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From the file

The Arms Race | We need to get the world vaccinated as fast as possible. We’re in an arms race: vaccines vs variants.

Mandatory Credit: Photo by Vadim Ghirda/AP/Shutterstock (12549958h) Member of the medical staff walks in a crowded COVID-19 isolation room at the University Emergency Hospital in Bucharest, Romania, . In Romania, a European Union country of around 19 million, only 35% of adults are fully inoculated against COVID-19 compared to an EU average of 74 Virus Outbreak , Bucharest, Romania – 22 Oct 2021
Europe’s pandemic disaster

Europe’s pandemic disaster

Mandatory Credit: Photo by Vadim Ghirda/AP/Shutterstock (12549958h) Member of the medical staff walks in a crowded COVID-19 isolation room at the University Emergency Hospital in Bucharest, Romania, . In Romania, a European Union country of around 19 million, only 35% of adults are fully inoculated against COVID-19 compared to an EU average of 74 Virus Outbreak , Bucharest, Romania – 22 Oct 2021

In this second despatch from Romania, Lara Spirit reports on the political and structural collapse that has thwarted vaccine rollout – and the lessons for the rest of the world

In Matei Bals hospital in Bucharest, nurses are reasoning with a young girl who is resisting a blood sample. This might be a typical scene in any medical setting – a minor frustration encountered countless times – were it not for the fact that this particular emergency unit has recently been transformed into an overflow for Covid patients, who surround her on the floor in makeshift camp beds.

Virtually all of these patients filling the halls of the hospitals I visit are unvaccinated, their directors tell me. Institutions like Matei Bals are running at more than double their official capacity, with lines of ambulance queues forming outside emergency units, and patients even being sent abroad for treatment.

In recent days, coverage of the crisis has prompted more to get vaccinated. Romania’s media is now crowded with grim images of body bags lining overcrowded hospitals, hospital fires that have plagued the near-derelict public estate, and grieving families insisting that the Covid threat is real and present – an indisputable testament to the horrors of its deadly fourth wave.

But when I visit Neghiniță vaccination centre in the Eastern part of Bucharest, I find it nearly empty. Across Romania, only one in three are vaccinated – the second lowest rate in Europe. At Neghiniță, a policeman lingers on the steps and soon beckons me to leave. Ten days later, in the latest of a string of vaccine fraud scandals, the centre is closed with immediate effect. Almost 180 arrest warrants are issued amid “suspicions of false certificates”. In this case, civil servants are suspected of modifying computer records to accredit the unvaccinated falsely, providing phoney certificates to those still extremely reluctant to get the jab itself. 

It is sobering to reflect that the European region was the only part of the world witnessing an increase in Covid cases at the end of October. And, even in that context, Romania’s soaring hospitalisations and death make it an outlier. Each day, the death rate continues to scale new heights: 591 died on Tuesday, in a country of just 19 million.

How did this happen, when vaccine doses in this EU member state are in abundant supply? Romania’s Covid tragedy is underpinned by deep vaccine hesitancy; embedded early in the pandemic by a lack of government communication to combat viral fake news. 

But the crisis also reflects chronic political failures: healthcare corruption, fraud and a decades-long parliamentary deadlock over reforms which has crippled the country’s ability to cope with this virus. Two men in the beleaguered department of health are at the centre of Romania’s vaccine story, but have alarmingly different explanations. 

The day I meet Andrei Baciu, Romania’s vaccine minister, the windows of his fifth floor Ministry of Interior office are flung wide open. I realise that above me is the roof from which Nicolae Ceaușescu, Romania’s Communist despot of 21 years, attempted unsuccessfully to flee execution with his wife in 1989. Outside us is Revolution Square, and on my way I pass by people staring at the statue built to commemorate that violent winter of 1989, when over 1,000 died in Romania – the deadliest of the not always bloodless revolutions which marked an end to communism in Eastern Europe. 

Little inside appears to have changed in the intervening decades, though the 35-year-old doctor and former model has made this office his own. A selection of vitamin pills form a tidy pile on his desk, while his Apple Watch and nearby AirPods are a reminder that Baciu was only a young child at the time of the revolution. 

The windows are open, Baciu explains, to stem the spread of the virus. He gestures behind me, where I’m surprised to see a small UV lamp attached to the wall for the same purpose. “I keep it on after every meeting”, he says, “there are numerous studies which show this helps”. 

