Health Board chief: We are too small to buy vaccines independently

Director of the Health Board Üllar Lanno would like to realign the agency to be able to handle any situation, also during crisis time. Photo: Konstantin Sednev

Director of the Health Board Üllar Lanno would like to realign the agency to be able to handle any situation, also during crisis time. Secondly, he deems it important to renew the board’s databases and get an overview of the situation of ambulance service providers and hospitals. In other words, Lanno stands ready to do his best for the board to justify expectations placed on it.

Üllar Lanno, last year brought major change to your life. You became the head of the Estonian Health Board three months ago. What have you found surprising in your new role?

I was ready for the challenge. I could rely on life and management experience, while I found an exhausted organization that had not had the chance to rest in the summer when I arrived. Their days that started at eight in the morning and often ran until midnight seemed inhumanely long. The second wave [of the coronavirus] forced the team to push on.

One is not likely to win the race on a tired horse. How many new employees did you have to hire?

Other state agencies that employ thousands of people, such as the Police and Border Guard Board, Rescue Board, Alarm Center and social ministry agencies, became the Health Board’s first lifeline. We also saw volunteers and hired new people of our own. We have seen thousands of helping hands and I could not tell you the exact number.

What are these helpers doing?

They usually help us call carriers and their close contacts as we are monitoring some 25,000 people. There is also counseling for schools and companies.

Unlike your predecessor, you have been considered a leader who does not argue and does what is expected of him. Do you agree?

I do not.

What kind of leader are you?

I have been working as a top executive for 17 years, used to run all European crime laboratories and represented Europe in the world. I have enough mettle to gauge the reaction and sensitivity various topics require. I am not one to simply follow orders as my know-how and experience are valuable.

Former head of the board’s emergency medicine department Martin Kadai had in-depth knowledge of communicable diseases, yet he was not heeded.

My experience suggests that everyone who is learned and professional enough is heeded.

How is running the Health Board different from running the Forensic Science Institute?

The pace is different. Crime discovery and the ensuing trial take on average eight years of which six to eight months is spent on forensic examination. At the Health Board, decisions need to be made in a matter of hours, often by next morning, while it also has twice the staff. One had years to shape a team and values at my last posting, while I am currently in charge of an agency that is constantly changing and will continue to change in the future.

The Ministry of Social Affairs promised in spring-summer to have a plan for the second wave of the virus. What was that plan once you took office?

I’m forced to admit that I started withy my own plan as I was handed nothing at all. Colleagues helped me get settled.

Immunization is one part of handling the crisis.

I knew what I needed to do and who would be in charge of what by the fourth week of October.

Vaccination is off to an expedient start in the USA, UK and Israel. Estonia decided to rely on European solidarity, while Germany also procured vaccines separately and is busy inoculating the population. Should Estonia have gone down the same path?

It amuses me whenever Estonia is compared to Israel. Europe should be seen as a whole and compared to Australia, for example, that is roughly the same size. First, we need to look at the relative importance of people vaccinated in the total population, consider the number of active cases and people who have recovered and have antibodies. That is how we get something resembling a big picture when comparing countries.

Therefore, Estonia should not try to procure vaccines directly?

We are a small country. Secondly, those with more information also have an advantage. Pfizer has plants in Belgium and Germany, which is why it is only natural these countries learn of free quantities first. However, the first EU shipment delivered exactly 9,750 doses to every member state.

Rapla Hospital allowed 20 doses of the vaccine to go bad over the weekend. What has the Health Board done to avoid such incidents and when could the results of supervision proceedings be in?

The Health Board is notified of all incidents, including this one. All institutions that receive the vaccine and the board can be more vigilant. To err is human on the one hand and a good indication of what can be done better on the other.

Family doctor Madis Veskimägi has criticized the way immunization is organized, saying that his staff of 20 only got an appointment for vaccination 12 days after the campaign started. You said in your reply that he was late putting in his request. How come?

