluctant to receive the Sinopharm jab. A survey of 1,000 people in the capital of Budapest by pollster Median and the 21 Research Center showed that among those willing to receive a vaccine, only 27% would take a Chinese vaccine, compared to 43% a Russian vaccine and 84% a jab developed in Western countries. The poll had a margin of error of plus or minus 3%.

Dutch begin COVID-19 vaccinations; last EU nation to do so

January 06, 2021

THE HAGUE, Netherlands (AP) — Nearly two weeks after most other European Union nations, the Netherlands on Wednesday began its COVID-19 vaccination program, with nursing home staff and front-line workers in hospitals first in line for the shot.

Sanna Elkadiri, a nurse at a nursing home for people with dementia, was the first to receive a shot of the Pfizer-BioNTech vaccine at a mass vaccination center in Veghel, 120 kilometers (75 miles) southeast of the capital, Amsterdam.

“This is a very important moment for me as a person who works in the care sector. You want to provide the care knowing that your clients are safe,” Elkadiri said. ”Without the vaccine that is not possible, but from now on I can do it."

The Dutch government has come under fierce criticism for its late start to vaccinations. Prime Minister Mark Rutte told lawmakers in a debate Tuesday that authorities had focused preparations on the easy-to-handle vaccine made by Oxford University and AstraZeneca, which hasn't yet been cleared for use in the EU, and not the Pfizer-BioNTech vaccine.

Dutch Health Minister Hugo de Jonge didn't comment on the criticism as he spoke before Elkadiri rolled up the left sleeve of her purple nurse's uniform to receive the first shot. Instead, he looked forward to a future with the virus under control.

“Finally, after 10 months of crisis, today we are starting to end this crisis," De Jonge said. But he warned that, "it will take a while before we have all the misery behind us. ” The Pfizer-BioNTech vaccine, which requires ultra-cold storage before it's used, is the only shot that has been approved so far by the European Medicines Agency. On Wednesday, the agency was considering approving another coronavirus vaccine, one made by Moderna.

“I’m very disappointed that we are two weeks behind other countries,” Rutte said in the Dutch parliament. The country's public health institute said that about 300,000 carers and hospital staff are first in line for shots. Two more large-scale vaccination centers are due to open Friday and by the end of next week, 25 should be open across the country, the institute said.

Health authorities plan to be able to vaccinate a maximum of 66,000 care workers per week from Jan. 18. In a tweet thanking staff involved in the rollout, Dutch King Willem-Alexander called the start of vaccinations “a turning point that provides hope of a way out of this crisis.”

The Netherlands is in the midst of a five-week tough lockdown imposed when infection rates were spiking across the country. In recent days, infection rates have been edging lower, but the country's public health institute said Tuesday that the lockdown hasn't yet produced a clear effect on infection rates.

Nearly 12,000 people are confirmed to have died of COVID-19 in the Netherlands since the pandemic started, though the true number is higher because not all people who died with symptoms were tested. Andre Rouvoet, chairman of the umbrella organization of local health authorities, welcomed the first vaccinations, which were aired live on Dutch television.

“It is symbolic of the hundreds of thousands — millions — of vaccinations that will be administered in the Netherlands in coming months,” he said.

Hungary gives 1st vaccine shots a day before EU's rollout

December 26, 2020

WARSAW, Poland (AP) — Hungarian doctors and health care workers began getting vaccinated Saturday with one of the continent's first shipments of the Pfizer-BioNTech coronavirus vaccine, upsetting the European Union's plans for a coordinated rollout of the first shots across the 27-nation bloc on Sunday.

The first shipments of the vaccine arrived at hospitals across the EU in super-cold containers late Friday and early Saturday after being sent from a manufacturing center in Belgium before Christmas. It was not immediately clear why Hungarian authorities began their vaccinations a day early. Authorities in Slovakia also announced that they planned to begin administering their first doses on Saturday evening.

European Commission President Ursula von der Leyen released a video celebrating the vaccine rollout, calling it “a touching moment of unity.” “Today, we start turning the page on a difficult year. The COVID-19 vaccine has been delivered to all EU countries. Vaccination will begin tomorrow across the EU," she said.

The rollout marks a moment of hope for a region that includes some of the world's earliest and worst-hit virus hot spots — Italy and Spain — and others like the Czech Republic, which were spared early on only to see their health care systems near their breaking point in the fall.

Altogether, the EU's 27 nations have seen at least 16 million coronavirus infections and more than 336,000 deaths. The vaccine rollout will help the bloc project a sense of unity in a complex lifesaving mission after it faced a year of difficulties in negotiating a post-Brexit trade deal with Britain. It also brings a sigh of relief for EU politicians who were frustrated after Britain, Canada and the United States began their vaccination programs earlier this month.

“It’s here, the good news at Christmas," German Health Minister Jens Spahn said at a news conference Saturday. "This vaccine is the decisive key to end this pandemic.” “It is the key to getting our lives back,” Spahn said.

The first shipments, however, are limited just under 10,000 doses in most countries, with the mass vaccination programs expected to begin only in January. Each country is deciding on its own who will get the first shots — but they are all putting the most vulnerable first.

