Montenegro's vaccination adventure: Lord, bless us with good health
Back in the day, the mega-popular regional star Lepa Brena sang the lyrics "Bless us, Lord, with health and joy" (“Daj, Bože, zdravlja i radosti”) in one of her songs. Although this hit is now over three decades old, the refrain is especially relevant today.
There aren't many parameters according to which a country with a population of just over half a million, such as Montenegro, can compare to countries with multifold inhabitants. This makes the successes of Montenegrin citizens, including athletes, who have worked hard enough to stand side by side with the best in the world - even greater and more worthy of respect. In the last few months, Montenegro, this time evoking regret instead of pride, has broken numerous records, be it regional or global, when it comes to the number of coronavirus cases.
Corona - free, corona everybody
In the middle of last year, the previous government, after declaring the end of the epidemic, since no new cases of contracted coronavirus had been recorded for approximately a month, tried to encourage tourists to visit the country. The campaign had the slogan – a "corona-free" destination. Before reaching the planned goal, new cases were registered and the "corona-free" motto was cynically reformulated on social media as "corona for everybody". At the end of 2020 and the beginning of 2021, the number of active cases exceeded 10 thousand, while at the beginning of March, that number was somewhere from eight to nine thousand. Montenegro has made its way to the infamous second place in the world in terms of the number of patients per million inhabitants. When the number of hospitalized persons per 100 thousand citizens is taken into account, the picture is quite bleak - in Montenegro this number is 72, while for example, in Macedonia it is 32. The number of deaths since the beginning of the epidemic exceeded one thousand, and only in February more than 150 people died as a result of COVID-19. Another infamous record was broken on March 8, when as many as 18 people died.
Although one doesn’t have to be an expert in epidemiology to see that this struggle is actually a struggle between life and death, society at large has completely been focusing on politics for more than half a year. At the end of August, for the first time in 30 years, the government of the Democratic Party of Socialists and its coalition partners were defeated in the elections. This brought about months of negotiations, delays (the 2021 budget has not been adopted by the beginning of March) and, albeit not formally, but essentially - a state of emergency. While all eyes are on political actors, few have noticed that the scenography or the backdrop for that political play is not looking so swell.
Medicine in the age of politics
When it became obvious that the introduced, abolished, amended and adjusted measures to combat the coronavirus did not yield the expected results, with yet another summer tourist season at the doorstep, the focus of public interest shifted to the procurement of vaccines. Tourism comprises almost a quarter of the country's GDP, and last year's tourist revenues were down by an incredible 90 percent, while in the region the "deficit" was around 50 percent. One needn't be an epidemiologist or a tourism expert to understand the following fact - without faster immunization of the population, there’s no returning to the way things were. Unfortunately, Montenegro once again did not find itself at the top in any parameter in this regard. Vaccination of medical staff began in February and continued in March with vaccination of the highest priority category - the population over 80 years of age.
The beginning of the mandate of the new Minister of Health, Jelena Borovinić Bojović, was marked by looking for the culprits for immunization not having started yet. As she has repeatedly put it, the one responsible for the slow pace is the previous Minister of Health, Kenan Hrapović, because, as she claims, among other things, not only did he not provide vaccines on time, he did not even reply to e-mails, after the initial interest in procurement. Due to suspicion of negligent work, Hrapović is also being investigated by the Special State Prosecutor's Office.
The ongoing vaccination started thanks to donations from Serbia and China, which donated two and thirty thousand doses respectively. In the meantime, five thousand of the 50,000 vaccines agreed in the negotiations with Russia were delivered. All this is an additional reason to add a new act in the political play, where the current majority is characterized as pro – Serbian i.e., pro - Russian. This has not changed and very likely will not change despite the fact that the Government extended the sanctions to Russia the day after the Russian "Sputnik V" vaccines were delivered, following EU foreign policy.
According to the announcements of the Minister of Health, over half a million vaccines will arrive in Montenegro in the coming period, approximately 200 thousand doses of "Sinofarm" from China, the same number of Russian "Sputnik V", and preliminary agreements for 150 thousand doses of "Pfizer" are underway. According to currently available information, the lattermost mentioned manufacturer has ceased production and distribution on a global level, so it is not possible to talk about more precise delivery deadlines. Within the COVAX initiative, over 80 thousand doses of "AstraZeneca" are expected, delivered in several stages. Talks are also ongoing with producers "Johnson" and "Moderna“, but they are on a “long stick", so they can hardly be expected to arrive during this year.
Health has no price, but vaccines do. However, as far as the exact price is concerned, there is no information so far. The budget has not been adopted as at the beginning of March, so it is not known how much or how they will be paid. Probably more telling than this is the fact that there was absolutely no interest of the public and the media for this information.
Vaccination is carried out on a voluntary basis. In order to better organize the whole process, a website was set-up where citizens can express their interest in immunization. As at the beginning of March, approximately 30 thousand citizens have registered. However, this is of very slight significance at this moment, because there aren't enough vaccines for everyone. Once sufficient vaccines have been obtained, the population can expect more information about when and where they will be able to get their jabs.
