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The Balkan State With Almost No Vaccines And No Idea How Many Of Its Citizens Are Vaccinated

A Bosnian medical worker checks patients' temperatures as they arrive at a vaccination station in Sarajevo.

SARAJEVO -- Bosnia-Herzegovina has dug itself into a COVID-19 hole.

Enfeebled politically and administratively, it was already knee-deep in trouble before the coronavirus pandemic hit the country hard -- it has the third-highest per capita death rate in the world after Peru and Hungary.

But now it is slipping even deeper in the COVID-19 fight, with none of its own vaccine doses outside of the small amount donated by the international COVAX system and no reliable way to know where it stands on the path to herd immunity.

Fifteen months after WHO declared a pandemic and six months after some global leaders rolled out mass-vaccination programs, Bosnian officials acknowledge that they have no idea how many of their citizens are vaccinated.

With a population of some 3.8 million, Bosnia has so far imported just over 530,000 doses, according to the Civil Affairs Ministry.

That is not even enough to fully vaccinate the priority groups.

And officials can confirm only about 180,000 people getting a first dose and a mere 50,000 receiving their second injections.

"I just want to return to normal life, and the moment I got vaccinated was the moment I got the coronavirus behind me," Sarajevo resident Irfan Godinjak told RFE/RL's Balkan Service.

Some Bosnians went to Serbia to get vaccinated against COVID-19.
Some Bosnians went to Serbia to get vaccinated against COVID-19.

Godinjak is one of a trickle of Bosnians who have traveled to nearby Serbia -- where the Russian and Chinese vaccines are particularly plentiful -- to get inoculated.

"Unfortunately, the authorities in Bosnia have done absolutely nothing to enable their citizens to get vaccinated against the coronavirus," Godinjak said. "I haven't had any trust in this country and its health-care system for a long time, and believe me, I was ready to pay and go anywhere to get the vaccine."

Bosnia -- historically and ethnically divided by the same internationally forged Dayton agreement that formalized its post-Yugoslav existence after the Bosnian War in 1995 -- had major hurdles built into its system before the pandemic ever emerged.

The country's administrative structure governed by that agreement has created a weak central government with most powers devolved to two autonomous entities: the Muslim and Croat federation and the predominantly Republika Srpska (along with the self-governing Brcko District).

Health care is among the powers overseen by the entities.

So while within the federation most health-care duties have been delegated to the cantons, and Brcko keeps largely to itself, the Republika Srpska runs a highly centralized health-care system that sometimes relies on resources from neighboring Serbia.

Long before the current public-health crisis, UN experts were warning that the system "provides only nominal coverage" for many Bosnians.

More recently, the Bosnian state doesn't have the legal power to negotiate directly with vaccine producers, and a parliamentary initiative in May to fast-track amendments to the country's law on public procurement to allow for quicker vaccine purchases failed.

The ensuing tangle, along with early scandals and mismanagement like tasking a raspberry farmer to import lifesaving equipment, has left many Bosnians guessing as to what comes next in the COVID-19 saga.

Serbia To The Rescue (For Some)

"We went to Serbia because we saw it was going very slowly here and I'm not sure when it would be our turn to receive the vaccine," says Milica Plavsic, a resident of the Republika Srpska who traveled with her husband to Serbia for both vaccine doses.

While Bosnia has largely floundered, Serbian President Aleksandar Vucic has prided himself on his administration's decision to cooperate closely with China from early in the pandemic for masks, medical equipment, and vaccines.

One of the results of that cooperation has been millions of doses of two vaccines developed by the Chinese companies Sinopharm and Sinovac, although neither has been approved by European or U.S. regulators.

By March, Serbia was a vaccination leader on a per-capita basis and, running up against vaccine hesitancy of its own, was offering to vaccinate foreigners from anywhere in the world.

Vaccines Donated By EU Arrive In Bosnia-Herzegovina
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Around 30,000 people crossed the Bosnian-Serbian border in the span of about three days following that announcement.

"Although it was logistically and also financially costly, we decided to do it -- more to relieve ourselves mentally than to take care of our health," Plavsic says.

Serbia doesn't know how many Bosnians it has vaccinated.

In a response to RFE/RL's Balkan Service, the Serbian government says it has data on the total number of foreigners it has vaccinated but those numbers aren't broken down by country.

The Serbian officials also say they have no obligation to hand over such information to countries that request it.

