Responsiveness, Strategy and Health as Diplomacy: The Unlikely Case of Serbia

Abstract

The virus had caught the world unawares. The term “the new normal” already became part of our everyday vocabulary. Its meaning changes and morphs, arguably it has already become a lot less prominent at the time of writing, some 20 months since the recorded emergence of COVID-19. Regardless, the sense of new norms and normative behaviours has overwhelmed the world.

It remains highly questionable whether the world will ever be truly comparable with the pre-2020 standards preceding the Event. Not that the world has not seen its fair share of plagues over the centuries. The latest such brutal infection that swept the globe killed more people than the Great War a century ago. What has changed since is that, once gladly built then mainly disappeared, the notion of a welfare state and its ethics mobilised governments and many national and supranational stakeholders into action.

Action which despite still being largely uncoordinated remains high on the agenda of international affairs. And although the world’s response to the covid pandemic has reinforced some global divides of wealth, development, regulation; equality, ethical distribution of medicine, intellectual property of its products; access to treatment; labour and skills needed etc—it also seems to have publicly enhanced the need for cooperation required for a meaningful and effective action against disease.

Serving as evidence that money is neither necessarily the prerequisite nor the answer, is the case of Serbia. Arguably, a state with very limited resources or influence on the world stage, in between powerful trading blocks and a customary portrayal in western press which seems less than flattering decades after the troubles, this small south European country responded rather better than many in the world’s far wealthiest countries per capita.

The teething problems with the pandemic response seem eerily commonplace: denial, then panic, blunt instruments and eventual realisation that a subtle strategy is the best tool against the invisible enemy. Not to underestimate the effects of covid on all levels of supply chains, on labour disruption, an increased sense of international distrust and blame-apportioning, it appears that often individual actors left to their own devices used such predicament as an opportunity.

What sets Serbia apart is (1) a brutally effective response in mid-March 2020 which created a hermetic curfew, especially on the over-65s, lasting for over 7 weeks; (2) the self-imposed national and international lockdown, then more limiting than the coinciding, widely reported one in Italy; (3) empirical data showing the causal impact of sudden loosening of restrictions over summer, leading to (4) a carefully coordinated strategy that included largely well-managed, less onerous partial restrictions and (5) an unprecedented effort aimed at mass-vaccination both of its own citizens and foreigners. The latter has a set of diplomatic characteristics: citizens of the region with even the loosest connection to Serbia felt invited to get vaccinated together with its own, by any number of jabs obtained by the country’s leadership from any and all brand actors, manufacturers and states willing to oblige.

Moreover, even though outside of any powerful trading blocs—or perhaps because of it—Serbia was able to rapidly obtain access to almost all the vaccines unburdened by ideological divides and state/corporate self-interests of global leaders. Further, it obtained the patent rights to produce first one, then two of the vaccines at its own self-managed immunological institutes. Immunological independence is becoming a new currency across levels of practice and discourse alike. Finally, despite its much diminished media image and a painfully transitioned economy, Serbia has long been donating some of its stock of vaccines to countries and states across the world, starting from its immediate neighbours and reaching farther afield than many, far wealthier ones.

The virus seems unique and the grim pandemic aftermath feels far from over. For a long time it flared up time and again, even where it was considered defeated; in places perceived as role models of success. There is no guarantee that horrific scenes of covid hospitals set up in sports venues will not return in some other guise and by some other agent. The image of the hazmat suit so darkly reminiscent of pictures of the plague immortalised in art and literature is inspiring a nightmarish narrative in many places. Finally, any astute social scientist will argue against judging of contemporary events without due caution.

The world’s organisations far surpassing in power any single state or individual urge caution and cooperation. This is just a snippet from the beginning of a new narrative of the care for the world’s health. Never seemingly more divided, it seems united in its goal towards healing.

1 Beyond Introduction: Conceptual Foundations

Three long winters and another one coming. The spectre of viral resurgence looms again.

At the time of completing this text in July 2022, another 2520 cases of covid were identified in Serbia (Politika, 2022¹). As compared with the approximate 400 per day only a week before, this seems like the evidence of The Virus’s resurgence in the summer of 2022; the informally labelled, current Centaurus strain being the likely culprit, and with the likelihood of new variants emerging as the disease mutates into the future.

Why “The Virus”? Why such capitalisation? This paper is about discourse just as much as it is about practice.² The global discursive, cultural and policy changes already brought about by the COVID-19 outbreak are greater in scope, scale and reach than those that came in the aftermath of many more deadly diseases of the past, including cholera, Variola Vera³ (smallpox), the bubonic plague and the most recent disastrous agent, the Spanish Flu. While the plague radically altered the demographics and very history of Europe from the fourteenth century, the Plague’s cultural impact is still felt in visual and textual narratives spreading across centuries and geographies, the impact of covid is most evidently an economic and cultural one. Compared to the relative death rate recorded, the economic and cultural effects of covid are highly significant.