The "National Strategy for Introduction, Distribution and Application of COVID-19 Vaccines" determines the priority categories for immunization - healthcare workers, about 20 thousand citizens over the age of 80, 15 thousand people aged 75 to 79, 24 thousand citizens aged 70 to 75, and in the fifth group there are almost 50 thousand citizens aged 65 to 69. When mass immunization of the general population starts, it will also cover foreigners with permanent residence in Montenegro.
The above number of vaccine doses is close to that required for immunization of the Montenegrin population. However, judging by some worrying tendencies that have come up in the beginning, it could happen that there is a "surplus". Research conducted at the end of 2020 showed that close to 40 percent of citizens are interested in getting the vaccine. In early March, that number was slightly higher, however it did not exceed 50 percent. This trend was made evident by a particularly worrying fact that in Podgorica, where the Clinical Center, the Health Center and numerous private outpatient clinics are located, less than 400 health workers have applied for vaccination.
Risk of a new epidemic
This is not the first time for this tendency of questioning the effectiveness of vaccines and their potentially negative consequences, to appear. Due to the low response of parents to the call to immunize their children with the MMR vaccine, which protects against measles, mumps and rubella, the state is almost constantly facing a potential epidemic. A few years ago, a campaign was launched to reverse this trend, but to no avail. Sanctioning didn’t work either. In 2019 alone, almost three times more parents were fined than from 2013 to 2017. A total of 140 parents paid approximately 15 thousand euros in fines. Almost 90 percent of children born in Podgorica in 2014 were vaccinated against MMR, and that percentage of children in 2019 dropped to just over 10 percent.
So, only one in ten children got the vaccine. Pediatrician and longtime director of the Health Center in the capital, where almost a third of the population of Montenegro lives, Nebojsa Kavaric, warns that the fact that there hasn’t been a smallpox outbreak is a mere coincidence and that what keeps that catastrophe at bay is the previously acquired collective immunity. "It is enough for one child in the contagious stage - four days before the appearance of measles and four days after recovery - to spread the disease and we will have an epidemic on our hands," Kavarić said. What a smallpox outbreak would mean in the midst of a coronavirus pandemic is clear to anyone who can add and subtract up to ten, but the question is whether the doctor's warnings can be heard with the ongoing political show, which will likely have as many episodes as those Bollywood production shows.
Redrawing of measures
The aforementioned Kavarić M.D. lost his job at the Health Center after more than 30 years of service. Apart from being a doctor, he is also a member of the party DPS that was in power up until recently. He is just one in the line of directors of health centers, hospitals and clinics, who were replaced after the election. Truth be told, all of them were also prominent members of the majority coalition in power until August. If the situation was not as it is, the replacement of doctors probably would not have caused so much concern among the citizens. The government elected at the beginning of December promised that there would be no more politics in the adoption of measures to suppress the pandemic, instead they would turn to "the experts". The public has obviously mistakenly assumed that they meant medical experts, and not experts in economy and finance.
By mid-March, it had been announced on two occasions that doctors were advocating a full lockdown. Both times, the government decided to introduce more restrictive measures, but not a lockdown because, as explained, it would mean complete collapse of the economy. After so many changes and adjustments of measures, no one is clear what is allowed, as well as when and where, and the recommendations and prohibitions intended for the preservation of health have once again become the subject of ridicule, especially on social media.
God, give us health
Prime Minister Zdravko Krivokapic, who came to that position as a person with no party affiliation, yet close to the church, was filmed several times violating the measures and not wearing a mask during religious ceremonies. He apologized for that to the citizens in a video message, and a few days later he did the same thing at the funeral of Bishop Atanasije in Trebinje.
The credibility of the Government is hanging on by a thread (just as the economy). If it should happen for it to completely lose credibility in a fight where the goal is the same for everyone - and that is health, it will unlikely be able to implement the reforms it is promising. Our "scenography" is not in best shape, and we are yet to find out what is happening behind the scenes, but without a doubt, Brena’s hit mentioned at the beginning, with minor modifications, is the most appropriate soundtrack - Bless us, Lord, with health and intellect. It seems that we have dropped the lyrics where she asks for "some money and youth".
*Daniela Vukčević is a graduate of journalism and communication at the Faculty of Political Science at the University of Belgrade. She has more than 10-year professional experience in Montenegrin national and regional media, print and electronic, specializing in economics and finance. Author of several research papers in the field of media.
This blog is published as part of the regional blogging initiative “Tales from the Region”, led by Res Publica and the Institute of Communication Studies, in partnership with Macropolis (Greece),
Lupiga (Croatia), Sbunker (Kosovo), Ne Davimo Beograd (Serbia), Analiziraj (Bosnia and Herzegovina), and Pcnen (Montenegro).