As elsewhere, the Western Balkans have been affected by conspiracy theories, with doubts about government policies and trust in institutions emerging in light of the pandemic. The scale and implications of these theories are particularly strong. While in most of Europe COVID conspiracies are supported by a quarter to a third of the population, more than 75% of WB citizens surveyed believe in one or several of six COVID theories. Education, age and gender do not significantly impact these numbers. Instead, there is a geopolitical pattern, where support for conspiracies often aligns with larger feelings about the USA and China. Minorities, more vulnerable and often less trusting in the state, might be more susceptible to conspiracies. There is a direct link between support for conspiracy theories and scepticism towards vaccination. A majority across the region does not plan to take the vaccine, a ratio considerably lower than elsewhere in Europe, where a majority favours taking the vaccine. Conspiracy theories constitute a risk for public health in the Western Balkans and weaken trust in institutions and states, promoting a populist worldview that undermines democratic development.