There’s no time to dwell on this epidemiological argument, for our interview is interrupted by seemingly frenzied text exchanges with the prime minister. Just that morning, his party’s leader failed to win parliamentary support for his new Cabinet. A previous no-confidence vote the week before plunged the country into political turmoil, leaving Romania – in the midst of the world’s worst Covid outbreak – without a government, as protracted negotiations stretch into the coming weeks.

Baciu prefers not to dwell on the political machinations that are naturally filling the papers. It’s a reminder that this isn’t the first time he’s been nominated as a minister for health: in 2015, at just 29 years old, his nomination to the same ministerial position lasted just hours. Pictures emerged from a modelling career some years before, while questions were raised about whether his medical experience was advanced enough to qualify him for the post, and the appointment was swiftly reversed.

Six years later, he finds himself once again in one of the government’s most important positions – but in very different circumstances, in which he is grappling with Romania’s faltering vaccine campaign, and the misinformation, miscommunication, weak administration and corruption it reflects. On the first of these deep-rooted problems, Baciu is unambiguous. “Fake news really had a devastating impact on Romania”, he says, “especially on the online environment”. 

“They come from all over the place”, he says, when I ask who the leading proponents of anti-vaccine discourse are. One of the most powerful voices dissuading citizens from getting the jab has been the Romanian Orthodox Church – the Archbishop of Tomis, Teodosie Petrescu, having claimed that that prayer was a stronger weapon against the virus han vaccination and even declaring: “I don’t dare encourage anyone to get the vaccine”.

These archiepiscopal statements were made on mainstream television – which is no surprise, given that some prominent presenters have been promoters of misinformation. But Baciu doesn’t want to comment personally on the chat show hosts who devote their prime time slots to anti-vaccination falsehoods. All the same, the scale of the attack has taken him aback: “Unfortunately the amplitude of the phenomenon, especially in the online environment, is something unbelievable”. 

At first glance, the Romanian government’s vaccination campaign resembles that of any other European nation: mass vaccination centres in schools, shopping centres, and hospitals; easily accessible online interfaces promoting walk-ins, including a live tracker of the number of doses available in each; regular press conferences to dispel myths about the vaccine, broadcast on television and attended by the prime minister and Baciu; and a priority queue early on for the vulnerable and sick. On the weekend of my departure, Baciu is hosting another vaccination spree, with 100,000 getting their first dose in a single day – the highest number since the pandemic began. 

The problem is that the surface impression is deeply misleading. In practice, the roll-out has been seriously hampered by corruption, maladministration and chronic underfunding – which has plagued the healthcare system for decades. There is a wider story of political decay to be told, and one which Romania’s former Minister of Health, Vlad Voiculescu, has now been at the heart of twice.

Voiculescu is one of Romania’s most polarising and prominent politicians. And the former economist isn’t bashful about any of this: when we meet, he soon presents the National Liberal Party’s paid Facebook advertising page (of which Baciu is a member), whose attack ads form a string of adversarial content about him.

Watch Alexander Nanau’s Oscar-nominated documentary, Collective (2019), and his notoriety is easy to understand. The film describes a hospital disinfectant scandal in 2016, in which lethally diluted sanitation products were used in the treatment of horrifically burned patients, causing deadly infections. We observe Voiculescu’s appointment as a technocrat tasked with cleaning up the health sector – and his naivety is palpable. He loses the election months later, having declared to one victim of the original fire: “I’ve learned since I’ve been here that everything underneath is rotten”.

Răzvan Luţac, a journalist who helped break these stories, tells me that none of those at the heart of this appalling public health scandal has yet been sentenced – and little has changed. Luţac splits his time between attending the relevant cases in court, and investigating the surge in healthcare corruption scandals that have arisen during the pandemic. 

The weak healthcare infrastructure was never going to cope well with the demands of Covid. But hospital fires became endemic (the most recent, last month, killed seven); ventilators in mobile ICUs were not expected to fail, either; and few anticipated that hospitals would be so full that patients would need to be sent abroad for treatment.

Corruption makes tackling any of this all the more difficult. In Romania, unlike most European nations, directors of hospitals are political appointees. In Câmpeni, an employee of a local restaurant and party ally was appointed manager of their city hospital. When asked about his qualifications, Valentin Gog replied: “I worked as a director at the Rivaly restaurant, which organises various events: weddings, baptisms, various. I was in charge of the organisation. Someone has to organise these too, right?”

Pandemic clientelism has been extreme. In June 2020, the director general of Unifarm, a state-owned company, was charged with corruption for soliciting a €760,000 bribe to assist another company in procuring masks and PPE. Luţac found 1 million of these masks which didn’t meet basic safety standards were distributed to 112 hospitals. It’s a procurement scandal of a different order to those we see in the UK – but, precisely because such problems are so familiar, the outrage in Romania has been subdued.

