“I am happy to work on the frontline and to see the Canadian medical system function so well”, Alecu Mătrăgună wrote in a Facebook post, “but I am sad that I was vaccinated before my mother, who works in the medical system in Moldova”. Mătrăgună is a Moldovan sonographer living in Montreal. His mother is 61 and a paediatrician with more than 30 years’ service under her belt. Yet, he told me, she has no idea when the Covid-19 vaccine might become available for her and for more than 53,300 other healthcare staff in Europe’s poorest country.
I had a similar reaction to Mătrăgună’s about my family in Moldova when I saw a sign at my local London pharmacy as long ago as early December, announcing that the vaccine was on its way. At the time, my grandmother had just recovered and my father was still battling with the effects of the virus.
Most western European governments have already vaccinated frontline workers and are moving into the second phase of their rollout, even if production problems are now undermining supplies. Moldova, Europe’s poorest country, has not been able to deliver a single jab yet because it can’t afford to buy the vaccine.
The Moldovan government does not expect to receive its first batch of vaccine before the end of February, and even that timetable is uncertain and fraught with bureaucratic delays. Ukraine, Georgia and Armenia are in a similar predicament. This is what the “catastrophic moral failure” over vaccine distribution, in the words of the head of the World Health Organization, Tedros Adhanom Ghebreyesus, looks like in Europe.
Europe’s most economically disadvantaged countries are relying on Covax, a facility for low-income nations led by WHO in response to the pandemic. The organisation will guarantee free jabs for 20% of a country’s population. As for the rest of the doses they need, these countries are seeking help from richer neighbours. That is hardly the way to solve a global pandemic. In an interconnected world, no country is safe until every country is safe.
I’ve been home in Chișinău since December, and news of Covid-19 related deaths of family friends, former colleagues, or well-known personalities are a daily occurrence. Indeed, the overall death rate in Moldova rose by 21% between May and December 2020, compared with the same period in 2019.
The healthcare system is overwhelmed. One man in his 60s, ill with the virus, had to wait for a free bed for three hours in the courtyard of the hospital in the cold. Last spring, videos of patients in smaller provincial hospitals showed shocking conditions, such as no heating or clean water. In one hospital, a man died in the toilet, and the staff, lacking protective equipment, were afraid to get close to him for hours. Eventually they asked other Covid-19 patients to take the body out and cover it with a blanket.
With a population of 2.6 million, Moldova has had just under 157,000 official Covid-19 cases, and more than 3,300 deaths. Yet the real infection numbers are likely to be a lot higher, since the government has only tested between 1,000 and 3,000 people daily, reaching an astonishing rate of 58% positive tests in December. People with light symptoms are often refused tests for weeks. Frontline doctors working on Covid wards are the only medics who are tested. Moreover, while my father and grandmother have both been seriously ill with many of the typical Covid symptoms, their tests came back negative. They were only tested once.
The infection rate among medical staff was 25% in May, the highest in Europe, compared with only 12% in neighbouring Romania.
The pandemic has shed light on the severe underfunding and poor management of the former Soviet Republic’s overstretched public health services. The longer term effects could prove catastrophic.
Mătrăgună’s case makes plain one of the Moldovan health system’s most chronic ailments: a medical brain drain. Just under a third of healthcare workers are of retirement age. The average monthly salary of a GP is now about £430, following a 30% increase in 2020. In addition to limited funds, those remaining at home struggle with corruption and the politicisation of hospital management. Many seek better opportunities and fairer systems abroad. Without massive injections of funding and healthcare modernisation,Moldova’s young medics will keep leaving for richer countries, while Moldovans at home will end up with even more substandardprovision.
Mass emigration isn’t just a problem for Moldova’s health system: it is probably the country’s biggest challenge. Lacking job opportunities at home or looking for better standards of living in the west, Russia, or Israel, more than a million Moldovans – myself included – have left the country. Over the past year, tens of thousands of us who either lost jobs abroad due to lockdown restrictions or are privileged enough to be able to work remotely, have returned home. Yet this reverse migration might be temporary unless the government finally offers some economic support to its citizens.
Masks are mandatory even on the streets, social distancing rules are in place and shops measure everyone’s temperature, but not all people obey the government recommendations and vaccine scepticism is anecdotally high, even among health professionals. In surveys, people say they are more concerned with the economic rather than the health crisis: illness does not even make it into the five main worries Moldovans have – it is topped by the future of their children, high prices, poverty, unemployment and corruption.
Throughout 2020, Moldova was one of the few European states that provided barely any financial relief to citizens or small businesses. The consequences could start to bite hard in 2021. Newly elected president Maia Sandu, a former World Bank economist, was inaugurated on Christmas Eve and secured promises from western partners including a donation of 200,000 vaccine doses from Romania and a €15m crisis grant from the EU.
But Moldova’s executive has since resigned, the government lacks a legitimate parliamentary majority and the political class is battling over how to organise snap parliamentary elections while also figuring out how to deliver a mass vaccination programme.
The light at the end of our tunnel is not even in sight.
Paula Erizanu is a Moldovan writer based in London.