In Hungary, the first shipment of 9,750 doses — enough to vaccinate 4,875 people, since two doses are needed per person — arrived by truck early Saturday and were taken to the South Pest Central Hospital in Budapest. The government said four other hospitals, two in Budapest and two others in the eastern cities of Debrecen and Nyíregyháza, would also receive vaccines from the initial shipment.

French authorities said they will prioritize the elderly, based on the virus's deadly impact on older people in previous virus surges in France. The French medical safety agency will monitor for any potential problems.

Germany, where the pandemic has cost more than 30,000 lives, will begin with those over 80 and people who take care of vulnerable groups. Spanish authorities said the first batch of the vaccine to reach the country had arrived in the central city of Guadalajara — where the first shots will be administered on Sunday morning at a nursing home.

In Italy, which has Europe's worst virus death toll at over 71,000 people, a nurse in Rome at Spallanzani Hospital, the main infectious diseases facility in the capital, will be the first in the country to receive the vaccine, followed by other health personnel.

In Poland, the first two people to be vaccinated on Sunday will be a nurse and a doctor at the Interior Ministry hospital in Warsaw, the main coronavirus hospital in the capital, followed by medical personnel in dozens of other hospitals.

Polish Prime Minister Mateusz Morawiecki called it the patriotic duty of Poles to get vaccinated — a message directed at a society where there is a high degree of vaccine hesitancy born from a general distrust of authorities.

In Bulgaria, where vaccine hesitancy also runs high, the first person to get the shot will be Health Minister Kostadin Angelov, who has promised an aggressive campaign to promote the benefits of the shots.

In Croatia, where the first batch of 9,750 vaccines arrived early on Saturday, a care home resident in Zagreb, the capital, will be the first to receive the vaccine on Sunday morning, according to state HRT TV. Authorities also planned to involve celebrities and other public figures in a pro-vaccination campaign.

“We have been waiting for this for a year now,” Romanian Prime Minister Florin Catu said on Saturday after the first batch of the vaccine arrived at a military-run storage facility there. The vaccinations begin as the first cases of a new variant of the virus that has been spreading in the U.K. have now been detected in France and Spain. The new variant, which British authorities said is much more easily transmitted, has caused European countries, the United States and China to put new restrictions on travel for people from Britain.

A French man living in England arrived in France on Dec. 19 and tested positive for the new variant Friday, the French public health agency said. He has no symptoms and is isolating in his home in the central city of Tours.

Meanwhile, health authorities in the Madrid region said they had confirmed the U.K. variant in four people, all of whom are in good health. Regional health chief Enrique Ruiz Escudero said the new strain had arrived when an infected person flew into Madrid’s airport.

German pharmaceutical company BioNTech is confident that its coronavirus vaccine works against the new U.K. variant, but further studies are needed to be completely certain.

Associated Press writers Lorne Cook in Brussels, David McHugh in Frankfurt, Germany, Angela Charlton in Paris, Joseph Wilson in Barcelona, Spain, Frances D'Emilio in Rome, Jovana Gec in Belgrade, Serbia, and Veselin Toshkov in Sofia, Bulgaria, contributed to this report.

Russia's COVID-19 vaccine rollout draws wary, mixed response

December 17, 2020

MOSCOW (AP) — While excitement and enthusiasm greeted the Western-developed coronavirus vaccine when it was rolled out, the Russian-made version has received a mixed response, with reports of empty Moscow clinics that offered the shot to health care workers and teachers — the first members of the public designated to receive it.

Kremlin officials and state-controlled media touted the Sputnik V vaccine as a major achievement after it was approved Aug. 11. But among Russians, hope that the shot would reverse the course of the COVID-19 crisis has become mixed with wariness and skepticism, reflecting concerns about how it was rushed out while still in its late-stage testing to ensure its effectiveness and safety.

Russia faced international criticism for approving a vaccine that hasn’t completed advanced trials among tens of thousands of people, and experts both at home and abroad warned against its wider use until the studies are completed.

Despite those warnings, authorities started offering it to certain high-risk groups, such as front-line medical workers, within weeks of approval. Alexander Gintsburg, head of the Gamaleya Institute that developed the vaccine, said last week over 150,000 Russians have gotten it.

One recipient was Dr. Alexander Zatsepin, an ICU specialist in Voronezh, a city 500 kilometers (310 miles) south of Moscow, who received the vaccine in October. “We’ve been working with COVID-19 patients since March, and every day when we come home, we worry about infecting our family members. So when some kind of opportunity to protect them and myself appeared, I thought it should be used,” he said.

But Zatsepin said he still takes precautions against infection because studies of the vaccine's effectiveness aren't over. “There is no absolute confidence yet,” he said. After Britain announced Dec. 2 it had approved a vaccine developed by drugmakers Pfizer and BioNTech, President Vladimir Putin told authorities to start a large-scale inoculation campaign, a sign of Moscow’s eagerness to be at the front of the race against the pandemic.

Russia approved its vaccine after it was tested on only a few dozen people, touting it as “the first in the world” to receive a go-ahead. Developers named it “Sputnik V,” a reference to the Soviet Union’s 1957 launch of the world's first satellite during the Cold War.