Voiculescu struggled once more to cope with the rottenness of the system, crippling staffing shortages, and the dire general conditions of public hospitals. His counterparts in other European nations have at least been able to rely upon the impact of the vaccine, and the diminishing pressure upon hospitals. Not so for Voiculescu.

In January, not long after his appointment as Romania’s Minister of Health in December 2020 for the second time and shortly before the arrival of the first vaccines, he discovered that, extraordinarily, he would have nothing to do with the roll-out campaign. 

On 4 January Voiculescu sent the prime minister, Florian Cîțu (a member of a different party), and the president his proposal for a vaccination strategy – to no avail. “Just before we came into the coalition government,” he says, “they set everything up so that, on vaccination, they don’t have to do anything with the Ministry of Health”.

In evidence, he pulls up his WhatsApp to the prime minister, which went unanswered. The slickly designed document attached to his message, which formed his proposal for the rollout, was ignored (and he’d even included the prime minister and his associates higher up the ladder of priority, to help its chances). Instead, the army and the presidential administration assumed control of the program in entirety and, Voiculescu argues, “didn’t prioritise the right people and had no communication campaign whatsoever”.

Until April, the rollout went ahead at a reasonable pace and Romania’s uptake was similar to elsewhere in the continent. But this pattern actually aroused Voiculescu’s suspicions: he checked the data and found that those vaccinated early on – when demand was high – included high ranking public servants, the secret services, those who vacation in state-owned villas, for instance, and those who retire early and cash in “special”, disproportionately high pensions. So much for the official “priority queue” for those most in need of the vaccines.

“My team started looking into it, and on World Transparency Day we published the whole data set,” he says. At this point, he claims, “the prime minister’s office made the data disappear from the website, and it was only after public pressure that the data was again published”.

“The prime minister immediately started an investigation, and I knew they were preparing my exit. Then I was fired”. 

Tensions had already been brewing in government for a while by the time of his dismissal. On 16 April, Voiculescu told a press conference that he believed the prime minister and president had been miscalculating cases and deaths, and in the latter case misreporting them. 

He reels off a litany of accusations to me, some made before but others that are new: cases were deliberately miscalculated; deaths underreported and then – this summer – drip fed in public announcements to try to end up at a plausible total with the minimum fuss; localised quarantines imposed on towns and regions belonging to political opponents, with little correlation to epidemiological data (he cites Timișoara as an example); corrupt testing systems and brazenly political appointments to key roles in Romania’s public services. 

In contrast to the message discipline of Andrei Baciu, Vlad Voiculescu – his former boss as Minister of Health from December 2020 to April 2021 – is remarkably unguarded (he refers to the smoothness of his opponents as “fluffy fluff”). You might expect this candour, given that he was dismissed. But he fully intends to return to political office. His candour is deliberate.

In the eyes of many Romanians, both Baciu and Voiculescu are politicians, and neither is to be trusted. This, in turn, reflects a fundamental challenge to the country’s vaccination campaign: what chance do public health communication campaigns have, when politicians are so distrusted and the line between health and politics has been porous for so long? It is impossible to understand the shocking divide between Romania’s vaccination rate and that achieved in most European nations without appreciating this: the lack of legitimacy that blights not only politicians but medical professionals with a single, tainted brush. 

When Tortoise’s #TheArmsRace campaign has reported from countries struggling to vaccinate their populations in the past four months, the essence of the problem has been straightforward: the poorest nations in the world have not had, and still do not have equal access to vaccine supply, and watch aghast as wealthier nations continue to hoard hundreds of millions of unused doses. 

In Romania, the picture is more complex. A toxic combination of extreme vaccine hesitancy, miscommunication, maladministration and corruption has led this country’s healthcare system to the edge of collapse. It is a reminder that real vaccine equality is only achieved once jabs get into arms: in some territories – perhaps many – the delivery of doses will not be enough.

Vlad Voicelescu and Andrei Baciu, two politicians at the heart of this crisis, have struggled in their different ways to drain some of the poison from the system. Baciu remains in post, and his vaccination “marathons” may be the green shoots of change.

Even if that proves to be the case – and that is no certainty – what will survive is a system desperately in need of root-and-branch reform. Romania’s Covid ordeal has lessons far beyond its borders.

Photographs Vadim Ghirda/AP/Shutterstock, Daniel Mihailescu/AFP via Getty Images

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