Serbia was one of the first countries in Europe to act decisively. Indeed, Serbia declared a national state of emergency effective 15 March 2020, and its borders were shut that day, very nearly hermetically (US Embassy in Serbia, 2020). The most unyielding of lockdowns was introduced, preventing intercity travel without special permission from the police. Foreigners non-domiciled in the land were barred from entry and its own citizens found to be entering and in breach of the 14-day entry quarantine were to be fined and/or imprisoned for up to 3 years (exit.al, 2020; Šantić and Antić, 2020). There was a special curfew for those aged 65 or over (Blic.rs, 2020a; eVršac, 2020; Informer.rs, 2020; Kurir.rs, 2020; RTV, 2020). With slight easing in late April 2020, it lasted 7 weeks and the elderly were allowed out only at night and very early in the morning, once a week, for up to 500 m outside of their residential address, with select shops especially open for the senior citizens exposed to such restrictions, unprecedented in peacetime. All this on the day with only 55 cases and no fatalities reported. (Swift response in the wake of disturbing reports from abroad, and as recent data substantiates, modelled on the 1972 smallpox outbreak when the virus was brought into the country for the first time in 42 years. This major threat was resolutely suppressed and beaten by the most uncompromising of actions (e.g. Мијалковић, 2022, among various others⁴).)

As will be seen, the consensus among authors and journalists in Serbia is that the traumatic experience in early 1972, with the smallpox import affecting Serbia had been decisive in the radical even overbearing moves to protect the populace during the early days of COVID-19. However, there were many pragmatic issues. Online retail, which is still in relative infancy and remains comparatively pricey even in the most developed of countries, was hardly developed in Serbia at the time, complicating the lives of those subjected to the harshest of restrictions (Антељ & Албуновић, 2020; B92.net, 2021a; Blic, 2020b; RTS, 2020). The visual distresses of those early days of the pandemic were particularly pronounced in the form of covid hospitals being set up in sports venues, and on the premises of Belgrade City Fair,⁵ otherwise a major event, trade show and exhibition space (Alo, 2020; paragraf.rs, 2020); the same occurred with the Novi Sad City Fair, as an impromptu covid clinic⁶ (Savanović, 2020).

Those, latter aspects of battling the COVID-19 pandemic quite frequently occurred across the world, and in some cases, over a rather significantly prolonged period, by comparison.

1.1 Where Does Serbia Then Differ and Stand out?

There are several aspects to the claim of such uniqueness explored in this text.

1.1.1 Historical Backdrop: Variola Vera—Major Disease Staved Off—Ingrained in Collective Memory

“Variola” is the name of the virus that causes smallpox (WHO, 2022b). The historical and cultural significance of its Latin species name will be explored in this section of the text. A disease of extreme mortality, it was considered near-eradicated in Europe and indeed in Yugoslavia until the 1972 outbreak (mortality, ranging in this instance from approx. 9 to 35% and at 20% on aggregate as reported⁷). The man identified as Patient Zero Ibrahim Hoti (Давидов-Кесар, 2022c; Ferhadbegović, 2020; Миладиновић/BBC, 2020; Telegraf.rs, 2020) returned from pilgrimage in February 1972. Давидов-Кесар (2022c) states that it is presumed he had contracted it in a Baghdad street market on 6 February as the mean incubation period is 11.3 days (Litvinjenko et al., 1973: 3). According to the Yugoslav paper submitted on behalf of the WHO in 1973, the disease had started to spread from 15 to 16 February of that year after his return to his native village of Dranjane in Kosovo, near the town of Djakovica/Gjakove (Litvinjenko et al., 1973: 1) and the final infection was detected on 11 April 1972. Litvinjenko et al. (1973: 2) further assert that Patient Zero may also likely have been infected in Basra on 3 February, as both cities were reported to have had a measurable number of cases of smallpox.

As Patient Zero was vaccinated, it is believed he had developed fewer identifiable symptoms of the smallpox disease and had been spreading the virus undetected for a while until the cause of his and other cases were identified on 14 March 1972. As a non-typical case, he had developed no lesions on his skin a month after the initial symptoms of fatigue but serological evidence pointed at him being the one who imported the virus into the country (Litvinjenko et al., 1973: 2). Reportedly, opinions are divided as to the effectiveness of inoculation he had received in Skopje as anecdotal narratives hint that he may have rubbed off the site of the injection with medicinal alcohol immediately after receiving the jab (Telegraf.rs, 2020). While this cannot be verified, both Ferhadbegović (2020) and Litvinjenko et al. (1973) state the mortality ranged considerably, dependent on whether or not a patient was vaccinated, with Ferhadbegović stating that for the unvaccinated the mortality rate was as high as 35% “and 9 per cent in those with the scars of old vaccinations.” The comparative severity of smallpox and COVID-19 is starkly different. Despite the enormous, comprehensive effort involving the entire country in Yugoslavia, there were 175 confirmed cases of the disease and 35 deaths or 20% in total (Давидов-Кесар, 2022b, c; Ferhadbegović, 2020; Пејовић, 2022; Litvinjenko et al., 1973; BBC, 2018, however, states that 40 fatalities had occurred in total). It is less known that a Yugoslav patient had also arrived in Hannover, which led to a local quarantine involving 645 people and the inoculation of another 70,000 (Ferhadbegović, 2020; also, as implicit in a graph—Fig. 4—presented in Litvinjenko et al., 1973: 12; Пејовић, 2022). However, in the end the same patient was the only one registered in Germany as positive (Ferhadbegović, 2020; Пејовић, 2022).

