A catastrophic fourth wave of the COVID-19 pandemic in Romania raised international concern due to a rapid surge in the number of infections and the high associated mortality. A country of approximately 19 million inhabitants, Romania recorded close to 20,000 daily infections, with more than 500 daily deaths, by mid-October 2021 (1). Consequently, the WHO sent experts to Romania to evaluate the ongoing situation, including the status of the COVID-19 vaccination campaign, and to help with an action plan. Here, we provide explanations for this dramatic reality using information from previously published academic analyses, the authors' personal involvement in the Romanian COVID-19 mitigation efforts, and press articles which describe the evolution of the pandemic in Romania.