More than just national pride is at stake. Russia has recorded more than 2.7 million cases of COVID-19, and over 49,000 deaths, and it wants to avoid another damaging lockdown of its economy. On Dec. 2, Putin cited a target of over 2 million doses in the coming days. Despite such a limited supply for a nation of 146 million, Moscow immediately widened who was eligible for it. Shots are free to everyone in medical or educational facilities, both state and private; social and municipal workers; retail and service workers; and those in the arts.

The European Medicines Agency said it has not received a request from the vaccine makers to consider licensing it for use in the EU, but some data have been shared with the World Health Organization. The U.N. agency does not typically approve vaccines itself but waits for regulatory agencies to weigh in first. The Russian vaccine is reportedly under consideration for use in a global effort led by WHO to distribute COVID-19 vaccines to poorer countries.

Unlike in the U.K., where the first shots are going to the elderly, Sputnik V is going to those aged 18 to 60 who don’t have chronic illnesses and aren’t pregnant or breastfeeding. Putin himself hasn't gotten a Russian-made shot yet. The 68-year-old Russian leader said the shots in Russia are currently being recommended to people of a certain age, adding that “vaccines have not yet reached people like me.” “But I will definitely do it, as soon as it becomes possible,” Putin told the annual news conference Thursday.

Its developers have said study data suggests the vaccine was 91% effective, a conclusion based on 78 infections among nearly 23,000 participants. That’s far fewer cases than Western drugmakers have accumulated during final testing before analyzing their candidates’ efficacy, and important demographic and other details from the study have not been released.

Some experts say such efficacy rates inspire optimism, but public trust may be an issue. “I don’t so much worry about Sputnik V being unsafe or less effective than we need it to be," said Judy Twigg, a political science professor at Virginia Commonwealth University specializing in global health. “I worry about whether or not people are going to be willing to take it in Russia.”

A poll conducted in October by the Levada Center, Russia’s top independent pollster, showed that 59% of Russians were unwilling to get the shots even if offered for free. Denis Volkov, sociologist and deputy director of the Levada Center, says respondents cited unfinished clinical trials, saying the vaccine was “raw” and they were suspicious of the claims that Russia was the first country to have a vaccine while others were still working on theirs.

Some medical workers and teachers interviewed by The Associated Press expressed skepticism about the vaccine because it hasn’t been fully tested. Dr. Yekaterina Kasyanova of Siberia’s Kemerovo region said she didn't trust it enough to get the shot and has advised her mother, a teacher, not to get it either, adding: “The vaccine is several months old. … Long-term side effects are not known, its effectiveness hasn’t been proven.”

Dzhamilya Kryazheva, a teacher in Krasnogorsk near Moscow, echoed that sentiment. “I don’t intend to experiment on my body. I have three children,” she said. For other health care workers, the choice to be vaccinated was easy.

“People are dying here every day. Every day, we carry out corpses. What’s there to think about?” said Dr. Marina Pecherkina, an infectious disease specialist in the Far East city of Vladivostok. She got her shots in October because of her daily work with coronavirus patients.

Moscow Mayor Sergei Sobyanin said around 15,000 people received the shots since vaccinations started Dec. 5. But some media reports about the first days of the Moscow campaign showed empty clinics and medical workers offering the shots to anyone who walked in. In some instances, this was because the vaccine must be stored at minus 18 degrees Celsius (minus 0.4 degrees Fahrenheit), and each vial contains five doses. Once defrosted, it must be administered within two hours or discarded.

The rollout outside Moscow and the surrounding region appeared to go much slower, with Health Minister Mikhail Murashko declaring that all regions started the vaccination Dec. 15. Media reports suggested there may be problems with scaling up the manufacture and distribution of Sputnik V. It uses two different adenovirus vectors for the two-shot regimen, which complicates production. In addition, the low-temperature storage and transport makes it harder to move across the vast country.

There also were confused signals about whether recipients should consume alcohol. Deputy Prime Minister Tatyana Golikova said those getting vaccinated should refrain from drinking three days before and after the shots.

Several medical workers in Siberia who received the vaccine later reported contracting the virus, but health officials said not enough time had passed for them to develop the antibodies. Dr. Yevgenia Alexeyeva in the Siberian city of Tomsk tested positive for the virus 12 days after her second shot. Alexeyeva said she wasn't surprised by the result and that it didn’t shake her confidence in the vaccine.

“The vaccine doesn’t guarantee that the person wouldn't get infected. But it should protect us from developing a severe case,” Alexeyeva said.

Vladimir Kondrashov and Anatoly Kozlov in Moscow, and Tatyana Salimova in Tomsk, contributed to this report.

As deaths rise, vaccine opponents find a foothold in Bosnia

September 30, 2021

SARAJEVO, Bosnia-Herzegovina (AP) — Hospitals across Bosnia are again filling with COVID-19 patients gasping for air, and the country's pandemic death toll is rising. Yet vaccination sites are mostly empty and unused coronavirus vaccines are fast approaching their expiration dates.

When the European Union launched its mass vaccination campaign, non-member Bosnia struggled along with most other Balkan nations to get supplies. By late spring, however, hundreds of thousands of doses started pouring into the country.

But after an initial rush of people clamoring to get jabbed, demand for shots quickly slowed. It is now down to a trickle even though Bosnia has Europe's highest coronavirus mortality rate at 4.5%, according to Johns Hopkins University data.

