11 age cohort. on 12 september 2022, the first omicron-adapted covid-19 vaccines arrived in bulgaria, with 290,880 comirnaty original/omicron ba.1 and 1800 spikevax bivalent original/omicron ba.1 being delivered. moderna's vaccine for the omicron strain is only administered in specific immunization cabinets and was initially not available in most hospital settings. in late october 2022, 10,200 doses of the valneva vaccine were delivered to bulgaria. in january 2023, the three-dose the pfizer–biontech vaccine for children in the age bracket from 6 months to 4 years old and the new sanofi vaccine, to be used as a booster, became available in bulgaria. percentage of vaccinated according to the vaccine received (as of 31 may 2022) pfizer–biontech (66.0%) moderna (11.3%) oxford-astrazeneca (10.9%) janssen (11.8%) the covid-19 vaccination point located in the ndk metro station in sofia. the christmas market in sofia, one of the outdoor venues that required a green certificate. number of vaccinations by vaccine type the numbers refer to total doses administered, broken down by vaccine manufacturer. (as of 30 july 2022, drawing on information from the plusmen.bg webpage) public vaccinations listed here are individuals who had their actual vaccination procedure captured on video, posted photos from the place in which their vaccine was administered or were subject to a media announcement of such nature for the purpose of popularizing the vaccination campaign. individual occupation date vaccine notes reference (s) kostadin angelov minister of health, 2020-2021 27 december 2020 pfizer–biontech first bulgarian to be vaccinated tikhon tiveriopolski bulgarian orthodox church bishop 27 december 2020 pfizer–biontech rada prokopova physician, head cardiologist at st. anna hospital 27 december 2020 pfizer–biontech first physician to be vaccinated ivan madzharov chairman of the bulgarian medical association 27 december 2020 pfizer–biontech ventsislav mutafchiyski military doctor, covid-19 taskforce chief, 2020-2021 27 december 2020 pfizer–biontech also received a booster dose asen baltov physician, head of pirogov hospital 27 december 2020 pfizer–biontech had previously recovered from covid-19 krasimir gigov head of the vaccinаtion coordination council, 2020-2021 27 december 2020 pfizer–biontech mustafa karadaya chairman of mrf, 2016- 16 april 2021 not specified also received a booster dose stoycho katsarov caretaker minister of health, 2021 12 june 2021 janssen recovered from covid-19; also received a pfizer-biontech booster dose boyko borisov prime minister, 2009–2013, 2014–2017, 2017–2021 27 july 2021 moderna had previously recovered from covid-19; also received a booster dose tomislav donchev politician 27 july 2021 moderna delyan dobrev politician 27 july 2021 pfizer–biontech had previously recovered from covid-19 mladen marinov politician, jurist 27 july 2021 not specified had previously recovered from covid-19 anna alexandrova politician 27 july 2021 not specified had previously recovered from covid-19 delyan peevski politician, entrepreneur 22 october 2021 not specified yordan tsonev politician, deputy chairman of mrf 22 october 2021 not specified radoslav revanski politician, mayor of belitsa 22 october 2021 not specified ahmed ahmedov politician, deputy chairman of mrf 16 november 2021 not specified stanislav anastasov politician, deputy chairman of mrf 16 november 2021 not specified halil letifov politician, deputy chairman of mrf 16 november 2021 not specified iskra mihaylova politician, mep 16 november 2021 not specified atidzhe alieva-veli politician, mep 16 november 2021 not specified uti bachvarov actor, tv host, professional cook 14 december 2021 moderna had previously recovered from covid-19 rumen radev president, 2017- 6 january 2022 not specified medical aspects pertaining to the vaccinations general considerations asparouh iliev, a bulgarian specialist in molecular neuroinfectiology from the university of bern, has praised the two rna vaccines, characterizing them as extremely safe and also regarding them as very similar to each other. he has pointed out that the astrazeneca vaccine has an excellent safety profile and may actually be offering even better protection than shown from the preliminary studies, considering the whole comparison exercise between the three vaccines to be pointless, urging people to take up the opportunity to get themselves vaccinated, with allergist bogdan petrunov maintaining that astrazeneca is in no way inferior to the rna vaccines. in april 2021, pulmonologist kosta kostov, while acknowledging the issue of vaccine reservations in bulgaria, also stated that the narrative that all approved vaccines on the eu level are equally safe and effective is fallacious. an influenza vaccine to be used in bulgaria during the autumn and winter of 2022. andrey chorbanov, a member of the institute of microbiology at bas and a leading figure behind the ongoing development of the bulgarian vaccine, while supportive of vaccinating vulnerable groups, maintains that naturally acquired immunity is much stronger than the vaccine-induced one, believing that the people who have recovered from covid-19 have very durable immunity and has opposed mandatory vaccinations against covid-19 for young and healthy people. in his view, the major question mark surrounding the vaccines remains their actual effectiveness while their safety and the side effects are not an issue. similarly, immunologist velizar shivarov affirms that people who have antibodies can afford to wait to be vaccinated. in february 2021, todor kantardzhiev, a member of the national operational headquarters for the fight against the coronavirus in bulgaria, claimed that one vaccine dose may be sufficient for the people who have recovered from a covid-19 infection and has also expressed the viewpoint that a person who gets infected between the two jabs may not need the second injection. allergist bogdan petrunov and neuroinfectiologist asparouh iliev have contested chorbanov's claims, emphasizing that vaccine-induced immunity is significantly more reliable than the naturally acquired one, especially with regard to the mutant strains of the virus, thus offering a greater breadth of protection, even if infection-generated immunity can be quite strong. people who have recovered from covid-19 may undergo the two-dose vaccination process no earlier than 3 months after the laboratory confirmation of their diagnosis. in the case of citizens who become infected after receiving their first injection (in the case of two-shot vaccines), the second dose of the vaccine is to be administered