The Importance Of Knowing

Experts say an awareness of vaccination rates and dispersal is crucial for several reasons.

It is at the heart of any effort to control COVID-19 and enables officials to better target their resources or restrictions.

It also demonstrates the safety and efficacy of vaccines versus herd immunity through natural infection, which is especially important in the Balkans, which has some of the highest rates of "vaccination hesitancy" in Europe and the world.

Effective tracking of vaccinations also protects the most vulnerable segments of society -- including newborns and others who can't be vaccinated -- and alerts officials to the risk of fresh outbreaks as countries reopen.

Neither the respective entity institutions nor the Brcko district have reliable figures on the total number of vaccinated Bosnians.

Republika Srpska's health authorities say they hope to launch cooperation soon with Serbia's Public Health Institute that will include a request for data on the number of Bosnians who got vaccinated there.

But a spokeswoman for the Republika Srpska's health institute in Banja Luka, Milka Mrdja, says that is still in the planning stages and it is "totally unknown how many citizens from Republika Srpska were vaccinated in Serbia."

Data on dual Bosnian-and-Serbian citizens "can be a problem," the institute acknowledges.

Many of those getting vaccinated in Serbia don't say where they're from. But dual citizens can simply flash their Serbian passport.

"That's why our recommendation to all citizens is to call their family doctors after vaccination in Serbia and bring a confirmation of vaccination, because then we can pull the database from health centers," Mrdja says. "That's the only way to find out the number of [Bosnian] citizens vaccinated outside [Bosnia-Herzegovina]."

Officials on June 16 publicly appealed for people to do just that.

Plavsic says she saw the invitation and plans to register.

"Even though it's not obligatory, of course I'll go and report that I got vaccinated in Serbia," she says. "I have a lot of friends in my neighborhood who did the same thing, and I think it's important that it gets registered somewhere so that at some point we can have records of exactly how many people in Bosnia have been vaccinated."

'Can't Be Collected' Like That

But there is currently no such invitation within the federation, and neither is there any data on how many of its residents have been vaccinated abroad.

The head of nursing at the Brcko district's public health center, Zorka Mijatovic, says it will be difficult to determine how many Bosnians are vaccinated against COVID-19.

Such information "can't be collected on a voluntary basis," she says, and no health institution in the country is obliged to enter vaccination information on someone's health-care account.

"Unfortunately, no serious statistics are made that way, nor will Bosnia ever get relevant data on how many of its citizens have been vaccinated against the coronavirus," Mijatovic says.

In April, the public-health authority for the national capital and its surrounding canton, Sarajevo, created a portal for citizens to register themselves as having been fully vaccinated.

The information from that online application could eventually be used to issue certificates of vaccination, something like a "COVID-19 passport."

So far, about 5,000 Sarajevans have done so, but officials think the real number is higher.

"Of course this isn't relevant data, and that number is certainly higher," says Amir Ljubovic from the Sarajevo Canton's Health Insurance Institute.

He cites an estimate of 10,000 Bosnians vaccinated in March alone.

"But there's no official data on that anywhere," Ljubovic says. "It's true that hundreds of applications [for the vaccine passports] come in every day, but that's just the number applying voluntarily. I can apply with one dose of the vaccine, then supplement it with data on revaccination later."

He says such registration "is important for all of our future travels."

"Because if you travel anywhere with a Bosnian passport, then it's more practical to have Bosnian documents on vaccination."

But the scheme could face a challenge corroborating the voluntary information with proof of vaccination -- and ultimately with domestic and international travel requirements.

So far, Brussels has resisted recognizing the efficacy of vaccines that have not been authorized as safe and effective by the European Medicines Agency.

Those include Russia's Sputnik V and the two Chinese vaccines being widely used in Serbia.

"I know about the application and I registered as a vaccinated citizen," says Godinjak. "But believe me, I don't think any country will accept vaccination data at its border that is issued on a cantonal basis but rather will ask for that data at a national level."

For citizens like Godinjak with two passports there's a workaround. But that won't be the case for the millions of Bosnians without dual citizenship.

"As far as I'm concerned, the vaccination certificate I received from Serbia is the only thing I'll show," he says.

As of June 23, Bosnia has recorded nearly 205,000 cases of coronavirus and 9,651 deaths. It has a per capita death rate from COVID-19 of 2,960 deaths for every million people.

Written by Andy Heil based on reporting by RFE/RL Balkan Service correspondents Dragana Erjavec and Milorad Milojevic