covid-19 vaccination in romania covid-19 vaccination in romania covid-19 vaccination in romania started on 27 december 2020. it was announced that the process would be divided into three phases. medical personnel would be vaccinated first (first phase), followed by the population at risk (second phase), and finally by the rest of the population (third phase). vaccination was declared free and non-mandatory. as of march 2022, five types of vaccines (pfizer/biontech, moderna, oxford/astrazeneca, janssen and novavax) were authorized to be used in romania. this is the largest vaccination campaign in the modern history of romania. covid-19 vaccination in romaniadate27 december 2020–presentlocationnationwidecausecovid-19 pandemic in romaniaorganised bygovernment of romaniaparticipantsprimary course: 8,140,13742.4% first booster: 1,766,6219.2% second booster: 27,5190.1%websitevaccinare-covid.gov.ro former pnl prime minister and self-appointed coordinator of the vaccination campaign florin cîțu aimed to have 10.4 million people (or 70% of the country's population) vaccinated by the end of september 2021. however, by the end of september 2021, romania had the second lowest vaccination rate in the european union, 33%, just before bulgaria, and sold part of its expiring vaccine stock to denmark, ireland, and south korea. the low vaccination rate had exposed entrenched distrust in state institutions, misinformation campaigns, poor rural infrastructure, and weak vaccine education. background responsibility for covid-19 vaccine deployment the national coordinating committee for covid-19 vaccination activities (romanian: comitetul național de coordonare a activităților privind vaccinarea împotriva covid-19; abbreviated cncav) is the inter-ministerial body responsible for developing the national vaccination strategy. it was established on 20 november 2020 by prime minister's decree and is under the direct subordination of the general secretariat of the government and the coordination of the prime minister. the first president of the committee is valeriu gheorghiță, doctor at the central military hospital in bucharest. romania heavily relied on its military and intelligence services to set up quickly the infrastructure needed to roll out the shots throughout the country. the romanian army and structures from the ministry of interior are involved in the distribution and transport of vaccines. the online platform used for vaccine registration is also administered by an agency with military status, the special telecommunication service. vaccines on order romania has ordered 120 million doses of vaccine or 7.5 doses for each person who can be vaccinated. as of 10 february 2022, it received 31.8 million doses, of which it used only about 16 million. amid disinterest in vaccination, romania sold or donated almost 5 million doses to countries such as argentina, denmark, egypt, ireland, moldova, serbia, south korea, and ukraine. vaccineorigindoses ordereddoses delivereddoses usedapprovaldeployment pfizer/biontechus/germany20 million19,842,05912,776,224 21 december 2020 26 december 2020 modernaus3.4 million4,247,9001,007,017 6 january 2021 12 january 2021 oxford/astrazenecauk/sweden—4,478,000852,356 29 january 2021 7 february 2021 janssennetherlands/israel8 million3,785,1001,826,313 11 march 2021 4 may 2021 novavaxus 20 december 2021pending curevacgermanypendingpending valnevafrancependingpending sanofi/gskfrance/ukpendingpending total 120 million rollout schedule on 26 december 2020, ion cantacuzino institute in bucharest received the first symbolic 10,000-dose batch of the pfizer/biontech vaccine. the truck with the first doses of vaccine entered romania at nădlac customs the day before in the presence of raed arafat, head of the department for emergency situations and valeriu gheorghiță, head of the national coordinating committee for covid-19 vaccination activities. vaccination began on 27 december in 10 infectious disease hospitals across the country, with mihaela anghel, a nurse at the matei balș national institute for infectious diseases in bucharest, being the first person vaccinated. anghel was among the personnel that treated the country's first infected person on 27 february of the same year. on 29 december 2020, romanian president klaus iohannis announced that romania would help moldova with a donation of 200,000 doses of covid-19 vaccine units in the future during his meeting with the moldovan president maia sandu in the country as part of a collaboration project about the covid-19 pandemic and other topics between the two countries. iohannis