Sixteen months ago, on the heels of national elections and before the country's COVID-19 caseload surged ahead of the rest of the Western Balkans, southwestern Serbia already had a big problem.
The city of Novi Pazar was being battered by new coronavirus infections, overwhelming a local medical center.
A visit by Prime Minister Ana Brnabic and her health minister intended to show national resolve instead went off the rails, as overmatched doctors literally turned their backs on the VIPs to protest for protective equipment and other essential supplies.
It was a harbinger of the growing epidemic.
But it was also a stark reminder of a deficit of public trust that would further crater months later, when Serbian authorities were shown to be wildly understating COVID-19 death tolls in Novi Pazar, a predominantly Bosniak city, and elsewhere.
Fast forward to the current COVID-19 wave, as Serbia creeps up on 1 million confirmed cases and 8,500 deaths, officially, and trust remains a crucial factor in the seemingly stalled vaccination drive to control the pandemic.
"I was an anti-vaxxer because of [my] distrust in the health-care system," Edin Rizvanovic, a 48-year-old Novi Pazar resident, told RFE/RL's Balkan Service recently. "And I decided to get the vaccine for a similar reason -- which is inadequate treatment in our country, as far as Novi Pazar is concerned."
He cited the scandal around the understated death tolls as a factor in his vaccine hesitancy, alongside early nontransparency around the procurement of vaccines and his desire to see that it was safe for others first -- some of the same reasons that have kept the majority of Serbia's 7 million people away.
But in mid-September, about 10 weeks into the current COVID-19 wave, Edin lined up along with several of his friends and got vaccinated.
Once he made up his mind to get the shot, Rizvanovic says, "I didn't think about it in the least. I even took three of my best friends -- so I influenced them."
'From The General To The Specific'
Around the globe, mistrust has been identified as a significant factor in resistance to getting vaccinated against COVID-19.
Perhaps nowhere more than in the Balkans, where online disinformation and support for coronavirus hoaxes and conspiracy theories also contribute to low vaccination rates compared to the rest of Europe.
Data from the U.S.-based Johns Hopkins University shows that no country in the Western Balkans has fully vaccinated more than 45 percent of its population, despite the surprisingly widespread availability of vaccines in some places.
Serbia, whose President Aleksandar Vucic proudly touted his early success securing Chinese and Russian vaccines, has vaccinated only about 42 percent of its 7 million residents. North Macedonia and Montenegro are lower at around 35 percent, followed by Kosovo at 30 percent and Bosnia-Herzegovina at a woeful 15 percent.
"In the case of Serbia, there is a general distrust of the state and political parties and institutions," says Jasna Milosevic Djordjevic, a professor of social psychology at Singidunum University in Belgrade who has authored research on anti-vax sentiment in the current pandemic.
"In the research we conducted, respondents told us, for example, that they don't believe in the SNS [the ruling Serbian Progressive Party] so they don't get vaccinated, but also that they don't believe in the [government's] crisis staff, medical staff, or doctors. So distrust extends from the general to the specific in the medical system."
A recent study showed that, in Denmark, for example, which has fully vaccinated around 75 percent of citizens and recently declared its epidemic effectively over and reopened completely, more than 90 percent of Danes trusted their health authorities.
Branko Richtman, a microbiologist at the University of Warwick in the United Kingdom, said transparency and timely information are common factors in countries with high vaccination rates.
"When you live in a country where academic degrees are earned in a couple of months, where diplomas are bought, where students buy graduation theses, where hospitals operate on the basis of 'envelopes,' it’s no wonder people don’t trust health authorities,” Richtman, who was a volunteer in Oxford's COVID-19 vaccine-development program, told RFE/RL.
Choosing A Vaccine
Early recipients of COVID-19 vaccines in Serbia often were given no choice as to which shot they would receive, despite lingering questions around both major Chinese vaccines and Russia's Sputnik V.
Five vaccines are now approved by Serbian authorities: China's Sinopharm, Sputnik V, and the Pfizer/BioNTech and Oxford/AstraZeneca shots, along with the Moderna vaccine, which has been authorized but not procured.
Experts are divided over the usefulness of choice among vaccines in such national vaccination campaigns.
Rizvanovic got to choose his vaccine, and suggested he wanted to avoid the Chinese shot even though some of his friends got it.
He wanted either the Pfizer/BioNTech vaccine or Sputnik V for his 74-year-old mother, he says.
And his Novi Pazar neighbors are increasingly willing to join the list of the vaccinated, too, Rizvanovic says, as the lines have grown at vaccination centers.
Monthly vaccination numbers more than tripled in Novi Pazar in September to more than 3,600 doses in a population of nearly 79,000, according to Serbia's eGovernment website.
Sefadil Spahic, director of the Public Health Institute in Novi Pazar, told RFE/RL that there are several factors behind rising vaccination numbers, and increasing public awareness is among them.
"We needed to work hard to raise the level of health education regarding the vaccine," Spahic says, adding that some problems were foreseen but there is still a strong anti-vaccination lobby.
"Another factor is the worsening of the epidemic situation," Spahic says, "where we had a large number of people who fell ill in a short time, when we saw that they were mostly young people who were not vaccinated, and when we had a lot of deaths of unvaccinated people."
Rizvanovic said that, in his case, seeing was believing.
He got vaccinated in part because millions of his countrymen and billions of people around the world got the shot seemingly without side effects, but also for the same reason he thinks other Novi Pazar residents are coming around on the issue.
"That's why they get vaccinated here, because they see that whoever...[is hospitalized with COVID-19], it's hard [for them] to get out," Rizvanovic says. "If someone has an accompanying illness and this coronavirus hits them, they don't come out -- they're either transported somewhere outside or they don't come out."