In Yugoslavia in the spring of 1972, the deadly epidemic had spread across several towns and cities (Ilic & Ilic, 2022; Litvinjenko et al., 1973; Trifunović, 2017) before eventually being contained through nationwide concerted effort. This, however, could not have been achieved without vastly effective measures involving the strictest state of emergency. Startlingly, over the 55 days of crisis, the health service had vaccinated 18 million people out of the then Yugoslav population of 20 million. The government had asked the WHO for a supply of another 2 million more effective vaccines half-way through the process (Henderson, 2008: 918); the entire city of Belgrade, then counting 1.2 million inhabitants was inoculated in 10 days (Давидов-Кесар, 2022c); the effectiveness of the campaign to contain the virus and protect the populace is just as significant, noting that it took 4 and 5 weeks respectively to identify the cause in two distinct contexts (Давидов-Кесар, 2022a, c; Пејовић, 2022). D A Henderson, then WHO’s Chief of Global Smallpox Eradication Programme, stated that Yugoslavian medical staff and his policy-lead counterparts in the country:

…took very heroic steps to stop the spread. They stopped cars along the road to vaccinate people; they went from village to village, vaccinating almost the entire country—18 million out of 20 million people. The secretary of health was deeply concerned as to whether they were succeeding so he asked me to come and review what was going on. I did, and I told him they had done a really fine job and I agreed to say so on the radio to reassure the country.

Henderson (2008: 918)

In addition to the initial, main outbreak in Kosovo, Belgrade as the capital was the second most affected part of the country. The virus had failed to spread to the west, with one case also reported in Montenegro. According to historic data (Пејовић, 2022), the authorities of Slovenia, then a republic of federal Yugoslavia, would not allow entry to anyone from other parts of the country unless they possessed “the yellow booklet,” i.e. the document proving vaccination—rather reminiscent of the far more recent “covid passports,” vaccination certificates, COVID-19 track & trace and testing apps, etc.

The reported harrowing experience affecting Belgradians is reflected in the fact that two popular leisure spots “Čarapić’s Elm” and the romantically named “1000 Roses” (“Чарапићев брест,” “1000 ружа”) were among the four sites of the quarantine, the other two being respective major clinics for infectious, tropical diseases and skin/STI infections (BBC, 2018; Новости онлајн, 2022). In the feature series published in March and April 2022, to coincide with the semi-centenary of the smallpox outbreak, Belgrade’s respected “Politika” daily had interviewed some of the key surviving protagonists among the health care professionals who led the fight against the smallpox virus, as health authorities in Serbia were the ones who bore the brunt: Dr. Ana Gligić, Prof. Dr. Radmilo Petrović, Prof. Dr. Zoran Radovanović (Давидов-Кесар, 189,190,c). Dr. Gligić provides an exhaustive description on how the Variola virus was thoroughly destroyed, sealed and buried in the grounds of the Torlak Virology Institute where she worked during the 1972 smallpox epidemic, adding that a live virus of the Spanish Flu was isolated in Greenland from a deceased sufferer buried in permafrost and thus urging exceptional caution with such agents. The WHO, she claims, called five times to check that the procedure had been followed through in Belgrade (Давидов-Кесар, 2022a).

Belgrade’s leading “broadsheet” also revisited the fact that reading between the lines was required at the time, not least as the leadership of Yugoslavia had aimed to pre-empt any sense of panic before effective measures were in place (Пејовић, 2022), which would threaten to add to the sense of uncertainty and concern. Пејовић (2022) also asserts that immediately upon learning of the smallpox diagnosis, the two lead specialists and department heads from the Belgrade Infectious Diseases Clinic were sent to Djakovica; Dr. Miomir Kecmanović; and Dr. Vojislav Šuvaković, both with extensive experience of treating smallpox in India on behalf of the WHO were there from the outset. BBC (2018) emphasises that Serbia had implemented its first smallpox vaccination drive in 1839 (at the time still a semi-autonomous principality under the auspices of the Ottoman Empire) and 14 years before Britain did so. Moreover, in an interview wittily entitled “How Variola defeated Corona,” historian Dr. Radina Vučetić reflects on the fact that Prince Miloš Obrenović, who ruled Serbia at the time had implemented an ambitious modernisation programme, contained a plague outbreak and passed laws that no-one could enter into marriage, attain a scholarship or get accepted into a grammar school without being inoculated, having seen three of his own children succumb to smallpox. Known as an autocrat, he elicited the assistance of civil servants and the Church to promote vaccination every 3 months (Мијалковић, 2022⁸).

Smallpox was declared eradicated by the WHO by 1980 (WHO, 2022b); the Yugoslav outbreak was the last of its kind in Europe and the most significant one in 20–25 years (Henderson, 2008: 918). The broad variety of sources consulted here agree that containing this outbreak was possible due to the resolute, organised and highly disciplined response involving health, the armed forces, police and civil service, engaging and educating the population.

This was the factual side of things, relating to the 55 days that led to the mass vaccination of 18 million [then] Yugoslavians.

The cultural, discursive impact of these crucial events is equally curious.

