As the countries of the Balkans strive to secure sufficient supplies of COVID-19 vaccine, many questions remain unanswered – how much will there be, when will it start and what will it all cost?
By Anja Vladisavljevic, Xhorxhina Bami, Sinisa Jakov Marusic, Samir Kajosevic, Danijel Kovacevic, Marcel Gascón Barberá, Svetoslav Todorov and Sasa Dragojlo
With UK grandmother Margaret Keenan becoming the first person in the world to receive the Pfizer/BioNTech COVID-19 vaccine as part of a mass vaccination programme on December 8, the countries of the Balkans are also stepping up preparations for a vaccine rollout.
But as states rush for their share of limited vaccine supplies, there are still many unknowns, not least how much it will cost and will there be enough.
Most countries in the region are part of the COVAX system, launched in April by the World Health Organisation, WHO, the European Commission and France to provide access to COVID-19 diagnostics, treatments and vaccines.
“Once a safe and effective vaccine(s) against COVID-19 will be available and licensed, we must ensure its fair distribution and access for all countries, irrespective of their income,” the WHO told BIRN.
By joining COVAX, countries classed as either ‘self-financing’ or ‘funded countries’ will gain access to its portfolio of vaccines.
Those that are self-financing will be guaranteed sufficient doses to protect a certain proportion of their population, depending on how much they buy into it; funded countries will receive enough doses to vaccinate up to 20 per cent of their population in the longer term.
The WHO says the programme represents “a huge success for multilateralism and cooperation.”
But that has not stopped many countries from pursuing insurance policies through separate, bilateral agreements with vaccine manufacturers. And the countries of the Balkans are no exception. The sums of money involved, however, are still largely secret.
Concern over vaccine hoarding
The European Commission, the executive arm of the European Union, is running a single central procurement procedure with vaccine manufacturers on behalf of all 27 member states, including Balkan countries Croatia, Bulgaria and Romania.
A spokesperson for the Commission said member states had signed an agreement under the EU Vaccines Strategy “setting out their commitment not to enter into parallel negotiations with vaccine manufacturers to those being led by the EU.”
According to the Croatian Public Health Institute, as part of the EU Vaccine Strategy, the country has ordered 5.6 million doses of coronavirus vaccine for the first phase of vaccination from a number of manufacturers including AstraZeneca, Pfizer, Johnson & Johnson, Moderna and CureVac.
Prices, however, “are a corporate secret,” the Institute says on its website, “and the negotiators agree to not disclose this information to the public.”
But Bulgaria has put a figure on how much it will spend to secure enough vaccines for the country of seven million people – nearly 194 million euros, according to an announcement made during a meeting in early November between Prime Minister Boyko Borissov and the country’s expert medical team dealing with the fight against the spread of COVID-19.
At the time, Bulgaria was pursuing the vaccine made by Janssen Pharmaceutica NV of Johnson & Johnson. It has since signed with Pfizer, securing an initial 125,000 doses – enough for 60,000 people – via the EU Vaccines Strategy at an undisclosed price.
Health Minister Kostadin Angelov has said he expects vaccinations to begin shortly after December 31, while senior health officials have said the plan is to vaccinate 70-75 per cent of the population in the near future.
In neighbouring Romania, President Klaus Iohannis announced in early November 3 that the country would receive, through the EU, 10 million doses of COVID-19 vaccine but, again, nothing has been disclosed about the prices involved.
Iohannis said a first batch of more than a million doses will arrive during the first quarter of 2021.
Romanian Health Minister Nelu Tataru has vowed that the government “will acquire vaccines for the whole population”, but gave no details on where from or at what cost. “They say you can speak about immunization when you have 60-70 per cent of the population vaccinated,” Tataru said at the end of November.
In line with EU rules, Bucharest has pledged to donate a part of the vaccine allotment it receives to neighbouring Moldova, a former Romanian province with which it shares close cultural and linguistic ties.
Moldova this month also requested support via the COVAX initiative.
