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12. 8. 2020

The coronavirus crisis has severely affected pretty much every single country in the world. The loss of lives has been alarming, as 719,856 people have already died because of the disease. At the same time, the crisis provoked key political debate about leadership and the plan to contain the deadly virus. There has been a differing variety of success amongst the different responses adopted by countries; however, quite surprisingly, post-soviet countries of Central and Eastern (CEE) Europe have performed remarkably well. Their success has been largely overlooked by the international media, but it is key to understand where their low numbers are coming from, so other countries can potentially learn for the future.

There has been a quite prominent theory that the low numbers of infected patients in the CEE region has less to do with policy response but is more related to the Bacillus Calmette–Guérin (BCG) vaccine that was commonly distributed during communism. This relation was initially suggested because it made sense geographically. The most distinctive suggestion came from Germany; where although the governmental response has been the same, the region of Eastern Germany—previously controlled by the USSR—had much lower incidence of cases. Another presented case used was Spain and Portugal. Both countries are located on the same peninsula and are common tourist destinations. Portugal, where the BCG vaccine was commonly distributed, had a low number of cases; Spain, where it wasn’t, was a covid hot zone. It generally seemed that the incidence of coronavirus and BCG vaccination were coincidental.

This was supported to a degree by the medical properties of the BCG vaccine, which is regarded as immune boosting. This means that although it is originally targeted against some of the deadliest forms of tuberculosis, it can help the immune system against other unrelated pathogens as well, as it induces a genome-wide epigenetic reprogramming in monocytes. Such reprogramming leads to an innate immune memory, which essentially creates a more robust response and higher alertness of immune cells when encountering a pathogen. Therefore, it was hypothesized that in the countries with boosted immune cells the incidence of coronavirus would be lower.

The statistical results gathered by Mayda Gursel from the Department of Biological Sciences in the Middle East Technical University confirm this hypothesis. In March 2020, she compared the number of active covid cases for all countries that had at least 1000 cases, and she discovered that there is significantly lower death rate in countries that commonly distributed the BCG vaccine. Very similar results were shown by Luke A. J. O’Neill and Mihai G. Netea for the European Research Journal, where they report that BCG vaccination leads to a lower death rate for numerous different viral infections. The hypothetical basis is solid and the data confirms it. So should we attribute the success of the CEE region primarily to the BCG vaccine? It is not as simple as that.

The key concern is that the data is biased to a significant extent and does not always fit the pattern. The bias comes for three main reasons: firstly, there are significant demographic differences between the different countries, secondly, the way each country reports covid cases varies significantly and lastly, each country in the data set is at a different point on the epidemic curve.  For instance, in the UK, BCG was commonly used, but it was one of the countries hit the hardest by the pandemic. Further, there is no actual clinical evidence that would suggest BCG interacts in any way with the coronavirus as the World Health Organization warns. Therefore, it is necessary to look beyond this theory, which is only a pure theory at the moment.

Some have suggested that the success lies in the fact that the citizens of post-communist countries are more obedient and thus have not broken the government regulations. However, this is a strongly patronizing point of view that has no real value to the discussion and importantly understates the real reason for the region’s success. That reason, according to Martin McKee professor of European Public Health at the London School of Hygiene and Tropical Medicine, is the swiftness of the response and how far-reaching the restrictions on daily life were.

While thousands of people gathered in western countries without any restrictions, like France and the UK, CCE had already significantly reduced the number of people permitted to gather. For instance, the Czech Republic announced a limit of 30 people on March 12th. Afterwards, the countries in the region introduced a state-wide quarantine shortly after the virus began to spread in Italy. It is also likely that face-masks were amongst the most vital policies that have been used by the countries, as Slovakia, the Czech Republic and Poland swiftly introduced the face-mask policy in public places. In the Czech Republic it was necessary to wear face masks indoors already on the 18th March, and it was mandatory on 24th March in neighboring Slovakia. For comparison, the UK made face-masks mandatory in public spaces only on 14th July.

Thus, the world needs to pay closer attention to the actual policies the CEE region enacted. Although it is very important to find an actual medical solution to the crisis, everything starts with government policies.


Written by Quido Haškovec, August 2020