On the subject of Variola Vera, the named agent of the disease, acclaimed Serbian film director Goran Marković, had produced the eponymous movie that affected scores of viewers across Serbia and quite possibly across former Yugoslavia (IMDb, n.d./2022; Lazic, 2012; prlekija-on.net, 2012; and, for instance, r/TrueFilm, 2021⁹). The feature film Variola Vera straddles genres; the author himself states that the primary aim was to present a satire that would use the epidemic as a metaphor for society and that he had been long inspired by Albert Camus’s The Plague, aiming to create his own filmic rendition of the theme (Lazic, 2012). The result is a curious mix of genres: satire, horror, disaster movie, social drama and chiller. Released at the tenth anniversary of the outbreak, it had an impact well-described as a “cult” following. Mandić (2019: 495) takes issue with some aspects of the liberal poetic licence which suggested that there was corruption, soap-like intrigue, dishonesty and negligence among the staff who treated the outbreak at one of Belgrade’s quarantined clinics. Indeed, such is the example of courageous nurse Dušica Spasić, after whom an award for outstanding nurses in the land was named following her passing when fitting the outbreak (Давидов-Кесар, 2022c).

Regardless of one’s stance on such interpretations of sombre facts within the arts, the film has left a deep mark on media audiences within Serbia and has been a frequent referential point in pop culture and slang, for example relating to one-liners, characters, citations, etc. The significance of this may be somewhat related to contemporary matters discussed in this paper. Fifty years is a relatively short period of time for a society to absorb and reflect on such experience and cultural content tends to reinforce, reinterpret and [re]direct such reflexions.

1.1.2 Discipline, Libertarian Responses, Regulation and Popular Scepticism

In 2020, Serbia’s first, exceptionally strict initial lockdown, curfew and border closure policy proved a success. As was the case in the 1972 smallpox outbreak, this elicited the involvement of the border force, police, the military, in addition to health care sectors normally assigned the task. While Ritchie et al. (2022), WHO (2022a) and others provide very useful infographics and/or dashboards to monitor the spread and incidence of COVID-19 infections, recoveries and fatalities, it is rather ironic that most easily accessible collated data relating to the timeline and key events seems provided by Wikipedia (!). Irrespective of its improved functionality, this source is not one that can be considered sufficiently dependable for a matter of this gravity. (Perhaps this is something that can be of use to researchers and policymakers alike as a call for enhanced simplicity and readability of data presentations in accessible formats.) Following 7.5 weeks of measures among the strictest in Europe, an easing of those was announced on 6 May 2020 (srbija.gov.rs, 2020; Đokić & Čvorović, 2021). While some highly critical texts have appeared to question the motivation behind the easing of measures (e.g. EWB, 2020; Ioniță, 2021), the WHO (2022a) dashboard can be triangulated to such treatises. There are indications that June 2020 saw a rise in the numbers of cases though further comparisons do not appear to be definitively causal. Moreover, the coverage of protests in Serbia in early July 2020 may be indicative of a discursive practice seeking to identify the causes within perspectives known to accustomed external observers of the region. Once more, it is worth engaging in a reflexive, contextual comparison, especially now that sufficient time has elapsed to prevent the metaphorical “Heisenbergian” blurring that occurs in dealing with contemporary events¹⁰ (Katz & Csordas. 2003; Savić, 2001; Todorovic, 2022). The features of the protests of July 2020 in Belgrade may be contrasted with other reported instances worldwide¹¹ so as to arrive at a comparative perspective rooted in adequate contexts (e.g. BBC, 2020a, b; CNN, 2022; Convery, 2021; DW.com, 2021b; EWB, 2020; Ferhadbegović, 2020; Ioniță, 2021; Jones, 2020; Özdüzen et al., 2021; Reuters, 2020). The July 2020 short lockdown was cancelled and yet, the pattern of lockdowns, mandatory tests and mandatory safety measures continued to be implemented over the following months in ways that appear to comply with the overall strategies elsewhere, though arguably in a less weighty manner than in some instances. However, as stated in The Heritage Foundation Economic Freedom Index (2022), the country ranks as 111th in terms of the stringency of its response to the covid pandemic. This contrasts with its 59th global rank in terms of overall economic freedom and progress since 2017. Similar indicators are worth looking at in the context of sections to follow, which deal with the significant drive to procure, supply, distribute and donate COVID-19 vaccines.

Two years on, an AP article neatly sums up all the internal contradictions of varied inescapable suppositions about the July 2020 protest (Stojanovic, 2020) and its aftermath being the reversal of an earlier decision to impose a new lockdown at that time. Conversely, and in relation to the perceived libertarianism—or scepticism of the Serbian public—in an almost prophetic article by the BBC (2018) dealing with the circumvention of measles vaccination, citing Dr. Radovanović, a key protagonist of the 1972 fight against Variola,¹² that “[people] even perceive doctors as the authorities,¹³ which have let them down many times before.” The term “libertarian” in its multiple meanings plays a significant role in Serbian language. The word “slobodarski,” as the literal translation would have it, would score fairly high in content analysis of media texts in the language. In this respect, once more as contrasted with other media texts relating to other lockdown protests worldwide, the nonconformist response of parts of the populace can be explored by a dispassionate reader: e.g. BBC (2020a, b), CNN (2022), Convery (2021), DW.com (2021a, b), EWB (2020), Ferhadbegović (2020), Ioniță (2021), Jones (2020), Özdüzen et al. (2021), Reuters (2020), once more raising the age-old question about the balance between individual liberties and the common good invoked so many times since early 2020.