himself was vaccinated on 15 january 2021. the first batch of covid-19 vaccines destined to be sent to moldova from romania, composed of an amount of 20,000 of them, was approved by the government of romania on 24 february 2021. moldova received 21,600 oxford/astrazeneca vaccine doses on 27 february from romania, which started being administered on 2 march. moldova donated 1,810 of these units to the authorities of the unrecognized state of transnistria on 5 march, which thanked the romanian state for the help. other donations from romania to moldova took place on 27 march (50,400 doses) and 7 may (100,800 doses). the first 14,000-dose batch of the moderna vaccine arrived in the country on 12 january 2021. the vaccine began to be administered on 4 february. an oxford/astrazeneca and johnson & johnson vaccination center at isho timișoara the oxford/astrazeneca vaccine arrived in the country on 7 february, the first 81,000 doses being distributed to regional storage centers during the same day. until 8 march, the vaccination with oxford/astrazeneca was intended only for people aged between 18 and 55 years, on the grounds that in the third phase of oxford/astrazeneca's clinical trials too few volunteers over 55 were enrolled; on 8 march, cncav dropped the age limit for the administration of this vaccine. on 11 march, cncav temporarily quarantined 4,257 doses from oxford/astrazeneca's abv2856 batch as an "extreme precautionary measure", hours after italy banned use of this same batch following the deaths in sicily of two men who had been inoculated with doses from it. romania had received 81,600 doses from the abv2856 batch and administered most of them. vaccination with these doses was resumed on 19 march after the european medicines agency (ema) declared the oxford/astrazeneca vaccine safe for use. in april, ema found a possible link between the oxford/astrazeneca vaccine and very rare cases of unusual blood clots with low platelet counts, although it said its benefits far outweighed the risks and did not announce any restrictions. as of 4 april, ema received reports of 222 cases of a rare thrombosis affecting the brain or abdomen among some 34 million people in europe who have received the oxford/astrazeneca jab; most occurred in women under 60 within two weeks of vaccination. as a precaution, several european countries limited the use of the oxford/astrazeneca vaccine to older age groups. according to valeriu gheorghiță, president of cncav, no cases of vaccine-related thrombosis had been confirmed in romania as of 6 april; he did, however, mention seven cases of unrelated thrombosis in seven people vaccinated against covid-19, four with pfizer/biontech and three with oxford/astrazeneca. on 8 april, cncav decided to continue the vaccination with oxford/astrazeneca for all age groups. valeriu gheorghiță announced on 9 march that the third phase of vaccination will first start rolling out in the localities with an incidence rate of at least 4.5‰. the people from nine localities – seven county seats (alba iulia, baia mare, brașov, cluj-napoca, giurgiu, timișoara and zalău), a municipality (petroșani) and a commune (sânpetru) – could schedule their appointments on the national vaccination platform before the effective start of the third phase, which was set to begin on 15 march. the authorities introduced waiting lists for appointments, however, without the possibility for people to choose the type of vaccine. in order to optimize the distribution of vaccine doses, it was decided that each vaccination center should inoculate only one type of vaccine. on 11 march, the one-shot janssen covid-19 vaccine became the fourth vaccine to be conditionally approved on the eu level, arriving in romania on 14 april. the 60,000 doses in the first batch remained in storage, as romanian authorities waited for indications from ema regarding the safety of the vaccine. in the us, the centers for disease control and prevention and the food and drug administration recommended a temporary halt on johnson & johnson vaccinations in the country after the appearance of six cases of a rare and severe type of blood clot in people inoculated with this vaccine; by mid-april, more than 6.8 million doses of the janssen vaccine have been administered in the us. ema finally gave green light to the janssen vaccine on 20 april, and the first doses began to be distributed to vaccination centers in romania on 4 may. in april, family doctors joined the vaccination teams, with first shots being administered in timiș county. at the beginning of the month, the participation rate