BELGRADE -- Serbia's hard-fought head start using an early embrace of non-Western vaccines at the risk of jilting its EU neighbors could be disintegrating at a crucial phase of the coronavirus pandemic.
Demand for any of four vaccines Serbia offers is lagging behind supplies in one of the former Yugoslavia's most closely followed countries, despite the arrival of at least 2 million doses and an open door to vaccination for anyone who wants it.
Two of the shots -- Pfizer/BioNTech and AstraZeneca -- have been approved by European regulators, while the other two -- China's Sinopharm and Russia's Sputnik-V -- have not.
The online application drive appears to be getting tripped up by a stubborn combination of anti-vax sentiment and conspiracy mongering, general mistrust of authorities, and the government's proud embrace of its front-runner status in the global race to achieve herd immunity.
"It's a handful of information that's constantly changing, exchanging, refuting each other: these affect [fertility], these don't, these have been tested," says Emil, a 29-year-old from Nis, Serbia's third-largest city.
He attributes his reluctance to apply for a shot to "mistrust."
"Somehow it's not just trust, but also uncertainty about whether those people themselves know what they're talking about," Emil says.
Another resident of this ancient gateway city between East and West, 28-year-old Nevena, says she's afraid of how a vaccine might affect her fetus.
"It takes at least a year for the vaccine to be tested for use in order to be safe," she says, highlighting a concern around the world since the speed of the COVID-19 vaccines shattered previous records for development. "Many scientists say that all that has not been examined yet."
While acknowledging that there were no major clinical trials of vaccines on pregnant women, health experts and researchers say there were no ill effects from the vaccines on pregnant lab animals and that they are closely monitoring pregnant patients during the rollout.
They also stress that pregnant women are at a higher risk than most people of having severe COVID-19 symptoms.
Both the World Health Organization (WHO) and the U.S. Centers for Disease Control, for instance, advise pregnant women to get vaccinated.
No, Thank You
Sign-ups were opened to all of Serbia's nearly 7 million residents on January 11, mostly through an e-government portal.
By February 27, more than 21 doses had been administered per 100 citizens, according to government figures (two doses are advised for each of the vaccines approved so far in Serbia).
That placed Serbia's vaccine rollout fifth in the world behind only Israel, the United Arab Emirates, the United Kingdom, and the United States among states or territories with populations above 100,000.
But crucially, more than six weeks into the campaign, only around 1 million people had signed up for a shot by late February.
That leaves around 5.5 million Serbians seemingly in no hurry and on no timeline for vaccination.
In addition to inherent risks, such lethargy could be magnified by an easing in attitudes to social distancing and other restrictive behavior that could cost lives down the line.
As Serbia's vaccination rate outpaced much of Europe and the world in the latter half of February, its infection rate surged.
Marija Gnjatovic, a research associate at the Institute for the Application of Nuclear Energy (INEP) in Belgrade, says people have relaxed too much and know too little about when they can be considered protected in some way.
Most Serbians have so far received the Chinese-made vaccine Sinopharm, she says. "This vaccine is very high-quality and very good, with few side effects, but it produces antibodies more slowly compared to the [newer] technologies, like the Pfizer and Sputnik-V vaccines," Gnjatovic says.
She adds that "We can't see the effects yet of vaccination in Serbia -- they'll only be visible in the next month to two months."
Most experts think it will take at least 70-80 percent of a population to achieve herd immunity against COVID-19, when enough people's immune systems are primed through vaccination or previous infection to stifle illness and hopefully transmission.
Herd immunity against measles requires about 95 percent and polio around 80 percent, according to the WHO. But a member of the Serbian government's COVID-19 crisis team, epidemiologist Branislav Tiodorovic, has suggested herd immunity could be reached at just 60 percent. He also predicted Serbia would roll into summer with only sporadic cases.
But even to reach that low bar, Serbia needs 3 million more of its citizens to sign up and get vaccinated.
Highly Politicized
That could prove challenging, given the intense politicization of COVID-19 and the vaccine effort in Serbia.
Senior Serbian officials starting with President Aleksandar Vucic dismissed the coronavirus outbreak early on in a public bid to court goodwill from China.
Another member of the government's current crisis team, Branimir Nestorovic, famously stood next to Vucic and urged Serbian women to go shopping in Italy in late February 2020, just as that country was becoming Europe's COVID-19 "hub."
Vucic and the government soon pivoted into a lockdown, but they reopened ahead of summer elections against a backdrop of rising cases and subsequent evidence that infection figures were being suppressed.
Boosted by an opposition boycott, Vucic and his Progressive Party emerged with a strong majority in parliament in the June elections.
He then parlayed his courtship of Beijing into more than 1.5 million doses of the Sinopharm vaccine beginning in mid-January, making Serbia the first European country to receive that Chinese-made vaccine.
The WHO and EU medicines regulators still have not approved either Sinopharm or Russia's Sputnik V vaccine.
Dario Hajric, a sociologist and political commentator, bemoans politicization as "the big problem" with the vaccine rollout, saying it was "set that way on the official side from the start."
"First we had that shameful mockery of the virus, so we had a certain 'Dr. Nestorovic' promoted to media star, [then] we had juggling the real numbers of infected and dead before the elections, [and] the purchase of the vaccine was turned into a personal feat of the president," Hajric says.
"All of that undermined the trust in the state, in the crisis headquarters, in the health-care system."
He says the "infodemic" of misinformation that has plagued pandemic responses around the world -- it's a term first put into widespread use by the WHO -- contributes to the distrust of official information, including about the origin of the coronavirus and vaccines.
A BiEPAG study from late last year indicated that more than half of respondents in the Western Balkans would not get vaccinated.
"People trust obscure Facebook groups more than they trust the World Health Organization, which is a wider problem than Serbia itself," Hajric says.
Pushing Back
Ivana Prokic, an epidemiologist and coordinator of the local United Against COVID (UPK), says promoting vaccination is a painstaking job in a society with so many anti-vaxxers and a broader problem with misinformation that predates COVID-19.
Her group, which unites thousands of doctors and other medical professionals, has already filed a complaint against the government crisis team's Nestorovic. UPK claims Nestorovic has repeatedly spread scientifically disproven information along with other specious claims, among other things.
Nestorovic, who frequently posts articles challenging conventional wisdom on the pandemic including one this week describing it as the "biggest health scam of the 21st century," has invited UPK representatives to debate him on television.
Meanwhile, the UPK is busy pressing for better public information about vaccination, including dispelling many of the myths that are putting the brakes on the sign-up effort.
Prokic agrees with Hajric that Vucic and the government's public boasting at its early success procuring vaccines -- it was over 2 million doses at last count -- could be hampering the outreach effort. "That campaign also encourages those who are hesitant to think that it may not be necessary to get vaccinated," she says.
In the absence of a significant rise in public enthusiasm to get vaccinated, she suggests that Serbia's only option might be a politically explosive battle over mandatory vaccination.
"At least for the riskiest groups, or in the event of travel, which are by no means foreign concepts because they already exist with other vaccines and travel to certain countries, [mandatory shots might be necessary]," Prokic says. "A milder variant would be optional vaccination but access to state institutions, educational institutions, workplaces, and public transportation [would be prohibited]."
Meanwhile, back in Nis, 65-year-old Miroslav says his son got vaccinated and signed his father up right away.
"Just in the last 10 days, the number of people suffering from coronavirus has increased," he says. "For preventive reasons, I decided to get vaccinated. If it's good enough for you, it's good enough for the people close to you."