“All participating countries, including the Republic of Moldova, regardless of income levels, will have equal access to these vaccines once they are developed,” the country’s ministry of health said.
There is growing concern, however, over vaccine hoarding by rich countries at the expense of poor.
“Bilateral contracting between rich countries, groups of countries and producers definitely affects the availability of products in the rest of the world,” said Ana Vracar, who has spent years researching global and local health issues as programme coordinator at the Organisation for Workers’ Initiative and Democratisation, BRID, in Croatia.
Vracar cited an estimate from the World Federation of Public Health Associations, WFPHA, that so 80 per cent of vaccine doses that could be produced in 2021 are already reserved for high-income countries that are home to only 20 per cent of the world’s population.
“In practice, this means that the remaining resources will be very expensive and therefore inaccessible to lower-income countries,” Vracar told BIRN.
The WHO told BIRN it was committed to “fairness and equity” in the distribution of public health goods.
“While the agency is not naive to ongoing bilateral deals and national interests, the COVAX effort to build a global endeavour towards collective action can and will enhance access for all despite nationalistic behaviours,” it said.
Besides COVAX, Serbs eye Russian and Chinese vaccines too
According to President Aleksandar Vucic, Serbia has so far secured 1.8 million vaccine doses via COVAX, with a first shipment of 10,000 expected in December, a further 340,000 in Q1 2021, 500,000 in Q2 and Q3 and 450,000 in the last three months of the year.
Vucic said it looked likely to be Pfizer, but that Belgrade was also negotiating with Orthodox ally Russia as well as China.
“We negotiate with everyone else who could also provide the vaccine, since we need much larger quantities,” Vucic told media.
But it is not known how much money Serbia put into the COVAX system or into bilateral deals with other countries or companies. BIRN asked the health ministry for details but received no reply.
In Bosnia and Herzegovina, the state government says the country should received 1.23 million vaccine doses next year, via the COVAX system.
The government says this will cover roughly 20 per cent of the population, on the assumption the vaccine requires two doses.
But like Serbia, the mainly Serb-populated Republika Srpska, one of two entities in Bosnia, is also bidding for the Sputnik vaccine produced by fellow Orthodox Christian ally Russia.
“We are intensively negotiating with the competent Russian institutions on the delivery of the Sputnik vaccine, and, realistically, the first contingent will be delivered to Republika Srpska in February next year,” Dusko Perovic, head of the Republika Srpska Representation in Moscow, told the Republika Srpska news agency Srna on December 7.
For the vaccine to be used legally, however, it needs approval from the Bosnian Agency for Medical Products and Medical Devices, not merely the Republika Srpska health ministry.
For some, COVAX is the only way
Montenegro is so far relying solely on COVAX, which it signed up on October 9. Podgorica agreed to pay 646,000 euros for 248,800 doses, or enough for 20 per cent of the population.
The health minister at the time, Kenan Hrapovic, said the COVAX initiative was “the most favourable option for all less developed countries and countries in transition, including Montenegro, in terms of procurement of vaccine for COVID-19, because it provides a high degree of safety and transparency.”
North Macedonia, a country of just over two million people, also expects to receive 800,000 doses via the COVAX initiative, with the government already setting aside 6.7 million euros to pay for it.
“The first vaccine that will be approved on the market will be equally distributed among all countries that have applied through the COVAX mechanism,” the country’s health ministry said.
“At the same time when the most developed countries get the vaccine, we will get it too. The exact time is not known yet but expectations are that this could happen near the end of December or January.”
Skopje is also looking at ways to secure another 800,000 doses directly from manufacturers, including Pfizer and AstraZeneca.
Kosovo signed up to the COVAX initiative this month, with Health Minister Armend Zemaj announcing on Facebook that 360,000 doses would be provided for free. Zemaj has said the country plans to secure a total of 1.2 million through different channels.
Ismete Humolli of the WHO in Kosovo told Voice of America that vaccinations in the country may begin in mid-March or early April.