among family doctors was about 50–55%. on 17 april, romania made a new donation to moldova: 132,000 vaccine units were given to the latter. in an effort to boost rural access to the vaccine, officials launched on 21 april the first mobile vaccination centers in seven counties; in the first phase, mainly moderna vaccine was distributed in these centers. on 24 april, the first drive-through vaccination center was inaugurated in the parking lot of deva shopping city. between 23 and 26 april, timișoara regional business center hosted a three-day non-stop vaccination marathon. in the first such action in the country, 6,722 people were vaccinated by more than 500 volunteers. other vaccination marathons soon followed in bucharest, cluj-napoca, târgu mureș and iași. in the first weekend of may, walk-in vaccinations were introduced in all centers in the country, with priority for people over 60. previously, as oxford/astrazeneca vaccine stockpiled throughout the country, only people interested in getting this vaccine were able to show up at the vaccination centers without prior appointment. on 2 june, authorities began immunizing children aged 12 to 15 with the pfizer/biontech vaccine. previously, on 28 may, ema issued a recommendation for the authorization of the pfizer/biontech vaccine for this age group. in the first week, almost 9,400 12-to-15-year-olds have received the vaccine, most of them in bucharest. on january 24, 2022, some 114,000 doses on pediatric pfizer/biontech vaccine arrived in the country, for the start of the vaccination campaign of children aged between 5 and 11, which took start on january 26, 2022. the vaccination schedule for children with comirnaty pediatric vaccine is 10 µg/dose every 21 days (instead of the 30 µg/dose for the standard comirnaty vaccine); each dose is administered intramuscularly, similar to other eligible age groups. on february 10, 2022, valeriu gheorghiță announced that 917,800 doses of the astrazeneca vaccine have expired, and would therefore be destroyed. vaccine storage and distribution centers the ion cantacuzino institute in bucharest and six military hospitals in the country are the centers where the covid-19 vaccine is stored, as they have freezers with a large capacity that can ensure storage in the required conditions (e.g., cold chains of −80 °c). ion cantacuzino institutebucharestiacob czihac hospitaliașiconstantin papilian hospitalcluj-napocaalexandru gafencu hospitalconstanțaștefan odobleja hospitalcraiovaqueen marie hospitalbrașovvictor popescu hospitaltimișoaravaccine storage and distribution centers vaccine priority groups vaccination against covid-19 in romania is carried out in three phases, in which priority is given to medical staff, people over 65, people with chronic diseases, people with disabilities, homeless people and essential workers (lawmakers, military personnel, magistrates, teachers, commercial workers, etc.). phasepriority groupsnumber eligible (estimated) ihealth and social workers160,000 ii high-risk population5 million essential workers1.5 million iiigeneral population in early march, the ministry of health began publishing official data on vaccines administered at each center in the country on the government's open data portal. data from 27 december 2020 to 5 march 2021 revealed cases of nepotism regarding the vaccination of military personnel and over 7,000 vaccinations ahead of priority groups. apart from these, local news agencies reported numerous instances of queue-jumping occurring throughout the romanian healthcare system, as waiting lists were vulnerable to corruption. vaccination centers before the official start of the vaccination campaign, the ministry of health identified 899 vaccination centers throughout the country: 302 in health units for the immunization of medical staff and 597 in other spaces for phases ii and iii. 583 of them were operational by 30 january 2021. as of 9 march 2021, before the start of the largest phase of the vaccination campaign, 678 vaccination centers with 990 flows were active in the country; according to valeriu gheorghiță, the total number of vaccination centers would be 1,137. vaccination centers have a fairly good distribution in the national territory of romania. adverse reaction reporting as of 4 february 2022, adverse reactions were reported in 19,918 vaccinated people (0.121% or 1.21 reactions at 1,000 doses administered). most of them were general reactions (fever, headache, myalgia, asthenia, urticaria, etc.). only six severe allergic reactions were reported as of 4 february 2022. the median age of people