Dr. Edin Drljevic, an infectious disease specialist at one of Bosnia’s largest hospitals, in Sarajevo, thinks the disconnect is partly a result of authorities failing to properly promote vaccination against COVID-19.

“At first, we only had negative publicity because of the failure to secure vaccines, but once the vaccines finally started arriving, mainly through donations, people became picky,” he said. So far, just under 13% of Bosnia’s 3.3 million people have been fully vaccinated, among the lowest shares in Europe. Even people willing to get inoculated are putting off shots so they can choose the vaccine they want instead of receiving whichever one is available.

Bosnia currently administers the Pfizer-BioNTech, Sputnik V, Sinopharm and AstraZeneca vaccines. AstraZeneca's product, while the most widely available, appears to enjoy the least trust because of extensive news coverage when numerous European countries temporary suspended its use due to concerns about possible, rare side effects.

“The bottom line is, people are poorly informed and lack up-to-date knowledge,” Drljevic said. With so few takers, over 50,000 AstraZeneca vaccine doses have already expired; an additional 350,000 doses are set to expire in October

The pandemic has amplified the many problems of the Balkan nation, which is still struggling to recover from a devastating interethnic war in 1992-95. Nearly half of Bosnia's people live under or close to the poverty line.

The country has an extreme shortage of doctors and nurses, as well as rampant public corruption. Several elected and appointed government officials are under investigation or on trial for suspected malfeasance in the procurement of needed medical equipment and supplies during the pandemic.

The high-profile cases make Bosnians susceptible to claims that their leaders are acting in concert with corrupt pharmaceutical companies and are “happy to sacrifice them” for personal gain, according to Slavo Kukic, a sociology professor at Mostar University in southern Bosnia.

“People in Bosnia generally distrust the authorities. They (have been) lied to and manipulated for the past 30 years, and it makes it easier (for the anti-vaccine movement) to convince them that it is wise to not protect themselves from the virus, that it is a risk worth taking,” Kukic said.

While vaccine hesitancy in Bosnia might be among the most extreme globally, the country is not the only one in Europe facing that problem. The International Federation of Red Cross and Red Crescent Societies voiced concern Thursday at low immunization rates in parts of the continent, calling for urgent action to tackle vaccine hesitancy and misinformation.

In a press release, it warned that disinformation about vaccines’ side effects and potential risks, coupled with the introduction of vaccine passes was “sparking anger and violence” and has led to “concerning incidents against medical services, media and the general public” in the United Kingdom and numerous EU member including Italy, The Netherlands, Poland, Slovenia and France.

"Without addressing people’s concerns and fears, vaccines may not find their way into the arms of those most at risk, even where doses are available,” IFRC regional director for Europe Birgitte Bischoff Ebbesen said. “Increased community engagement is needed to tackle vaccine hesitancy, myths and disinformation.”

In Bosnia, health professionals and vaccine recipients note the absence of a coordinated, hard-hitting national campaign to counter vaccine hesitancy. There are no public service ads, billboards, incentives or mass mailings encouraging people to get vaccinated or advising them how to do it.

Meanwhile, activists with strong anti-vaccine opinions dominate the discussion on social networks and in the comment sections of news sites. An opposition lawmaker, Lana Prlic, announced on Facebook last week that she had received her second dose of AstraZeneca vaccine and urged followers to get their shots as soon as possible “to protect themselves and others." Her post attracted over 28,000 comments in 24 hours, most of them filled with insults and misinformation.

Jagoda Savic, Bosnia’s most vocal anti-vaccination activist for over a decade, asserts with pride that her profile has grown during the pandemic. “People stop me in the street to say hello, to congratulate me and ask me to keep up the good work,” she said. “I get so many messages (of support) on Facebook that I can no longer respond to all of them.”

Savic claims that coronavirus vaccines were not put through standard safety testing before being approved for use, and that they have caused severe adverse reactions in 1.2 million people in the European Union, the U.K. and the United States.

Similar claims have been made in other countries, and scientists and health authorities have repeatedly rejected them. Savic countered that information from reputable sources may cause doubts about the “dangers” of vaccines, but “in their heart and soul, people know the truth.”

Bosnia has reported close to 240,000 confirmed cases and more than 10,500 deaths in the pandemic. Savic asserts the figures are inflated, arguing incorrectly that that molecular PCR tests — the primary method for diagnosing COVID-19 — produce a huge number of false positives.

“Unfortunately, I have the impression that we are simply letting anti-vaccination lobbies and movements highjack the public debate and spread misinformation that discourages people from getting immunized,” Bakir Nakas, a retired infectious disease specialist, said.

While waiting to get her second coronavirus vaccine shot in Sarajevo last week, cancer patient Mirjana Golijanin said she thinks some fellow Bosnians are refusing because they perceive such behavior as a way of opposing the powerful and rich.

“I think it is simply an expression of the need to offer some sort of resistance, even if all they are resisting is a vaccine,” Golijanin said.

