Mongolia had big plans for a COVID-free summer. What went wrong?

ERDENEBULGAN, ARKHANGAI PROVINCE, MONGOLIA — The three-story rural hospital is running out of beds. A slender young woman sits in a narrow bunk, borrowed from a nearby dormitory. A masked and hooded nurse examines him carefully, using a portable radio to communicate with a doctor in the crowded facility.
The patient, Ganzul Tsogtgerel, is a 20-year-old business student at the University of Humanities in Ulaanbaatar, the capital of Mongolia. Although fully vaccinated and keen to wear a mask, she caught a “breakthrough infection” with COVID-19 while spending the summer with her parents in Arkhangai province.
“It was already 16 days after my second dose,” she says in disbelief. “Suddenly one day I had a headache, I coughed and I lost my sense of taste and smell.”
Ganzul’s shock and disappointment reflects the national mood.
Based on its healthy population, border controls and stockpile of free vaccines – Oxford-AstraZeneca from the UK, Pfizer-BioNTech from the US, Sinopharm from China and Sputnik V from Russia – Mongolian officials have confidently promised a “COVID-free summer” in early April.
But the virus had other plans.
As temperatures rose, so did COVID-19 numbers in Mongolia, fueled by a convergence of political events, holiday travel and breakthrough cases – especially among those who had been injected with AstraZeneca or Sinopharm, which according to the World Health Organization are only 63% and 79% effective, respectively, against symptomatic infection.
To top it off, the government’s ambitions to achieve herd immunity stalled as a growing anti-vaccination movement seized on every setback.
“Anyway, the people who were vaccinated also got infected with the coronavirus,” says Baigal Nyamjav, 37, an accountant in Ulaanbaatar who rejected the shots for his family. “Maybe in five or eight years we will have a well-tested and improved vaccine.”
Mongolia’s COVID-free summer seemed within reach in May, as it vaccinated people faster than any other country, according to the Global Disaster Preparedness Center, a joint initiative of the American Red Cross and the Federation. International Red Cross and Red Crescent Society. Companies. With more than a third of the population at least partially vaccinated, the government announced cash incentives of 50,000 Mongolian togrog ($18) for recipients of the second dose and eased lockdown measures on May 8.
“People started to organize a lot of trips and picnics, as well as meetings between friends and families as soon as the confinement was lifted”, explains Myagmarsuren Erbat, resident doctor. “Many factors have also impacted the growing prevalence and epidemic of COVID-19, in terms of multiple medal and state award ceremonies, and subsequent home celebrations by recipients.”

On May 24, the start of the presidential campaign, Mongolia recorded 539 new cases; on June 10, the day after the election, the number reached 1,312.
Campaign regulations required venues to be sanitized and all participants to remain masked and at least 1.5 meters (5ft) apart, but witnesses say the rules were not strictly applied – and that there were no participation limits.
“A distance between people was only a chair, or 40 centimeters [16 inches] at most,” says Bilguun Jamsran, describing an event in Uvs province, western Mongolia, with several hundred voters.
Worried, authorities canceled National Naadam Festival celebrations but not the holiday itself; cases continued to climb as families gathered for the July 10-19 celebration, which honors Mongolia’s nomadic spirit.

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As the virus spread quickly and quietly, so did the Vaccine Opposition Association, founded by seven women earlier this year. On Facebook, they share stories about vaccine side effects and breakthrough infections, promote homeopathic treatments such as burning thyme and horse manure, and organize protests.
“Just four hours after we started a hunger strike, the police dispersed us,” said one of the group’s founders, Otgontsetseg Sanjaa, 48, from Ulaanbaatar, who demonstrated outside the headquarters of the government on May 26 and helped collect more than 3,000 signatures calling for a break in vaccinations.
Other anti-vaxxers are following the Department of Health’s pandemic advice on masking, sanitizing and social distancing – but drawing the line at the shots, which they fear is too new to be sure. In response, Dashpagma Otgonbayar, director of the immunization department at the National Center for Communicable Diseases, explains that the World Health Organization has endorsed all four formulas and vaccinated patients experience milder cases than their unvaccinated peers.
Where government guidelines and incentives have failed, seeing the impact of severe infections – and hearing about the more contagious delta variant – has convinced some hesitant Mongolians to change their minds.

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“I am sorry that I was not vaccinated; if vaccinated, COVID would be milder,” says Enkhjargal Batbayar, 39, a nomadic herder from Arkhangai who spent 13 days hospitalized in March. “While I was being treated, my husband and two children were vaccinated.”
L. Enkhsaikhan, head of the Department of Public Health Policy and Implementation Coordination of the Ministry of Health, confirms that Mongolians are “actively getting vaccinated” and adds that AstraZeneca boosters are given to workers eligible medical and law enforcement personnel.
Even from her hospital room, where she ended up despite her best efforts, Ganzul urged people to get vaccinated as soon as possible, with all options available.
“Vaccines are the brainchild of many smart people around the world,” she says. “They have conquered the plagues.”
As of the last day of August, Mongolia had recorded 213,820 confirmed cases of COVID-19 and 931 deaths. The percentages were relatively low – less than 6% of its population infected, and of those, less than 1% died – but large enough to ruin the country’s plans for a COVID-free summer, or even fall and winter.
Maybe if everyone gets vaccinated, says Ganzul, Mongolia’s COVID-free summer could come in 2022.