In terms of the breadth of discourse, there are a few more observations to be made. Never has this been truer than with the public role of celebrities as role models. And with the benefit of hindsight, it appears that some luminaries can get away with more than others (Allen, 2020; Kuenssberg, 2022; Pietras, 2020). Arguably, however, it is the degree of publicity and the reach of someone’s position as a positive role model of health, as in sports, that played a role in the following case which in turn had no less than a diplomatic effect. The terming of libertarianism and its multiple interpretations including individual choice is a feature that does seem to play a part here. Media narratives surrounding one of the world’s leading tennis players (Clarey & Peltier, 2020a, b; Mitchell, 2020; Rathborn, 2020; Rogulj, 2020) and his erroneous initiative to hold an international tennis tournament in Zadar, Croatia, in June 2020 seems to play a major role in subsequent outcomes that continue to affect his standing in the public perception around the world. Despite his profuse apologies, Serbian tennis player Novak Djoković was caught within a controversy that evaded the likes of musicians et al. which seems to continue and is indicative of the matters of freedom of movement and such like, in the emerging new normal and foreseeable oscillations between fresh policy measures.¹⁴

Argued as a matter of principle, public health and adherence to standards, regulation and equal rights for all under the law, the continued narrative produced significantly passionate overtones in January 2022 concerning the player’s involvement—or lack thereof—in the Australian Open Grand Slam tournament (Agarwal et al., 2022). Articulated along the discursive proclamations of sovereignty, border control, equal rights, and duties under rule of law, [in]considerate behaviour, etc., and risking an international diplomatic spat, was the enforced quarantine detention in a hotel normally designated to the least privileged of humans: refugees and asylum seekers. This being followed by the unvaccinated¹⁵ [post-recovery] athlete’s subsequent deportation. Analysts, commentators and critics from the full diversity and breadth of discursive spectrums claimed that the positive aftermath of the very public row involving border agencies, state and federal ministers and the judiciary had pointed at the flaws that far surpass the fortunes of an otherwise, rather fortunate individual (e.g. Abramsky, 2022; BBC, 2022; Byers, 2022; DS, 2022; Freckelton, 2022; Higgins, 2022; Miller, 2022; O’Sullivan, 2022).

Having looked at the facts of the matter, journalists and others (e.g. Horton, 2022) could not find a definite legal flaw in what the player had done, though as Abramsky (2022) points out, sundry find him obnoxious, which does remain a matter of personal taste, not policy, or law. The [perceived?] faux pas of the player’s very public statements seem to be the crux of what is interpretive not factual and perhaps, a discursive matter bordering pointed public relations bluster¹⁶ (astutely identified by Attree, 2022 in advance of the event)—gone wrong. Discursive context is key, and it is therefore worth re-examining contextual constellations where appropriate.¹⁷

The contexts of diplomacy and vaccination, indeed logically lead to vaccine diplomacy, next.

1.2 Substantive or Instrumental Vaccination Strategy: Pragmatism, Diplomacy or Altruism?

Relative to its size, economic status and rank, world position, impact and overall prosperity (Legatum Institute, 2021; Moody’s Analytics, 2022; The Heritage Foundation, 2022; The World Bank, 2022), Serbia achieved a great deal more than many far wealthier nations during the first few months of the global vaccination drive, than was to be plausibly expected.

An illuminating quote from article by The Economist (2021):

Serbia may not have had such glowing press coverage since the first world war

The said article also features representations on autocracy and pointed references as to the significant origin of its vaccination programme being beyond the established pharmaceutical offerings in the west.¹⁸ Related global press coverage includes other insightful commentary, some of it somewhat satirical:

Belgrade’s purchase of Chinese, Russian and western jabs also recalls non-aligned¹⁹ movement’s golden days

(Hopkins, 2021)

This, together with the reporter’s musings suggesting that the “autocratic” leadership, had used its own people as a testing ground by offering non-western vaccines before they were approved by the EU. Irrespective of related commentary hinting at varied ulterior motives (the two texts are not an exception²⁰), the result was one which meant that inoculation—notably offered but not mandated²¹—had in its initial phase reached more people in the small Balkan country than many others in its far wealthier EU neighbourhood (Delauney, 2021; Juncos, 2021; Karčić, 2021; Öztürk, 2021a; Petrov, 2021; Vuksanovic, 2021b). This, moreover, to the extent to which Serbian vaccination programme was almost immediately offered to the citizens of neighbouring countries (ABC News, 2021; Schlappig, 2021). Among the first to visit Belgrade and accept the immunisation offer was the prominent Croatian journalist and author, Vedrana Rudan (Kerbler, 2021; B92.net, 2021b). Habitually outspoken on any subject of interest, Rudan animatedly proclaimed her wonder with the Serbian “buffet menu laden with vaccines” (B92.net, 2021b).