Two Europes: Low vaccine rates in east overwhelm ICUs

September 28, 2021

BUCHAREST, Romania (AP) — In a packed intensive care unit for coronavirus patients in Romania’s capital, Bucharest, 55-year-old Adrian Pica sits on his bed receiving supplementary oxygen to help him breathe. “I didn’t want to get vaccinated because I was afraid,” he said.

Around 72% of adults in the 27-nation European Union have been fully vaccinated against COVID-19, but a stubbornly low uptake of the shots in some eastern EU nations now risks overwhelming hospitals amid a surge of infections due to the more contagious delta variant.

“Until now I didn’t believe in COVID-19,” Pica, who said his early symptoms left him sweating and feeling suffocated, told The Associated Press. “I thought it was just like the flu. But now I’m sick and hospitalized. I want to get a vaccine.”

Bulgaria and Romania are lagging dramatically behind as the EU’s two least-vaccinated nations, with just 22% and 33% of their adult populations fully inoculated. Rapidly increasing new infections have forced authorities to tighten virus restrictions in the two countries, while other EU nations such as France, Spain, Denmark and Portugal have all exceeded 80% vaccine coverage and eased restrictions.

Stella Kyriakides, the EU’s health commissioner, said the “worrying gap” on vaccinations needs urgently addressing. Slovakia, Croatia and Latvia have vaccinated around 50% of all their adults. But jab uptake in many Central and Eastern European countries has remained weak or declined.

In Norway, where about 70% of the population has been vaccinated, authorities on Saturday scrapped restrictions that Prime Minister Erna Holberg called “the strictest measures in peacetime.” Nordic neighbor Denmark lifted virus restrictions on Sept. 10, while the U.K. has also abandoned most pandemic restrictions due to high vaccine rates.

In contrast, at Bucharest’s Marius Nasta Institute of Pneumology, the ICU's chief doctor, Genoveva Cadar, says the beds are now at 100% capacity and around 98% of all the virus patients are unvaccinated.

“In comparison to previous waves, people are arriving with more severe forms” of the disease, she said, adding that many patients in this latest surge are younger than in previous ones. “Very quickly they end up intubated — and the prognosis is extremely bleak.”

New daily coronavirus cases in Romania, a country of 19 million residents, have grown exponentially over the last month, while the number of people getting vaccinated has declined to worrying lows. Romanian officials reported 11,049 new cases on Tuesday, the highest daily tally since the pandemic started. Government data shows that 91.5% of COVID-19 deaths in Romania during Sept. 18-23 involved unvaccinated patients.

On Sunday, 1,220 of Romania's 1,239 ICU beds for virus patients were occupied. In many cases, only deaths freed up spaces. At the Marius Nasta Institute, a mobile ICU on hospital grounds that opened Monday already was full.

“I don’t know how we’re going to get over the next period, but we’re definitely going to be here,” hospital manager Beatrice Mahler told the AP. “We’re going to do everything we can (but) we don't have a winning recipe.”

Vlad Mixich, a Romanian public health specialist, told the AP that a “historic distrust of authorities” together with what he said was a very weak government vaccination campaign has contributed to the low vaccine uptake among his compatriots.

“During the vaccination campaign, unfortunately the politicians were the main communicators,” he said, adding that a frequent turnover in the country's health ministers has had a massive impact on efforts to inoculate Romanians.

In neighboring Bulgaria, an alarming 23% of people said they do not want to get vaccinated, compared with only 9% across the bloc, according to a Eurobarometer survey. Sabila Marinova, the ICU manager at a hospital in Bulgaria’s northern town of Veliko Tarnovo, says none of its COVID-19 patients is vaccinated.

“We are very exhausted," she said. “It seems that this horror has no end.” The vice president of Romania’s national vaccination committee, Andrei Baciu, said that fake news has been a key factor in keeping people from getting jabbed.

“There is and was a culture that promotes fake news. We are working with a team of specialists to combat (it) ... right now there is a high number of (infections) due to low vaccination rates,” he said, adding that the government is looking to increase ICU capacity.

Sometimes medical workers in Eastern Europe face additional risks. In September in Bulgaria’s port city of Varna, a group opposed to vaccines attacked a medical team at a mobile vaccination station. Health Minister Stoycho Katsarov condemned the attack, saying “we will not allow our medics to be insulted, publicly harassed and humiliated” for trying to save lives.

The implementation of vaccine passports, which allow people to show their vaccine status to carry out day-to-day activities, may be one of few options left for European governments at a loss on how to encourage their vaccine-hesitant citizens to get jabbed.

Experts say vaccine skeptics in parts of Europe could hamper the entire continent's efforts to end the pandemic. Back at the Marius Nasta Institute, Nicoleta Birtea, a 63-year-old unvaccinated COVID-19 patient who had previous health issues, says she woke up a month ago feeling dizzy and ill and called for an ambulance.

“I hope that I got here on time,” she said, adding “I understand very clearly that the vaccine can’t protect you.”

Moscow opens dozens of coronavirus vaccination centers

December 05, 2020

MOSCOW (AP) — Thousands of doctors, teachers and others in high-risk groups have signed up for COVID-19 vaccinations in Moscow starting Saturday, a precursor to a sweeping Russia-wide immunization effort.

The vaccinations come three days after President Vladimir Putin ordered the launch of a “large-scale” COVID-19 immunization campaign even though a Russian-designed vaccine has yet to complete the advanced studies needed to ensure its effectiveness and safety in line with established scientific protocols.