at least 6 months after the laboratory diagnosis has become official. the recommendations of the national vaccination operational headquarters in bulgaria are that the second dose of the oxford-astrazeneca vaccine be administered at least 10 weeks after the first. the mixing of different types of vaccines, especially when it comes to attempting to complete the second step of the vaccination process by using another vaccine, was initially not advised, but was still considered a possibility, depending on the conclusions of further studies and there are currently indications that combining astrazeneca and pfizer may generate a more powerful immune response, as adenovirus vaccines tend to be superior in stimulating t cell responses while rna ones produce higher antibody levels. virologist radostina aleksandrova notes that the protective antibody titers as a result of the mixing of these vaccines can be up to six times higher, though cautions that the sample sizes in terms of study participants have been small and there are some uncertainties regarding the efficacy and safety. in april 2021 the health minister clarified that oxford-astrazeneca will not be administered to women under the age of 60 with an elevated risk for thrombosis and/or a history of thrombocytopenia. chief health inspector angel kunchev stated that women under 30 who are heavy smokers, take contraceptives and are overweight are the most at risk for blood clots. the people who have received the first dose of this vaccine without experiencing any serious adverse effects may complete the vaccination process with the same one while those who do not wish so may choose one of the two rna vaccines for their second jab, but no earlier than 84 days after the first oxford-astrazeneca injection. bulgaria had previously also considered combining the astrazeneca and johnson & johnson vaccines. as of 10 may 2021, it was reported that very few of the people who were due their second dose had decided to pick a rna vaccine instead of astrazeneca. on 26 august 2021, it was revealed that approximately 3000 bulgarians had opted to take a rna vaccine as their second dose. immunologist bogdan petrunov has recommended that bulgarians also get the flu vaccine in addition to a covid-19 one. in bulgaria a number of medical practitioners advise that there is at least a ten-day to a two-week interval between the administering of a flu and a covid-19 vaccine. however, both shots can also be received simultaneously, according to autumn 2022 guidelines from the ministry of health, which are consistent with the advice of the european commission and the who. the country bought 190,000 influenza vaccines for the period between october 2022 and february 2023. an outdoor table at a café in krasno selo requiring a green certificate. an eating establishment with a presumably fully vaccinated staff. pre-vaccination and immediate aftermath according to experts, there is no need for a person who is asymptomatic or mildly symptomatic to be tested for covid-19 prior to getting the vaccine. a person who has been vaccinated is generally recommended to be kept for observation for 15–20 minutes in the rare case any potential side effects need to be managed. people who want to receive a booster dose do not need to be tested for antibodies. in october 2021, the ministry of health published further information regarding the contraindications to an immunization with pfizer-biontech - having a severe allergy to a component of the vaccine, belonging to an age group below that specified in the short characteristics of the vaccine and being in isolation or showing symptoms of covid-19. due to the low vaccination rate, caretaker health minister asen medzhidiev stated in august 2022 that medical practitioners will be allowed to open multiple dose vials of the pfizer-biontech vaccine even if there is only one person present who is wishing to be vaccinated. post-vaccination as of 4 january 2021, only 4 adverse reactions to the vaccines administered had been reported to the executive agency for medicines - they included headaches and muscle pain, with all of the recipients' symptoms quickly subsiding. as of 12 march 2021, slightly over 830 messages regarding unwelcome side effects had been filed. as of 19 march 2021, about 1200 such reports had been submitted, with the frequency being 4 for every 1000 vaccinated for astrazeneca, 3 for every 1000 individuals for moderna, and slightly over 2 per 1000 for pfizer. according to other sources, the frequency of such complaints for all three vaccines was roughly 3.2 for every 1000 shots administered, with high fever (over 38 degrees celsius) seen as a more typical side effect of astrazeneca. as of 17 january 2022, 3861 complaints had been posted, with 10% of them assessed to meet the seriousness criteria, and no fatal outcomes conclusively proven to have been linked to vaccines. the latter clarification was made largely in response to allegations made by controversial infectiologist atanas mangarov who had made statements suggesting that there had been fatalities attributable to the vaccines. as of 3 may 2022, 4069 such messages had been submitted, equivalent to a frequency of 0.92 post-vaccination effects per 1000 doses. as of 1 september 2022, 4176 such notifications had been received, equaling the same ratio of 0.92 vaccine-related grievances per 1000 doses. as of 24 november 2022, 4188 such reports had been posted, equivalent to 0.91 per 1000 doses. bogdan kirilov, the executive director of the bulgarian drug agency, noted that all of the serious adverse reactions in the case of astrazeneca had occurred after the first dose. according to a ministry of health report from october 2021, side effects are more frequent after the second dose in the case of rna vaccines, with high fever being rare. todor kantardzhiev stated in january 2021 that the side effects of the covid-19 vaccines are no different from those of the influenza vaccines. in march 2021, a number of eu countries temporarily suspended vaccinations with oxford astrazeneca after reports of fatal or life-threatening blood clots with low platelet counts in a few people who had recently received a dose, even though no direct causal link has been established with the vaccine. bulgaria is among the 17 eu recipients of vaccines that are part of the abv5300 batch, which has been under investigation by the austrian health authorities as well as by the european medicines agency (ema). bulgaria had received 31 200 doses from this batch on 12 february, with most of them administered, but no serious adverse effects were reported until 12