April will forever be in my memory as a month of painful unfairness: it is when I had my first Covid-19 vaccine in the UK and my unvaccinated father died of the virus in Bulgaria. I’m a middle-aged, healthy woman. My father was a vulnerable 85-year-old with underlying health conditions.
I have a pile of letters from the NHS that arrived for my father since January, inviting him to get a vaccination in London, the city he left for his native Bulgaria six months before. With sadness and disquiet, I wonder why Bulgaria did not protect my father in his old age while the UK’s NHS has made every endeavour to do so. Why have I been protected in my middle age while about 90% of Bulgarians over 80 have not?
Bulgaria is a small country rarely covered in the global news, and its Covid-related deaths are one tiny dune in the desert of lives lost around the world. But it provides a valuable case study, a cautionary tale of why an economic, rather than an ethical, vaccination policy is bad for any economy.
Bulgaria is part of a regional virus hotspot: four of the seven countries with the highest cumulative death rates in the world, significantly higher than in India, are in the western Balkans. Bulgaria is one. Meanwhile, on 4 May the health minister, Kostadin Angelov, made the extraordinary claim that “the third wave of Covid-19 passed virtually unnoticed in Bulgaria. Our medics coped”.
I’m shocked to discover how scant the evidence is. Bulgaria appears to be one of the few EU countries for which the European Centre for Disease Prevention and Control does not publish age-related Covid mortality data. This in itself is a meaningful finding: when it comes to Covid policymaking, Bulgaria does not apply an “age lens”, or perhaps any demographic data lens at all. Further digging unearthed a little-known source that has recorded every Covid-related death in Bulgaria since April 2020. My colleagues at Addy Kassova Audience Strategy (AKAS) crunched the data to aggregate it by demographics, and a stark contrast with Britain emerges. Bulgaria’s saving-the-economy approach to vaccination versus the UK’s saving-lives approach have led to vastly differing outcomes for the over-70s.
Dimitrina Petrova is a Bulgarian health equality expert and civil society leader. Her research indicates that the Bulgarian vaccine plan, the primary purpose of which is to curtail the spread of Covid rather than to save lives, is immensely unfair towards the old. It has unclear goals, but prioritises the economically active, less vulnerable younger population over the economically inactive, more vulnerable older population. In Bulgaria, those over 65 were in the fourth group on vaccination priority lists, giving way, says Petrova, to “pretty much everyone else in society” – the health workforce, teaching staff, anyone involved in “basic public life activities”. Belatedly, the government announced this week that over-60s will now be prioritised for vaccination.
The UK’s priority groups are clear. Primarily, the aim is to reduce Covid mortality and only then to curtail its spread. The first five groups to be offered vaccinations in England (with a similar pattern in the other UK nations) covered everyone over 65, starting with the most vulnerable. Petrova concludes that the Bulgarian vaccination plan “places higher value on the state apparatus and the economy than on human life and health” and therefore “creates inequality by not prioritising those that need vaccines most and prioritising those who already benefit from more power and resources”.
In the week of my father’s death, Bulgaria had the 2nd worst Covid-related mortality rate in the EU while the UK had the fourth lowest death rate in Europe. On 8 April (the day he died), 7% of Bulgaria’s over-80s had received at least one vaccine, compared with about 97% in England for the same age group. A month later, Bulgaria’s figure was just 10%.
I’m stunned by this data: a generation of older people in Bulgaria have been sacrificed in a trade-off with the economy. I remember the calls I made to my father’s doctor, asking for him to be vaccinated. “He is too low on the priority list”, I was told, “there are no vaccines available for him”.
The situation is exacerbated by the government’s disingenuous narrative about the pandemic’s third wave, its failing vaccination campaign, and by the media, which is accused of “pursuing scandal and views at the expense of clarity and understanding” and failing to hold the government to account.
My father’s life is one among thousands lost in Bulgaria. He was 85, a man of ample vitality who should have had more time. His death was preventable. The government’s policy amounted to saying he was no longer of economic value to society, so his life was less worth saving.
Yet an approach that relies on curtailing Covid rather than saving lives is ultimately bad for the economy. In not protecting the most vulnerable, the healthcare system is endangered, the pandemic is prolonged and the economy stalls further. The UK, where policies also failed elderly people in the first wave, corrected its approach with a vaccination programme anchored in preserving lives. Is the value governments place on human life a measure of how well equipped a country is to cope with major crises? I’m inclined to think it is.