The Russian leader said Wednesday that more than 2 million doses of the Sputnik V jab will be available in the next few days, allowing authorities to offer jabs to medical workers and teachers across the country starting late next week.

Moscow, which currently accounts for about a quarter of the country's new daily infections, moved ahead of the curve, opening 70 vaccination facilities on Saturday. Doctors, teachers and municipal workers were invited to book a time to receive a jab, and Moscow Mayor Sergei Sobyanin said that about 5,000 signed up in a few hours after the system began operating on Friday.

Russia boasted that Sputnik V was the world’s “first registered COVID-19 vaccine” after the government gave it regulatory approval in early August. The move drew criticism from international experts, who pointed out that the vaccine had only been tested on several dozen people at the time.

Putin has shrugged off doubts about it, saying in August that one of his daughters was among the early vaccine recipients. Over the past months, Sputnik V has been offered to medical workers and teachers even as it was still in the middle of advanced trials. Several top officials said they also have received the jabs, and earlier this week the Russian military began vaccinating crews of navy ships scheduled to depart on a mission.

Health Minister Mikhail Murashko said Wednesday that more than 100,000 people in Russia already have received the shots. The free vaccine is offered to people aged 18 to 60 who don’t suffer from chronic illnesses and aren’t pregnant or breastfeeding.

The two-shot Sputnik V was developed by the Moscow-based Gamaleya Institute. An advanced study among 40,000 volunteers was announced two weeks after the vaccine received government approval and that is still ongoing.

Last month, developers of the vaccine said interim analysis of trial data showed it was 91.4% effective. The conclusion was based on 39 infections among 18,794 study participants that received both doses of either the vaccine or a placebo, which is a much lower number of infections than Western drugmakers have looked at when assessing the effectiveness of their vaccines. Two other Russia-designed vaccines are also undergoing tests.

On Wednesday, Britain became the first country in the West to authorize the use of a vaccine against the coronavirus developed by U.S. drugmaker Pfizer and Germany’s BioNTech. Russia has been swept with a resurgence of the outbreak this fall, with numbers of new infections exceeding the levels recorded early in the pandemic, but the authorities so far have refrained from a tight lockdown imposed in the spring.

On Saturday, Russia reported a new record high of daily infections at 28,782, including 7,993 in Moscow. The government task force has recorded a total of 42,684 virus-related deaths since the start of the outbreak.

Russia’s total of over 2.4 million confirmed cases is currently the fourth-largest caseload in the world behind the United States, India and Brazil.

Egypt establishes largest coronavirus vaccine factory in Middle East

September 10, 2021

Egypt is getting ready to open a large factory to produce coronavirus vaccines, at a time when the country is seeing a modest uptick in cases and inoculation rates remain low.

In cooperation with major international companies in the field of vaccines, Egypt is set to inaugurate the VACSERA factory complex in the 6th of October City, a suburb of Cairo, to produce various types of vaccines, including the seasonal influenza vaccine, pneumococcal vaccine and polio vaccine.

Egypt recorded 368 new cases of the coronavirus on Sept. 6, with the daily average over the preceding seven days standing at 319 cases. While this marks a slight increase from infections in July, it still remains well below the pandemic’s peak in the country in the summer of 2020, when cases were averaging over 1,500 per day.

Meanwhile, Egypt has seen a slow rollout of vaccinations. About 10.4 million doses have been administered so far, enough to inoculate just over 5% of the country’s 100 million plus population.

In July, Egypt started manufacturing the first batch of serum — 1 million doses — at the factory of  VACSERA Holding Company for Biological Products and Vaccines, in the Agouza neighborhood of Cairo, under the name "VACSERA-Sinovac made in Egypt."

On Aug. 30, Prime Minister Mustafa Madbouly inspected the factory complex to check on the preparations for the start of the vaccine production in the coming period.

He was accompanied by Minister of Health and Population Hala Zayed, Giza Gov. Ahmed Rashid and a number of leaders and officials of the Ministry of Health and the VACSERA factory complex.

During the tour, Zayed said that a coronavirus vaccine factory has been established on an area of ​​about 6,000 square meters (1.5 acres) to produce vaccines within the VACSERA factory complex, which extends over a total area of ​​60,000 square meters (15 acres). The vaccine factory is expected to start operating later this year.

The minister also explained that the production capacity of the factory will be 24,000 packages per hour. She said it is expected to be the largest vaccine production factory in the Middle East and Africa and a regional center for the manufacture and export of vaccines to African countries, thus localizing the vaccine industry on the African continent.

Asked about the vision of the VACSERA factory complex in the 6th of October City, Zayed said that it aims to produce various types of vaccines in cooperation with major international companies in this field.

On Aug. 23, the VACSERA-Sinovac vaccine obtained an emergency use license from Egypt’s Drug Authority, as it meets the global rules and references followed by the World Health Organization (WHO) to assess the safety, quality and effectiveness of vaccines and to confirm the sustainability of their availability.

Amjad al-Haddad, head of the Allergy and Immunology Department at the Serum and Vaccine Authority, told Al-Monitor over the phone that the main goal behind the local manufacture of the vaccine is to achieve what can be called Egyptian pharmaceutical security in the face of the coronavirus, which is still spreading through mutations.