Indeed, Euronews (2021c) confirms that, at the time of Serbia’s early immunisation drive, it had as many as four vaccines to offer its citizens and those willing to venture in. Emmanouilidou (2021) further goes on to suggest that such breadth of variety has political connotations, a ballot as she frames the term, claiming that this outcome which enabled choice and secured access to diverse vaccines needs to be subjected to critical scrutiny on “politicization.” In an interview for Euronews, Prime Minister Ana Brnabić reasoned against contemplations of such nature as she had stated that her government put health before politics, racing to secure the immunisation of its citizens:

We were one of the first five countries to sign a contract with Pfizer/BioNtech. And we also signed for Sputnik V also for the Chinese vaccine Sinopharm. We were the second country in Europe to get the first dispatches of the Pfizer vaccine immediately after the UK.

(Euronews, 2021b)

It is, nonetheless, noteworthy that an impact on EU’s soft power was detected in the region (Juncos, 2021; Safi & Pantovic, 2021) and that a drive to create a legacy of reconciliation in the wake of a common threat was identified. While Kovacic (2021) focuses on the goodwill effect in the West Balkans region, and Reuters (2021a) points out that the country donated thousands of vaccines to “former enemy,” there were regional responses that pointed out, somewhat in line with Hopkins’s (2021) critique, that the AstraZeneca vaccine batch donated had not been approved by the EU at the time (Öztürk, 2021a). As stated in a number of reports, the donations of tens of thousands of vials to Bosnia (Öztürk, 2021a; Reuters, 2021a, b; srbija.gov.rs, 2021), Montenegro (Tirana Times, 2021) and North Macedonia (Radio Free Europe, 2021; zdravlje.gov.rs, 2021) have been followed by a number of similar initiatives far surpassing the region of Southeast Europe.

Not contrasting the notion of Non-Aligned Movement logic, Serbia’s vaccine donations across the world included those sent to Angola (mfa.gov.rs, 2021a, b), Iran (Öztürk, 2021b), Lebanon (OLJ, 2021), Namibia (mfa.gov.rs, 2021a, b), Uganda (mfa.gov.rs, 2021a, b, c) and, rather notably, an EU member state, the Czech Republic (Johnston, 2021; republicworld.com, 2021; Telegraf.rs, 2021). Given recent history and the country’s less than enviable economic standing, the question of motives beyond altruism remains plausible. Some analyses seem to point at convoluted diplomatic ruses allegedly aimed at the tactics of its own tensions with Serbia’s [former] province (Vuksanovic, 2021b), however, even a cursory examination of the varied recipients of such aid invalidates such supposition. Namely, Czech Republic, Montenegro and North Macedonia had all established diplomatic relations with Kosovo years ago. While it is not implausible that an altruistic motive genuinely exists (e.g. Savkovic, 2022), when combined with a low uptake of vaccines past the initial stage of adoption among Serbia’s populace now stalling at 67% wholly vaccinated²² (Boytchev, 2021; Our World in Data, 2022), a diplomatic effort would be conclusive. Such efforts would not appear to be of limited aim, scale and scope as suggested by Vuksanovic (2021b) and authors of like inclination. The notion of goodwill; the soft power seemingly reserved for those who may afford it; the concept of value beyond immediate gain, all seem plausible. Not least the legacy of a post-colonial club of equals that is the Non-Aligned Movement (NAM) where Serbia is now a respected observer, hosting the 50th Anniversary Summit²³ of the NAM (Dragojlo, 2021).

Such unexpected results as those that lead to an improved position on the world stage appear to inform and part-formulate some rather critical commentary (DW.com, 2021a) while Conley and Saric (2021) take a more balanced view in their comprehensive analysis of these contexts in the West Balkan region. Kovacic (2021) cites Serbian publisher Robert Coban: “this is Serbia’s best soft power move in the past 50 years,” and reiteration by the PM Brnabić, that members of her government are “not interested in politics, we are interested in saving lives.” In the text with an elegantly formulated title, revealing the contexts of soft power, health strategies and goodwill that balances complex constellations of interest, Bechev (2021) refers to the Serbian President Vučić “stealing the vaccine diplomacy show.”

In several treatises and commentaries which indicate that Serbia had attained a great deal of unexpected soft power, Dinic (2021), Filipovic (2022), Subotić (2021) and Tzifakis and Prelec (2021) connect the shift from mask diplomacy²⁴ to vaccine diplomacy (Vuksanovic, 2021a, b; Verma, 2020; Wang, 2021) in the Balkans [and beyond], with the broader and increasingly more challenging matters involving major players on the world stage.²⁵

As the acme of such efforts, defined as immunological autonomy (an independence would be contingent on own, self-developed intellectual property based on proprietary patents), Serbia initially secured the licensing rights to two vaccines, Sputnik V and Sinovac. The former is being produced by the Torlak Virology Institute, instrumental in the 1972 battle against smallpox (torlakinstitut.com/en, 2022; Euractiv.rs, 2021; Ralev, 2021; TANJUG, 2021) and the latter by teleSUR (2021) Vuksanovic and Vladisavljev (2021).

