Mass vaccinations against the coronavirus (COVID-19) of enough people to create herd immunity are seen as the only way to enable life to return to normal and economies to rebound. This is a problem for the Western Balkans, where not only are vaccine rollouts either yet to start or lagging behind their richer neighbours to the north and west, but officials also face the challenge of high levels of scepticism and belief in conspiracy theories about the vaccine. 

Take North Macedonia, where negative comments and conspiracy theories are swirling on social media, fuelling the fears of the substantial part of the population that are already skeptical about the vaccines, says bne IntelliNews’ correspondent in Skopje. More than 40% of respondents to a December survey by the Balkans in Europe Policy Advisory Group (BiEPAG) in North Macedonia said they would "certainly" not be vaccinated, while more than 10% said they "probably would not" be vaccinated.  

This will be a challenge for the authorities who want 60-70% of the population to receive the vaccine. Vaccination will be free and on a voluntary basis. Priority will be given to health workers from COVID-19 centres, citizens over 65 and chronically ill people — once the country finally receives its first vaccines. 

The most serious concern of those who do not want to be vaccinated is the safety of the vaccine, as it was developed over a short period of time, a common theme across the region. More exotic conspiracy theories also abound; around 50% of respondents to the BiEPAG survey believe the Chinese government engineered the coronavirus in a lab; other popular theories are that Microsoft founder Bill Gates is using the coronavirus to push a vaccine with a microchip capable of tracking people, that the US military developed the coronavirus as a bioweapon and a link between 5G technology and the coronavirus.

Overall, more than 75% of Western Balkans citizens believe in one or several COVID theories, considerably higher than the approximately one third across Europe. “[T]he strength of conspiracies in the Western Balkans, considerably more prevalent in wide segments of society than elsewhere in Europe, underlines and reinforces the lack of trust in society and institutions,” said the report, adding that “It is not easy to confront this volatile mix.”

No trust in governments or doctors 

In Bosnia, says bne IntelliNews’ correspondent in Sarajevo, people do not trust either their governments or doctors. Nor is there widespread observance of restrictions to prevent the spread of the disease. Signs that people have changed their behaviour in response to the epidemic — such as people wearing facemasks — are visible only in Sarajevo and a handful of other major cities but elsewhere people live as normal. 

This has contributed to varying infection rates across the country; in Sarajevo the official infection rate is 19% (though many locals believe it is really much higher) while in East Sarajevo in Republika Srpska, which is only two kilometres away from Sarajevo, the infection rate is higher than 60%. 

The death rate in Bosnia for the full year 2020 was actually lower than in previous years. Although it increased significantly in November, more people died from diseases other than COVID-19. People therefore attribute the increased mortality to the decision of the crisis staff to abolish examinations for chronic patients, adding to the lack of trust in doctors.

Most people do not plan to get vaccinated — even if it becomes mandatory — and this is especially true for doctors and nurses. According to the latest polls published in federal government documents, 55% of respondents say they will not be vaccinated, 18% are undecided and 27% would be vaccinated. So far, no reliable survey on vaccination has been published in Republika Srpska, but many citizens in this entity have indicated they would prefer to receive Russian vaccines.

Securing vaccines 

As of late January, only two Western Balkans countries — Albania and Serbia — had launched vaccination programmes. In both countries the prime minsters and other top officials were among the first to get vaccinated, doing so publicly in an attempt to lead by example and convince their populations that the vaccines are safe. 

Serbia has received vaccines from both China and Russia, as well as limited quantities of the Pfizer/BionTech vaccine. So far it has mainly rolled out the Russian vaccine, but in recent days 1mn doses arrived in Serbia from China. Surveys by Globsec show that 41% of citizens have confidence in vaccines, while 56% do not trust them and say they will not be vaccinated.

In Albania, Prime Minister Edi Rama was among the first to receive the vaccine, and on January 17 he announced that 369 doctors and nurses had received their first doses from 975 that arrived in the country as a donation from an EU member.

The government has secured 500,000 doses of COVID-19 vaccines in direct talks with Pfizer and BioNTech, which sparked a scandal as opposition politicians tried to force the government to say what it had paid for them, and Rama refused. According to local media reports, it will take between 14 and 24 months to vaccinate the population, starting with healthcare workers and the over-75s.