Khaled Mujahid, assistant minister of health and population for media and awareness, and the official spokesman for the ministry, told Al-Monitor that based on the latest data for Egypt until Sept. 5, the total number of COVID-19 cases was 290,027, including 241,964 cases that have been cured, and 16,789 deaths.

However, he noted that studies and research confirm that this virus requires periodic vaccinations, thus proving the state’s need to secure a strategic stockpile of vaccines to cover the needs of Egyptian citizens.

Haddad said that this step undoubtedly exemplifies the Egyptian state’s keenness to preserve the health of Egyptians by meeting local needs and exporting the surplus.

He stressed that accelerating the pace of vaccinations in Egypt will protect the country against any regression waves as far the virus is concerned, which is the goal that the international community is striving to achieve, especially considering that the virus is mutating.

Ensuring the presence of vaccines, he added that it is also a guarantee that no new variants of the virus will appear if the entire population is vaccinated.

The chairwoman of the Board of Directors of the Holding Company for Biological Products and Vaccines (VACSERA), Heba Wali, told Al-Monitor over the phone that the vaccine factory includes ​​laboratories to monitor the production quality, with eight central laboratories equipped with the latest equipment to measure the stability and test the safety of the final product and the manufacturing inputs according to the standards recommended by the WHO.

The factory, she said, also includes refrigerators for preserving the vaccine in its various stages, starting from the raw materials to the final product, and the storage capacity in these cooling units reaches 150 million doses.

These refrigerators, she noted, are equipped in accordance with the international standards for preserving vaccines, as well as an electronic monitor to ensure safe storage.

Wali said that the two VACSERA factories were equipped and rehabilitated at a cost of 785 million Egyptian pounds ($50 million).

She said that the VACSERA factory in Agouza produces 300,000 doses of vaccine in one work cycle, which is roughly 60 days. The VACSERA factory’s annual production capacity is expected to reach 110 million to 220 million doses.

The factory, she concluded, is scheduled to produce during the next six months about 80 million doses in cooperation with the Chinese Sinovac.

Source: al-Monitor.

Link: https://www.al-monitor.com/originals/2021/09/egypt-establishes-largest-coronavirus-vaccine-factory-middle-east.

Citing high shot rates, Danes end COVID-19 restriction

September 10, 2021

COPENHAGEN, Denmark (AP) — After 548 days with restrictions to limit the spread of COVID-19, Denmark's high vaccination rate has enabled the Scandinavian country to become one of the first European Union nations to lift all domestic restrictions.

The return to normality has been gradual, but as of Friday, the digital pass — a proof of having been vaccinated — is no longer required when entering night clubs, making it the last virus safeguard to fall.

More than 80% of people above the age of 12 have had the two shots. “I wouldn’t say it is too early. We have opened the door but we have also said that we can close it if needed,” Soeren Riis Paludan, a professor of virology with the Aarhus University in Denmark’s second largest city, told The Associated Press.

As of midnight, the Danish government no longer considers COVID-19 “a socially critical disease.” Health Minister Magnus Heunicke said Aug. 27 that “the epidemic is under control” but warned: “we are not out of the epidemic” and the government will act as needed if necessary.

Jens Lundgren, a professor of viral diseases at the Copenhagen University Hospital said the government would be “quite willing" to reintroduce restrictions if infections spike again. He pointed at night clubs being the last thing to open because “it is the activity associated with the highest risk of transmission.”

“The world is in the middle of a pandemic and none of us can claim that we are beyond the pandemic,” said Lundgren who described Denmark as being “an isolated island” where the vaccine rollout has worked.

“Nobody should have the illusion that we are over this.” The tipping point in Denmark to start easing restrictions came when a majority in the age group of 50+ had the two shots, Riis Paludan said. Since Aug. 14, a face mask on public transportation is no longer mandatory. On Sept. 1, night clubs reopened, limits on public gatherings were removed and it was no longer mandatory to show the pass when one wanted to be seated inside restaurants, or go to soccer games, fitness centers or hairdresser.

However, the face mask or shield are still mandatory at airports and people are advised to wear one when at the doctor's, test centers or hospitals. Distancing is still recommended and strict entry restrictions still apply for non Danes at the borders. The outbreak is still considered “an ordinary dangerous illness.”

“The ghost of corona sits in the back of our head,” said Frank Oestergaard, a patron in a downtown Copenhagen restaurant. After more than a year, several European countries are starting to see the light at the end of the tunnel, but with caveats. Some have lifted restrictions but will introduce a vaccination passport. Others expect to do so soon. And in some places, there are few restrictions and they are not respected.

On July 19, the British government lifted remaining legal restrictions for England, though it still plans to introduce a vaccination passport for entry into nightclubs and other crowded venues at the end of September.

In Denmark's neighbor Sweden, which has stood out among European nations for its comparatively hands-off response to the pandemic, the government said earlier this month that most restrictions, including the ceiling for private and public gatherings and the advice to work from home, will be removed as of Sept. 29.