The discipline of health diplomacy, and its most recent tributary, that of vaccine diplomacy are very new additions to the larger contexts of social sciences, critical thought, CSR and sustainability as they stand at the intersection of those more established concepts. As stated in a somewhat paradoxical manner, this text is decisively not about politics as such. However, the notions of policy, regulation, communications; goodwill, control, discourse and others as seemingly disparate notions all converge in a challenging time like the one, we occupy. Discourse and narrative play an often decisive part in formulating what something is, and such ontology determines the trajectories and outcomes of practice. Therefore, the opportunities awarded by crises are no exception.

Sometimes it is necessary to quote rather than paraphrase an original source as it is so well formulated that interpretations may not do it justice. One such example is Jorgen Samso (2021), reporting from Serbia in 2021 for the American Public Broadcasting Service:

By March, Serbia hadn’t received a single Western vaccine through the European Union or the International COVAX programme.²⁶ Its tens of thousands of Pfizer and AstraZeneca vaccines were secured independently from manufacturers. Russia sent hundreds of thousands of vaccines, but nowhere near what China could offer.²⁷

…

Because of the Chinese vaccine deliveries, by mid-March, Serbia had vaccinated more adults than any of the other 27 countries in the European Union, becoming continental Europe’s best vaccinator. The country raced ahead with inoculations at double the rate of Spain and Germany, internationally trailing only behind Israel, the U.K. and the U.S.

The later slowdown in the uptake of vaccination opportunities may be attributed to a number of factors; as explored above, the libertarian approach (of which there may be many forms) is one possible root²⁸ of this. Discursive notions explored above, including those distrusting authority embodied in the hazmat suit and arguably ingrained through pop culture representations of The Plague/Variola Vera are not dissimilar to the Foucauldian (1975) notion of panopticism and body/discipline further asserted by the track/trace logic of the new normal. Experience of oppression as an inoculator from docility is counterbalanced by what is equally perceived as an absence of responsibility that influential individuals rather than groups tend to be identified with in public discourse. To complicate matters further, the term itself is not homogeneous (Barthes & Duisit, 1975) and while much innovation had occurred in technology of devices and content management tools since 1975 and the two treatises’ (Barthes and Foucault) rise to prominence, the ontological features of the two persist.²⁹ Coercion and mandatory behaviour modification led to reactionary responses recorded, while a proactive and educational approaches do not seem to have been inferior in effect. There is no doubt that ugly emanations of rejection of reason appeared across the globe, and in the case of Serbia that involved offensive chants against a prominent epidemiologist, a co-author of a study on Influenza (Radovanović & Kon, 2010) and much credited for the rational and comprehensive strategy of containment and control of the spread, much in the same way as his predecessors and counterparts in the alarming outbreak of 1972.³⁰ Yet despite all such incongruity in the face of the unprecedented,³¹ and without aiming to unrewardingly try to dissect the unknowable motivations of major decision makers at a time of contemporaneous developments, the meaning of which may only be revealed once the narratives, facts, layers of meaning and delicate action are disentangled after the event, there are measurable outcomes to be had which may be left to the historians of posterity.

That there were in existence some foundations of the new, the novel and the definitive qualitative change may be seen from the growing literature that had been—and should be consulted to benefit related research and novel treatises on, say, a digitised health policy of near-future incremental development (or disruptive for that matter, as the two converge in crises).

In the specific context of the Serbian response [an ongoing matter indeed as we live the history thus described and interacted with by means of minute observation], there are texts that would be of considerable use to the concrete developments at hand. These include: Barovic and Cardenas (2021) on the concrete case at hand explored here; Rokvić (2016) addressing principal matters; Maglajlija (2021) providing a contemporary critical angle; Penev et al. (2014) on commercial diplomacy in Serbia; Petrović-Ristić (2016) on the same subject, closely aligned to the current debate; Prvulović (2015), also providing theorisation in national/historical contexts preceding the crisis but formulating the logic of soft power [without “power”?]

Closer to the challenges and finding interim solutions but on a much grander scale than can ever be conceived to be done by a small country with fewer inhabitants than central boroughs of London, the response of which is inevitably tangled within these emerging trends: Rudolf (2021), Rofii (2020), Giusti and Tafuro Ambrosetti (2022), Kazharski and Makarychev (2021), Kurecic and Haluga (2021), Lee (2021), Indraswari and Lestari (2022), Suzuki and Yang (2022), Bachulska (2020), Brown and Ladwig (2020), Chattu and Chami (2020), Chattu et al. (2021), Fayyaz and Siddiqui (2021). Of value in this are also the works of Al Bayaa (2020), providing an interim future perspective with a conceptual extrapolation; Godinho et al. (2022) analysing the tools that may assist implementation of such emerging trends.

Last not least, texts and treatises that lay the foundations of contemporary questions of health diplomacy that rapidly came to the fore as the result of crisis: Feldbaum and Michaud (2010), Kickbusch and Kökény (2013), Kickbusch and Liu (2022), Kickbusch et al. (2021), Kickbusch et al. (2007), Lee and Smith (2011), Michaud and Kates (2013). And as a logical conclusion, an array of texts on soft power, the power of culture to engage, educate, influence, mobilise and permeate, some of which include: Ang et al. (2015), Nisbett (2016) and Pajtinka (2014): Cultural diplomacy (e.g. Zamorano, 2016), forming a conceptual foundation, context-dependent and emphasis-sensitive—in this specific case veiled beyond the more concrete action but influencing it and being modified and articulated by it³² as it unfolds.

