September in the Caucasus: an issue of trust? Vaccination hesitancy in Georgia7 min read
During the early stages of the COVID-19 pandemic, Georgia was heralded as a beacon of success thanks to its swift reaction to the virus and low number of cases. As of September 2021, the situation looks starkly different. While the Delta variant continues to send shockwaves throughout Georgia, vaccination scepticism remains prevalent among the population. With only around 20% of the adult population fully vaccinated, understanding public opinion has become more vital than ever to combat the rising death toll.
At the start of August 2021, Georgia reached its new peak of cases and recorded the highest rate of deaths per 100,000 residents of any country. Despite these concerning figures, September has seen yet another drop in people registering for their first vaccine. The issue in Georgia, however, is not one of vaccine capacity — currently, the Pfizer, AstraZeneca, Sinopharm and Sinovac vaccines are all available to the public. Instead, the issue is one of vaccine acceptance. But, what are the causes of this widespread hesitancy among the Georgian population?
An issue of governance
In reaction to the rising case numbers, the Georgian government recently put in place several measures, including making face masks mandatory at outdoor gatherings of at least five people and delaying in-person studies until at least 4 October. Yet, the damage may have already been done. Over the summer, the Georgian government made the decision to relax restrictions, including permitting unvaccinated foreign citizens to enter the country. Given that less than 10% of its population had received one vaccination by August this year, why would the government take such a risky move? The answer comes down to one major factor: economic pressures.
Polling shows that the economic consequences of lockdowns constitute the greatest priority among Georgian citizens: a fact of which Prime Minister Irakli Garibashvili seems deeply aware. Overall, the Georgian economy has been hit hard by the pandemic, with the National Statistics Office reporting a 6.1% decline in 2020 alone. This was particularly felt within Georgia’s vital tourism industry, which saw 80% fewer international visitors in 2020 compared to the previous year. With the upcoming local elections set for 2 October, it is perhaps not surprising that the government is hesitant to strengthen COVID-19 restrictions. However, this is something of a double-edged sword, as the decision to soften restrictions has undermined the message of urgency regarding inoculations. The reality is that vaccines hold the key to fighting coronavirus and without a significant increase in inoculations, recent measures remain inadequate.
An issue of access
The issue of global vaccine inequity has been widely reported on, with low- and lower-middle-income states suffering from the high prices per COVID-19 vaccine dose. Indeed, vaccine inequity undoubtedly affected Georgia, which only started its rollout on 15 March this year and remains heavily reliant on the COVAX vaccine-sharing initiative. However, in Georgia, the more pertinent vaccine distribution dilemma is that of national inequality.
Although vaccinations are free to all citizens over the age of 18, socioeconomic status still appears to play a decisive role in vaccine uptake. Recent data collected by the Caucasus Research Resource Center (CRRC) in collaboration with National Democratic Institute (NDI) found that 24% of respondents with the highest socioeconomic standing in terms of asset ownership received at least one dose, compared to only 3% of those within the lowest bracket. But if vaccines are free to the public, why does socioeconomic status continue to play a role?
One explanatory factor could be related to information access. A telling detail found in the CRRC/NDI survey was that only 42% of Georgians knew how to register for vaccination as of July 2021. Notably, lower levels of access to information about the vaccination process were seen most prevalently among those within the median and lowest socioeconomic brackets. Similarly, a stable internet connection is required to register for the vaccine, therefore posing an issue to those with limited access. There are also all the hidden costs of getting vaccinated: the travel to the nearest vaccine centre, the cost of childcare or missing half a day of work to get vaccinated. In light of this, it is clear that the most vulnerable members of society are those left behind.
An issue of (dis)information
It is not simply an issue of access to information, but the information itself that is a cause for concern. According to one survey, one in five respondents believes vaccines cause autism or could have serious adverse effects on their children. Naturally, many have placed blame on the Kremlin and the threat of hybrid warfare. These accusations are not entirely without reason; Russia has frequently launched disinformation campaigns against the U.S.-funded Lugar Research Centre based in Tbilisi, with some sources going as far as to claim that the coronavirus may have been created in the lab.
However, in regard to vaccine-specific disinformation, the evidence of its impact on the Georgian public opinion is a little shakier. While several pro-Russian sources have attempted to promote the superiority of the Russian-produced Sputnik V vaccine over its U.S. counterparts, these attempts to discredit the U.S.-funded research have proven largely ineffective. In fact, the greater threat may well be homegrown. For instance, several clergymen of the Georgian Orthodox Church claimed vaccines will “enslave humans, control people, subdue them” and are linked to the devil. Given the influential position the church holds in Georgian society, this has undoubtedly fuelled hesitancy among its religious population.
The crux of the matter: An issue of trust
Perhaps the most pervasive factor among Georgians is the matter of distrust. Despite a notable increase since the start of the pandemic, the Georgian population continues to suffer from low levels of trust, particularly concerning political institutions. Low levels of public trust in institutions are not an uncommon phenomenon across the post-communist states. Across many states of the former Eastern bloc, trust deficits are evident due to both the legacy of mistrust of Soviet organisations and poor institutional performance.
It is not just political institutions that suffer from this trust deficit. Mistrust extends to medical professionals and health practitioners as well. In Georgia, this scepticism was exacerbated following the tragic death of a 27-year-old Georgian nurse, Megi Bakradze, due to an allergic reaction upon receiving the AstraZeneca coronavirus vaccine earlier this year. Prior to her death — only four days after vaccine rollout began in Georgia — Bakradze appeared on television urging all those who could to be inoculated. Her death was later ruled to be caused by negligence from the medical staff who treated her.
Trust also serves as a significant factor when studying the attitudes of Georgian Dream party supporters. CRRC data shows that only 27% of supporters of the incumbent government said they were likely to avoid the vaccine, as opposed to 41% of other political party supporters. These numbers suggest that higher trust in the government correlates with lower levels of vaccine hesitancy, further demonstrating that vaccine hesitancy holds an inherently political dimension. Likewise, as one of the most trusted institutions among Georgians, the GOC holds great sway over public opinion. While its more extreme statements do not speak for the Church as a whole, the Holy Synod’s decision to not assist the vaccination campaign certainly sends mixed signals to its members.
While several factors can help to explain Georgia’s concerning levels of vaccine hesitancy among its population, the underlying issue appears to be that of a lack of trust. Whether it is low institutional trust due to its communist legacy or the consumption of disinformation on social media, it is clear that Georgia has a trust issue. However, conspiracy theories and residual Soviet mentalities alone cannot account for Georgia’s notably low levels of trust — it is hardly unique in these attributes. Indeed, it is compounded by several factors particular to Georgia: negative perceptions of the country’s economic performance, the harsh realities of a weakened economy, the influence of an equally sceptical church and the government’s shaky vaccination information campaign. Only by tackling this trust deficit can Georgia help to ensure the health of not only its own population but the global population as a whole.