Serbia lets people choose their COVID-19 vaccine. Some call it a ‘political ballot.’

While delivery delays and shot shortages have set many European countries behind on their COVID-19 vaccine goals, Serbia’s immunization program is speeding ahead — and people have several options.

“We have all kinds of vaccines,” said Dinko Gruhonjic, an independent journalist and assistant professor at the University of Novi Sad in northern Serbia.

“This is a really big success for Serbia.”

“This is a really big success for Serbia,” Gruhonjic said.

Gruhonjic recently got his second jab of the Pfizer-BioNTech vaccine, which he chose from four COVID-19 vaccines currently available in Serbia.

Serbia is believed to be the only country in Europe allowing citizens to pick their preferred vaccine.

Related: The biggest challenge for vaccine workers in Pakistan? Staying alive.

Approximately 1 in 5 people in Serbia have received at least one shot, and some 500,000 of the roughly 7 million people in the country have gotten both, according to data that Serbian health officials provided to The World. Serbia’s vaccination rate per 100 people is only second to the UK’s.

Although some Serbians see the rollout as a big win for the country — and a rare victory at that — others are critical of what they see as the politicization of vaccines and say it’s too early, especially while COVID-19 cases are still surging, to draw concrete conclusions.

Dr. Dragoslav Popovic, a public health consultant and president of the Public Health Association of Serbia, has mixed feelings about the rollout, but he’s glad that vaccines are available to them.

He went with the Sinopharm shot.

“It wasn’t my first choice, but I realized I would have to wait too long for [my top pick],” Popovic said.

Through the government portal set up for Serbians to make their vaccine selection, Popovic opted for any vaccine that was available at the time.

“And I did the same thing for my mom, who is 85 [years old],” he said.

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“We are all completely shocked, especially when we see that … countries that we consider more developed are still in shortage of vaccines,” said Jovana Gligorijevic, deputy editor-in-chief of the Serbian weekly news magazine Vreme.

“Here in Serbia, we’re not used to the system working for us. We’re not used to the government working in our interest — in the interest of citizens.” 

“Here in Serbia, we’re not used to the system working for us. We’re not used to the government working in our interest — in the interest of citizens,” Gligorijevic added, pointing to the country’s global corruption ranking, and declining press freedom in the country.  

A ‘political ballot’

While other countries in the region have placed their bets on receiving vaccines through the European Union and the World Health Organization’s COVAX program, Serbia’s turned to its powerful friends in the East: Russia and China. The vast majority of the vaccines in the country today are made by China’s Sinopharm, a state-owned company.

Serbia’s neighbors are benefiting, too. Bosnia and Herzegovina, Montenegro and North Macedonia, which have struggled to procure any COVID-19 vaccines, all recently received shot donations from Serbia.

But Gligorijevic and others say there’s reason to scrutinize aspects of the government’s vaccine procurement and rollout.

“It’s complicated because you cannot criticize the fact that citizens of our country got the chance to get vaccinated really, really fast,” Gligorijevic said. “But there are still questions that are completely legitimate to ask.”

For her, those questions revolve around transparency and safety. She said the government hasn’t been forthcoming about how much it’s paid for procured doses. And she’s concerned about the safety of the most widely available vaccine in the country today.

Related: Vaccine envy? There’s a German word for that.

Unlike its Western counterparts, Chinese vaccine-maker Sinopharm has not published phase 3 trial data in peer-reviewed medical journals, and researchers say they are eager to see more data about how it calculated its efficacy rates. The vaccine has not yet received emergency authorization by the WHO, although its makers have submitted materials for emergency-use validation, which public health experts see as a promising step.

While delighted there are shots available for people in his country, Popovic criticized the government’s decision to allow people to choose their preferred vaccine.

“I would rather go with the German, for example, model in which we are saying: ‘We give you a vaccine which is safe, effective and which is the best for the age group and your overall health conditions … and we hope you can trust us.’”

Most people don’t have the expertise to make that decision based on scientific evidence, Popovic said, and he worries about the possibility of people — especially the elderly and those with health conditions, and others in vulnerable categories — postponing immunization to receive their preferred vaccine.

He added that under Serbia’s model, what should be a public health decision has “turned into a political … ballot.”

“Those who support the Russians … vote for the Russian vaccine. Those who have some sympathy for Chinese support to Serbia … prefer the Chinese vaccines.” 

“Those who support the Russians … vote for the Russian vaccine. Those who have some sympathy for Chinese support to Serbia … prefer the Chinese vaccines,” Popovic said. 

‘This is the first time our government did something right’

Statements by Serbian President Aleksandar Vucic have further politicized the issue.

Related: France launches citizens’ collective to tackle widespread vaccine hesitancy

“Some vaccines… coming from the East were even safer than the ones from the West,” he told the news outlet Euronews in February.

Vucic also claimed during an interview with Serbia’s public broadcaster that he had seen Western intelligence reports that indicated that Chinese vaccines were superior.

Vucic’s critics say the Serbian president is putting political gain before public health and rolling out the red carpet for Beijing to advance its geopolitical interests in a region it considers key to its trillion-dollar “Belt and Road” infrastructure initiative. In recent years, Beijing has been pouring money into Serbia’s mining and energy sectors.

Those involved with Serbia’s vaccine rollout say public health, not politics, has been the priority.

“People are dying of COVID[-19]. Our hospitals are full. And the only idea that we all have in Serbia … is how to stop this pandemic and to return to normal life as soon as possible,” said Dr. Vladan Saponjic, an epidemiologist with Serbia’s Institute of Public Health — equivalent to the Centers for Disease Prevention and Control — who’s helping coordinate Serbia’s immunization program.

He said COVID-19 vaccines are the best and most efficient weapon currently available to fight the pandemic, and that he’s “only grateful” that the Serbian government has successfully managed to procure jabs for people in the country — for now, and the future.

Citizens who are being immunized say they’re grateful, too.

“My whole life … I see my position as someone who is opposing the government. But this is the first time our government did something right.”

“My whole life … I see my position as someone who is opposing the government. But this is the first time our government did something right,” said Danilo Krivokapic, a lawyer and the director of a nongovernmental organization in Belgrade.

Krivokapic, along with his siblings and his parents, recently got the Sinopharm vaccine. Meanwhile, he said, many of his friends in Western Europe aren’t scheduled to be vaccinated until June, the earliest.

“This is unprecedented for us living in this part of the world,” he said. 

The challenges ahead 

Some say it’s too early to deem Serbia’s vaccine drive a success, and public health experts agree the coming months will be critical.

Dr. Saponjic, with Serbia’s Institute of Public Health, said his primary concern was ensuring that people who are immunized continue to follow safety protocols.

“Some people … start to relax, to remove masks or stop keeping distance, and try to go back to normal [too] soon. And that presents a certain risk.”

This week, some public health experts urged Serbia’s government to impose new restrictions in the country amid a sharp rise in new COVID-19 cases.

Popovic with the Public Health Association of Serbia said he’s also wary about what comes next.

“The work that is ahead of us will be much more challenging than it is today.” 

“The work that is ahead of us will be much more challenging than it is today,” Popovic said, describing those who have already been vaccinated as “low-hanging fruit.”

While Serbia has a framework prioritizing health care workers and the elderly, members of the general public are also currently eligible to get vaccinated and have been receiving COVID-19 jabs.

The challenge, Popovic said, will be vaccinating those who are harder to reach, such as people in rural areas and people who have hesitations about being inoculated.

“Without reaching them with the vaccines, we will not be able to close the virus transmission in a country,” Popovic said.