1.2.1 A Summary: The Specificity and Uniqueness of Serbia’s Response to the COVID-19 Pandemic

First, as stated above, it was the speed—and notable strictness—of the state reaction to the pandemic. This may, to some extent be explained by the enduring memory of the last European outbreak of smallpox in 1972 (e.g. Давидов-Кесар, 189,190,c; Мијалковић, 2022; Миладиновић, 2022; Новости онлајн, 2022; Пејовић, 2022). It is quite opportune for the purposes of this text that this year (2022) Serbia marks the 50th anniversary of the terrifying outbreak of a most contagious and deadly virus which it has successfully beaten back in ’72.

Indeed, contemporary Serbian journalists, policymakers and medical professionals have not failed to draw parallels and point out at the effective utilisation of such extensive, valuable and costly experience of a major virology and immunology challenge that Serbian health care professionals had faced decades ago earning invaluable understanding of the matter. The smallpox event is indelibly carved into the national psyche, such memory enduring to some degree thanks to a feature film rendition framed within the borderline horror aesthetic,³³ which earned itself cult status in Serbia and across former Yugoslavia (e.g. prlekija-on.net, 2012).

Secondly, the comparatively temperate response to the Serbians’ rapid and severe public rejection of a second curfew during the summer 2020. The reading of which may indeed contrast the scrutiny of global media organisations reporting on the said events at the time of their occurrence³⁴ (e.g. Reuters, 2020). An aspect of such uniqueness is the imposition of rules both exacting regulatory control and their subsequent, sudden and significant easing, somewhat at the dismay of experts both established and emerging, during the early stages of the global pandemic.

Third: The enormous scale, scope and reach of Serbia’s early vaccination effort, relative to its size, global position, economic facility and perceived status, Serbia’s effort to secure, enable, supply, share and donate the vaccines in the immediate term as inoculation became a realistic prospect. Also, and extending the invitation across the region and beyond its borders to foreigners wishing to get vaccinated at a time when its powerful neighbouring trading bloc, the EU, struggled to procure and distribute vaccines to its citizens (e.g. B92, 2021b; EURACTIV with AFP, 2021; Euronews, 2021a; The Economist, 2021).

Fourth, the unexpectedly effective libertarian drive of its populace in the wake of the pandemic, comparable to only the most advanced democracies of the west, as the extensive reporting on the protests held in early July 2020 can be further studied in comparative terms (e.g. France24, 2021). Thus, the international publicity effects of such libertarianism, latterly oft perceived as irresponsible even illegitimately inconsiderate by those whose subsequent mandating strategies appeared far more stringent, and the impact on the tiniest of handful of global celebrities that the small country may claim (e.g. Higgins, 2022; Kacer et al., 2022).

Fifth, the unusual drive towards enhancing the nation state’s access to such intellectual property rights—albeit by licensing in from abroad—as well as its own production opportunities coming from the knowledge transfer from the antiviral vaccines. Those, to be produced and delivered to the populace, interested foreigners and donated to international partners. This appears now, subsequently but (arguably) not consequently, in July 2022 not without controversy due to the interim [likely long-term?] intensification of international affairs. And lastly, more as a footnote but not to be overlooked. A cultural impact, registered and identified in national treatises (Šuvaković, 2020; Vukomanović, 2020), relating to the notion of social distancing as well as broader societal effects such impact being articulated, quite uniquely, in a form of popular art which enjoyed international exposure quite recently. An unexpected and unlikely cultural outcome that had spread from the country outwards, though largely undetected and understated beyond its niche: That of a critical stance embodied in a song performed at one of the most inclusive of global media events, oft-dismissed as superficial, capricious and self-absorbed, the Eurovision Song Contest. International audiences seem to have recognised the value of those lyrics, both in front of their laptops and those who could afford the ticket and the education to read the cryptic lyrics about health care, equality of opportunity and mental health in the wake of the pandemic.

“In Corpore Sano,” a post-modernist art-pop composition reportedly selected by accident was hailed as Serbia’s hymn to health (Dotto, 2022). A YouTube “reaction genre” clip of an American couple viewing the performance reveals some of the “viral” aspects of the song (TK Top Tunes, 2022). In this instance, the meaning of the term is indeed related to the unpredictable spread of publicity, of content and of information across the Internet.

1.2.2 An Aftermath, the Epilogue, or Merely “Act One”: Emerging Cultures of Reflection and Insight

The shared experience that divides and unites the world at once. A song that discusses mental health emerging in the wake of the pandemic, films that do not construe horror as entertainment, the art that reveals deep anxieties about disease and frailty of life may all act as a counterweight to the extreme self-preservation logic of pseudo-evolutionary survival. At a time when education and meaning are just as effective as benevolent coercion and may perhaps act as coherent and consistent supplementary materials to formulate the need for individual responsibility, language is no longer an insurmountable barrier where digital tools enable translation simultaneously and the underpinning of Latin, the language of medicine, much philosophy and historical wisdom may contribute to a shared experience of humanity. Even in a miniscule way: Variola Vera in Corpore Sano—1972–2022, a footnote in history. Irrespective of whether or not there is much future history to be had, we do leave a trace.