Twenty hospitals, 53 family medicine centers and three ambulance service providers initially got the right to vaccinate medical staff. They plan who shows up and when and order vaccines from the board. If Dr. Veskimägi is not a member of the Estonian Family Medicine Association, perhaps information did not reach him in time.

Why do doctors in Tõstamaa have to drive to Pärnu to get vaccinated?

That is the case not just in Tõstamaa. It works like that everywhere in Estonia. The vaccine is still in short supply and it would not be expedient to send minute quantities to every single place. We will be boosting the number of immunization centers once we get more doses.

Where can people see the vaccination plan?

The plan is not public, while I can tell you that we aim to vaccinate healthcare workers in six weeks and nursing home staff and residents in the four weeks following.  Next will come Defense Forces and prisons medical staff. We can pick up our efforts once the European Medicines Agency greenlights vaccines by Moderna and AstraZeneca.

You’ve said that the quality of healthcare services needs to become more level. What is well and where do we need improvement?

The family medicine quality system was created several years ago. The best practices have been chosen and guidelines made available. I see no systematic problem in that sector. In the past three months, the Health Board has received five or six complaints about doctors only two of which concerned family physicians.

Is the quality of family medicine even across Estonia?

I believe that level to be very high. My wife started as a family doctor in 1999 that has allowed me to witness the impressive development of the sector firsthand.

The Health Board is in charge of family medicine supervision. Are family physicians happy with the board?

There was a lot of mistrust and accusations during our initial meetings but it was soon put to bed. You can ask family doctors about their level of satisfaction. I believe we have a constructive dialogue.

How does the hospital network look?

There is a notable gap in quality when we compare major hospitals and those in smaller cities. Top medical centers have pulled way ahead and we need to help the others catch up.

How to go about that?

There are many possibilities, from trainings to harmonization of the quality of work processes and data. We should make use of a “care and share” solution where the stronger help the weaker.

Hackers stole the personal information of 9,157 coronavirus patients or their close contacts in November. The Data Protection Inspectorate has launched an investigation into what it considers an illegal database and subsequent leak. What was the Health Board’s punishment?

Criminal proceedings are ongoing. To the best of my knowledge, the inspectorate has not made a decision yet. That said, cybercrime is a very serious problem everywhere in the world. When I was still working at the forensic institute, I learned of an incident where an entire hospital’s data was locked away and only released once a ransom was paid. Secure information systems are the only thing that helps.

How much attention is COVID-19 diverting away from supervision and developments?

Around 40 percent of staff have been reassigned to help with the COVID-19 workload in Northern Estonia. Other regions can currently manage on their own. National obligations, such as issuing activity licenses, are being upheld, while some work sections will inevitably suffer for as long as the virus continues spreading.

What three tasks have you set for yourself this year?

First, to adjust the Health Board to be able to handle any task for the next five years, also as concerns future crises. Secondly, we need to update our databases. The first artificial heart was approved in Europe last year. While we already had smart artificial cardiac pacemakers, the advent of 5G technology will bring new such devices. The Health Board will need to bring itself up to speed here. Thirdly, we need to map out the current situation of ambulance service provides, first contact medical care and hospitals. Additionally, our laboratories must be able to identify different mutations of the virus.

How did you celebrate New Year’s Eve?

My family and I welcomed the new year at a friend’s home. We were five people in all and located about a kilometer from the Health Board so I could return to work if necessary.

There was no need?

No, because the medical threat assessment and guidelines had been forwarded to the police. We need to commend the Estonian people for good behavior on New Year’s Eve.

And yet, photos published by newspapers showed people kissing and partying in the streets.

There is nothing wrong with communicating positive emotions to people in the same household, and I believe that people who were ill refrained from it.

What is your opinion on the need to explain the severity of the situation to people who are against wearing masks and vaccination?

Public polls suggested back in fall that around 60 percent of the population is interested in the vaccine. Opponents are a minority as most people want to be free of the risk of falling ill and return to life before the pandemic.