The dual economic impact of COVID-19 vaccine hesitancy - Bulgaria’s conundrum case

Bulgaria is assumed to be the country with the lowest COVID-19 vaccination coverage in the EU. The present study aims to highlight the economic impact of vaccine hesitancy. The period analyzed is from 1 January 2021 to 31 December 2021, examining hospitalization costs for COVID-19 patients, vaccine application costs, and vaccine type and dose administered. Results demonstrate a net impact of BGN 97 686 089 (€49 946 104) if 30% of the eligible population had been vaccinated and BGN 146 529 133 (€74 919 156) if a 45% rate had been achieved. In addition, 5.1 million unused doses were scrapped—more than those administered. The public health impact of vaccine hesitancy in Bulgaria led to a preventable medical crisis, substantial economic losses due to avoidable hospitalizations, and significant additional costs associated with the destruction of unused vaccines.