The Scandinavian country has not gone into lockdowns or closed businesses, relying instead on citizens’ sense of civic duty to control infection. According to official figures, 70% of people over the age of 15 have gotten both shots and nearly 82 % have received the first shot.

And despite a surge, most of the Balkan countries practically have no restrictions, and those which are in place are not respected. In late May, the Danish government presented the passport app featuring a QR code and a green bar if the person has been vaccinated twice or recently tested negative. A paper version also was available. People either had to scan the code or flash it before entering an airport, a harbor, a train station, a hairdresser or an eatery.

While in many European countries there were pockets of resistance such passes, people used it all the time in Denmark because people trust authorities, Riis Paludan said. Armed with their pass, people were able to get a haircut, have a drink with friends or attend a cultural event. “It was getting one’s freedom back instead of having to sit at home in isolation,” laughed Oestergaard.

“I think it’s very good, so hopefully we can get back to a normal day in the restaurant business without checking people and just no restrictions whatsoever. That’s nice,” said cafe owner Ralph Marker.

Bulgaria, EU's least vaccinated nation, faces deadly surge

September 08, 2021

VELIKO TARNOVO, Bulgaria (AP) — Standing outside the rundown public hospital in Bulgaria's northern town of Veliko Tarnovo, the vaccination unit's chief nurse voices a sad reality about her fellow citizens: “They don’t believe in vaccines.”

Bulgaria has one of the highest coronavirus death rates in the 27-nation European Union and is facing a new, rapid surge of infections due to the more infectious delta variant. Despite that, people in this Balkan nation are the most hesitant in the bloc to get vaccinated against COVID-19.

Only 20% of adults in Bulgaria, which has a population of 7 million, have so far been fully vaccinated. That puts it last in the EU, which has an average of 69% fully vaccinated. “We are open every day,” Yordanka Minekova, the chief vaccination nurse who has worked at the hospital for 35 years, told The Associated Press. “But people who want to be vaccinated are very few.”

Krasimira Nikolova, a 52-year-old restaurant worker, has chosen not to get vaccinated, saying she has doubts over the vaccines' effectiveness, even though the shots have been shown to be highly effective in preventing serious illness and deaths.

“I don’t believe vaccines work,” she told the AP. “I already had the virus. I don’t believe it’s so dangerous.” But Sibila Marinova, manager of Veliko Tarnovo’s intensive care unit, says the full COVID-19 ICU ward in her hospital shows that's simply not true.

“100% of the ICU patients are unvaccinated,” she told the AP, adding that staff shortages are only piling on more pressure. And she said she's angry that so many Bulgarians are refusing to get jabbed.

Bulgaria has access to all four of the vaccines approved by the EU — Pfizer, Moderna, AstraZeneca, and Johnson & Johnson. But since the start of the pandemic, more than 19,000 people in Bulgaria have died of COVID-19, the EU’s third-highest death rate, behind only the Czech Republic and Hungary. In the last week, an average of 41 people have died each day.

In response, the government imposed tighter restrictions Tuesday. Restaurants and cafes must close at 11 p.m. and their tables are limited to six people. Nightclubs have been shuttered and cinemas and theaters are limited to half capacity. Outdoors sports arenas are limited to 30% capacity.

“The low vaccination rate forces us to impose these measures,” Health Minister Stoycho Katsarov said. Despite being in a vulnerable age group, 71-year-old retiree Zhelyazko Marinov doesn't want to get vaccinated.

“I think I’m healthy enough and have a good natural immunity,” he said, adding that he could be persuaded to get vaccinated if he couldn't travel without a vaccine certificate. Mariya Sharkova, a public health law specialist, believes that Bulgaria's worryingly low vaccine uptake is the result of residents' low trust in official institutions, along with fake news about the shots, political instability and a weak national vaccination campaign.

“In Bulgaria, we don’t have good health literacy,” she told the AP. “Many people choose to believe conspiracy theories and fake news.” Only vaccines that are mandatory in Bulgaria — such as measles, mumps and rubella — have a high uptake. Sharkova said some blame has to lie with the government's vaccination program.

“They didn’t build any strategy on how to fight vaccine hesitancy,” she said. “We didn’t have any real information campaign for the vaccines. The ministry of health relies mainly on announcements on the ministry’s website, and I don’t think anyone actually goes on and reads it.”

“The best policy for such hesitant countries and populations as ours are mandatory vaccines,” said Sharkova, who is dismayed that national TV channels often invite vaccine-skeptic doctors to be on their programs.

But making COVID-19 vaccines mandatory could risk further polarizing the issue, she said. Hriska Zhelyazkova, a 67-year-old military officer from the coastal city of Burgas, says she distrusts vaccines because "they were created so quickly” -- apparently unaware that years of research laid the groundwork for the vaccine shots, which now have been used in hundreds of millions of people with exceedingly rare serious side effects.

Still, she said she may get vaccinated if authorities slap tougher restrictions on unvaccinated people. Back at the Veliko Tarnovo hospital, pro-vaccination drawings colored by children hang on the walls. “You are our superheroes,” one caption read.

But Minekova, the vaccination nurse, isn't optimistic about the future. “Somehow, I think it’s too late,” she said. “The right moment has been missed. I don’t see a way right now to solve this.”

Valentina Petrova contributed to this report from Burgas.