ERDENEBULGAN, ARKHANGAI PROVINCE, MONGOLIA — The rural three-story hospital has run out of beds. A thin young woman sits in a narrow bunk, borrowed from a nearby dormitory. A masked, hooded nurse carefully examines her, using a handheld radio to communicate with a doctor across the crowded facility.

The patient, Ganzul Tsogtgerel, is a 20-year-old business student at the University of the Humanities in Ulaanbaatar, Mongolia’s capital. Although fully vaccinated and diligent about wearing a mask, she caught a COVID-19 “breakthrough infection” while summering with her parents in Arkhangai province.

“It was already 16 days past my second dose,” she says in disbelief. “Suddenly one day, I had a headache, coughed and lost my sense of taste and smell.”

Ganzul’s shock and disappointment mirror the national mood.

Based on its healthy population, border controls and stockpile of free vaccines – Oxford-AstraZeneca from the United Kingdom, Pfizer-BioNTech from the United States, Sinopharm from China, and Sputnik V from Russia – Mongolia’s officials confidently promised a “COVID-free summer” in early April.

But the virus had other plans.

As temperatures rose, so did Mongolia’s COVID-19 numbers, fueled by a convergence of political events, holiday travel and breakthrough cases – particularly among those who had received AstraZeneca or Sinopharm shots, which the World Health Organization reports are only 63% and 79% effective, respectively, against symptomatic infection.

To top it off, the government’s ambitions of achieving herd immunity stalled as a growing anti-vaccination movement seized on each setback.

“People who got vaccinated have also been infected with the coronavirus anyway,” says Baigal Nyamjav, 37, an accountant in Ulaanbaatar who has rejected the jabs for his family. “Maybe in five or eight years we’ll have a well-tested and improved vaccine.”

Mongolia’s COVID-free summer had seemed well within reach in May, when it was vaccinating people faster than any other country, according to the Global Disaster Preparedness Center, a joint initiative of the American Red Cross and the International Federation of Red Cross and Red Crescent Societies. With more than one-third of the population at least partly vaccinated, the government announced 50,000 Mongolian togrog ($18) cash incentives for second-dose recipients and eased lockdown measures on May 8.

“People started organizing trips and picnics, as well as meetings among friends and families a lot as soon as the lockdown was lifted,” says Myagmarsuren Erbat, a resident doctor. “Many factors also made impact on the increasing COVID-19 prevalence and outbreak, in terms of multiple state medal and award handover ceremonies, and subsequent home celebrations by the recipients.”

Graphics by Matt Haney, GPJ

On May 24, the start of the presidential campaign period, Mongolia recorded 539 new cases; on June 10, the day after the election, the number reached 1,312.

Campaign regulations had required venues to be disinfected and all participants remain masked and at least 1.5 meters (5 feet) apart, but witnesses say the rules were not strictly enforced – and there were no limits on attendance.

“A distance between people was only one chair, which is 40 centimeters [16 inches] at most,” says Bilguun Jamsran, describing an event in western Mongolia’s Uvs province with several hundred voters.

Concerned, authorities canceled celebrations for the National Naadam Festival but not the public holiday itself; cases continued to spike as families gathered for the July 10-19 observance, which honors Mongolia’s nomadic spirit.

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As the virus quickly, quietly spread, 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, encourage homeopathic treatments such as burning thyme and horse manure, and organize protests.

“Just four hours after we went on hunger strike, the police dispersed us,” says one of the group’s founders, Otgontsetseg Sanjaa, 48, of Ulaanbaatar, who demonstrated outside Government House on May 26 and has helped collect more than 3,000 signatures demanding a pause in vaccinations.

Other anti-vaxxers follow the Ministry of Health’s pandemic advice regarding masking, sanitizing and social distancing – but draw the line at shots, which they fear are too new to be safe. In response, Dashpagma Otgonbayar, director of the Vaccination Department of the National Center for Communicable Diseases, explains that the World Health Organization approved all four formulas, and that vaccinated patients experience milder cases than their unvaccinated peers.

Where government directives 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’m sorry I didn’t get 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 health ministry’s Public Health Policy and Implementation Coordination Department, confirms that Mongolians “are actively getting vaccinated” and adds that AstraZeneca booster shots are being given to eligible medical workers and law enforcement.

Even from her hospital room, where she ended up despite her best efforts, Ganzul has urged people to get vaccinated as soon as possible, with any option available.

“Vaccines are the brainchild of many intelligent people around the world,” she says. “They have overcome plagues.”

By the last day of August, Mongolia had recorded 213,820 confirmed cases of COVID-19 and 931 deaths. The percentages were relatively small – 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 autumn and winter.

Perhaps if everyone gets vaccinated, Ganzul says, Mongolia’s COVID-free summer can happen in 2022.

Myagmarsuren Battur is a Global Press Journal reporter based in Mongolia.