[Feature] Bulgaria is sacrificing its older generations – how to stop that?

“I see this happen all the time. This is such a devious virus. Seemingly stable patients, usually older, suddenly crash catastrophically before our eyes.”

The sadness and exhaustion in her voice reveal the enormous strain the medical staff and national health system in Bulgaria have been under.

While flying from London to Sofia to bury my 85-year-old father, not having seen him since May 2020 due to lockdown travel restrictions, I keep rewinding and fast-forwarding conversations I had with family members and doctors in the week preceding his death.

“He was so lucky to get a bed in a hospital, because usually anyone over 80 is turned away.”

“Dad had such a look of relief when he was told he was going to hospital. The fear in his eyes turned to gratitude.”

I feel grateful that my father died in the care of supportive healthcare professionals, a situation which is more than many older people can hope for in Bulgaria right now.

But at the same time, I feel deep frustration as I recall phone-calls I made to his personal doctor earlier this year about getting him a vaccine, only to be told none were available to him.

Since science had found a way to protect him, I so wish my father had been vaccinated so he could still be with us now. But he was one of the 93 percent of Bulgarians over 80 who have not been vaccinated.

Linked to the pandemic, death rates in Bulgaria increased by 16.6 percent in 2020, compared to 2019.

Nevertheless, the majority (52 percent) of Bulgarians reject Covid vaccines. Recent research revealed only 10 percent of respondents committed to being vaccinated, with 37 percent undecided.

‘Not hesitant – hostile’

From personal discussions and accounts, I have discovered that many in Bulgaria are not just quietly rejecting Covid vaccines. They are actively and vocally hostile towards them.

Like conquistadors on a mission to slay as many vaccine-believers as possible, people are lashing out at the science with histrionic statements, calling vaccines ‘a genocide for elderly people.’

Furthermore, there is a proud rejection of statistics attempting to kill off any rational pro-vaccine argument that might put a spoke in the non-vaccination wheel. If you eliminate the power of facts, relativity becomes king: “my view is as valid as yours.” The hierarchy of perspectives is deconstructed.

But here is the inconvenient truth about vaccines and this situation which is leading to the effective sacrifice of older people, including my father, in Bulgaria.

Older people are much more likely than younger age groups to die from Covid. That’s why they have been identified as one of the five priority groups for vaccination in Bulgaria, as elsewhere.

Yet Bulgaria has the lowest proportion of vaccinated overs-70s and 80s in Europe. By 13 April 2021, just seven percent of over 80s had been vaccinated compared, for example, to 100 percent in Sweden and 98 percent in Ireland.

At 12 percent, the figure for Bulgarian 70–79-year-olds is a little better, but the lowest within the EU. No ‘genocide’ of the elderly has been observed in the 79 percent of EU countries who have vaccinated over half of their over-80s population.

Not vaccinating this group puts a disproportionate strain on countries’ health systems and costs countries dearly.

Nevertheless, there has been no campaign by the Bulgarian government around safe vaccination outcomes for older people, nor are these being reported by the news media.

Bulgaria has the highest rate of Covid-related hospitalisation in Europe.

It has the second-highest death rate in Europe, and is in the bottom third of EU countries in terms of testing rates, perhaps because, except for those hospitalised, tests are paid for by the individual.

Tests too expensive

Costing around 100 leva [€51], roughly seven percent of the average monthly gross salary in Bulgaria, tests are out of reach for many, potentially leading to the underreporting of cases, late hospitalisations and higher mortality rates.

Heartbreaking anecdotal evidence I heard in Sofia painted a picture of overwhelmed hospitals across the country turning away people in their 70s and 80s or neglecting those admitted. This requires urgent further investigation.

It is already clear that the outgoing government’s vaccination campaign has hitherto failed to convince Bulgarians of the importance of protecting themselves and others from Covid.

Adding insult to injury, and in the spirit of dismissing statistics, the news media has often focused on the rare outliers whose deaths have been associated with vaccination rather than on the thousands (millions worldwide) who have survived because of it.

The government’s methods of contacting the elderly about vaccination have been woefully inadequate.

Instead of addressing the low vaccine uptake among priority groups, the vaccine programme was opened up to the wider public, effectively encouraging the ‘survival of the fittest’: the mobile and technologically literate filled the slots while the elderly were further marginalised.

During my week in Sofia, I frequently spoke to middle-aged acquaintances who had been vaccinated, while their parents had not, a fact brought into stark focus as four of us sat in a restaurant, all having lost a parent to Covid complications.

A government vaccination campaign that prioritises the elderly would not only save lives, but healthcare costs too.

Three easy steps

To be successful, it needs to do three things:

Showcase the success of the vaccines in other countries (and be supported in this by the news media) to counteract the widespread scepticism that exists;

Publish data broken down by age so that policy becomes driven by evidence rather than opinion;

Communicate with older people via post and telephone, channels they use, providing vaccinations close to home in familiar settings.

How a society treats its elderly population is a measure of its humaneness and the value it places on human life.

It is not enough to rely on the kindness of individual doctors and nurses, like the doctor who was with my father as he passed away.

As a society, we must take the decision to save lives. It is our duty to ensure that the older generations are treated with dignity and respect; that they are given the opportunity to live a healthy longer life; and that no doors are shut to them when they need help most. Let Bulgaria be that society.