Serbia and Albania have at least started their vaccination programmes; the other four countries are still waiting to receive vaccines. 

North Macedonia expects to receive 800,000 vaccines each through three mechanisms, or 2.4mn in total, later this year and probably running into 2022. The first 5,850 doses of the Pfizer vaccines that were agreed through direct talks should arrive in February — though regulatory body MALMED has said there is a problem with the first Pfizer shipment as legal changes must be passed by the parliament. The government then expects another 17,550 in March and at least as many in April, with the rest to be shipped by the end of the year. Next month Macedonia should also receive the first doses through the Covax system, but the number of doses is not yet known. 

The government has been criticised by the opposition parties for being slow in securing COVID-19 vaccines after vaccinations started in Serbia and Albania. 

Kosovo has ordered 600,000 doses of the COVID-19 vaccine that is being developed by German biopharmaceutical company CureVac, but it has not been approved yet.  

The government of Kosovo’s outgoing Prime Minister Avdullah Hoti said earlier that Kosovo will provide 535,000 Pfizer vaccines, 600,000 vaccines through Austria, without specifying the name of the manufacturer, and 720,000 vaccines through the Covax system.  

The first doses are expected to arrive in Bosnia in February. The Bosnian Federation government adopted a vaccination plan against COVID-19 in mid January, with a goal of vaccinating at least 50% of the population. Vaccination will be voluntary and free, and the government has provided BAM13.6mn for the procurement of vaccines through the Covax mechanism from the 2021 budget. 

At entity level, the Bosnian Federation has pre-ordered an additional 800,000 doses of vaccine through a joint procurement by the European Commission. Republika Srpska contributed BAM5.7mn for the procurement of vaccines via Covax.

Losing patience with the central government’s efforts to secure vaccines, the government of Sarajevo Canton has instructed its Health Insurance Institute to initiate the procurement of vaccines. "We can no longer wait for the BiH Council of Ministers to procure vaccines, so we will start procuring them ourselves,” said Edin Forto, prime minister of the government of Sarajevo Canton.

So far, the Montenegrin government has focused solely on trying to obtain vaccines via Covax, but officials have indicated they are open to procuring vaccines from any source including China or Russia. 

EU "only thinking of itself”

The crisis has led the often divided nations of the Western Balkans to help each other out. North Macedonia, for example, will soon receive its first 8,000 doses of Pfizer vaccines from Serbia. 

Meanwhile, Rama attacked the EU as it became clear that the EU-aspiring Western Balkan states would be left behind by richer nations when it comes to securing vaccines. He said the bloc’s actions were "morally and politically unacceptable” and that the EU was "only thinking of itself".

"If you see how the European Union has conceived this process, for the moment it has decided to think only of itself … It has been left to the discretion of member states to build interactive processes for vaccines in bilateral ways with non-EU countries,” said Rama in mid-January. 

This was despite the €3.3bn package mobilised by the EU support the Western Balkan countries during the pandemic and the €70mn package adopted under the Instrument for Pre-Accession to help fund the access of Western Balkans partners to COVID-19 vaccines procured by EU member states.

Recovery linked to vaccination 

The later rollouts of vaccine programmes in the Western Balkans countries is problematic not only because of the human cost; the speed of economic recovery in the region countries as elsewhere will depend to a large extent on the vaccine rollout. 

A World Bank report released on January 5 stressed the importance of vaccine rollouts in enabling the recovery from the economy slump resulting from the pandemic. The development bank forecasts regional growth of 3.5% n the Western Balkans this year. However, it stressed that its outlook for the wider Central, Southeast and Eastern Europe and Eurasia region “predicated on the distribution of an effective vaccine early in 2021 in advanced economies and major emerging market and developing economies, including Russia, and later in the year for other countries.”

Albania’s central bank governor Gent Sejko has also said he believes that the economic crisis caused by the coronavirus pandemic in the country will be short-term and the rebound should be quick — if vaccination brings life back to normal.

There are other factors, not least the vaccine rollout and economic recovery in the EU countries that are the Western Balkans countries’ biggest markets and main destination for their economic migrants, meaning that as the EU economies especially Germany start to recover, those in Southeast Europe will too. Yet just like during the migrant crisis five years ago, there is a sense that despite their efforts to effect the reforms needed to integrate with the EU, as another crisis strikes the Western Balkans are again being left behind.