Assessing COVID-19 pandemic management: Death rate in Bulgaria is among the highest in the world, despite sufficient funds and vaccines

Bulgaria is one of the countries with the highest incidence and mortality of COVID-19 in the world. The lack of an effective vaccination campaign contributes to this. This is the conclusion of an audit report by the National Audit Office on how the country has managed the COVID-19 pandemic.

At the start of the pandemic, strict implementation of anti-epidemic measures led to a reduction in morbidity and mortality. In 2021, despite vaccine coverage, deaths increased substantially due to low vaccination coverage.

The report provides summary information not only on the measures taken and their implementation, but also on the impact of the pandemic on the entire health care system as well as on socio-economic life in the country.

At the beginning of the COVID-19 pandemic, as a result of strict anti-epidemic measures, a significantly lower level of excess mortality was reported in Bulgaria compared to the EU average. , However, the reverse trend is observed in 2021- the average excess mortality in Bulgaria is significantly higher than in the EU.

The majority of EU Member States report a significant reduction in excess mortality in 2021, except for:

Bulgaria - from 14.2% to 38%,

Slovakia - from 10.5 per cent to 35.7 per cent,

Estonia - from 2.3% to 19.4%,

Latvia - from 1.5 per cent to 21.7 per cent.

The relationship between the rapidity of the increase in the number of vaccinated persons and the vaccination coverage achieved and the annual excess mortality rate is evident. All other EU countries reporting a significant reduction in annual excess mortality in 2021 have a rapid increase in the number of vaccinated persons and a high level of vaccination coverage.

According to the Ministry of Health data from the COVID registry, for the period from the beginning of 2020 to the end of 2021, a total of 29,238 persons died from COVID-19, of which 8,031 in 2020, including 100 medical staff, and 21,207 in 2021, including 78 medical staff. Of the deceased medical staff, the number of doctors exceeds that of nurses. The highest mortality from COVID-19 is registered in Sofia city, the lowest - in Targovishte district. The highest mortality was registered among persons aged 70-79 years - a total of 10,894, and among persons aged 60-69 years - a total of 7,114. The lowest mortality rate was among persons aged 0-19 years - 24, and people aged over 90 - 724 deaths.

According to the NSI, in 2020 deaths from COVID-19 account for 6.9% of all deaths in the country, and in 2021 for 18.5%.

Of the significant financial resources secured for 2020 and 2021, the money spent to support staff directly involved in COVID-19 prevention activities far exceeds the money spent on medicines and vaccines, the National Audit Office report added.

The number of laboratories detecting the virus rose from three at the start of the pandemic to 123 by the end of 2021. However, the uneven spatial distribution of designated laboratories in medical and health facilities makes it difficult for a significant proportion of the population in small towns and three regional cities to access them quickly and easily.

The teams of the Emergency Care Centres attended to 670 244 emergency patients, representing 90% of all confirmed cases. The number of patients served at home was 463 841, or 70%.

From GP practices, 634,627 COVID-19 patients were served, (85% of all confirmed cases). There were 581,707 primary examinations and 231,496 secondary examinations.

For the period 2020-2021, 211,760 patients, or 28% of the total confirmed cases, were hospitalised in hospital care facilities. There were 17,783 patients admitted to intensive care, or 8.4 per cent of those hospitalised. They were treated in the absence of an established medical standard in Bulgaria "Anaesthesiology and Intensive Care".

In 2021, the number of hospitalised patients is almost three times higher than in 2020. The highest number of patients admitted to intensive care units was in Sofia city (4,309), Russe (1,308) and Plovdiv (1,253).

As at December 31, 2021, a total of 8,331,795 vaccine doses have been delivered, which is sufficient for the population as well as for the temporarily residing and transiting persons. People with a completed vaccination course account for only 29.8% of the population. Persons who have completed the vaccination course are most numerous in the age group 40 to 69 years - over 1 million persons (56% of the total vaccinated persons).

Due to the low vaccination rate in the country, there is a risk of scrapping of purchased vaccines due to expiry. A decision is taken to resell or donate unused and available quantities. A total of 643,980 doses were donated and resold in the period 2020-2021. A further donation of more than 3 million doses was made in 2022.

The audit resulted in 11 recommendations to the Minister of Health. He must take action to implement them and notify the Head of the National Audit Office in writing by 31 October 2024.