Family doctors not happy with state vaccination strategy

Ruth Kalda. Photo: Kristjan Teedema / Tartu Postimees

For months, there have been reports that the pace of vaccination is not what it should be. This has now been admitted by the social minister and the ministry’s secretary general. While there is talk of a small part of teachers, rescue workers and policemen being vaccinated and a pilot project for vaccinating people in the 60-69 age group, there are many family medicine centers all over Estonia that have not finished vaccinating people in risk groups.

Family doctors stand ready to administer vaccines that they are simply not given. Deliveries that do come through come with very little warning that sends family medicine centers scrambling to notify people in time. Postimees’ information suggests these concerns are shared by family doctors all over Estonia.

Head of Estonia’s COVID-19 prevalence survey, family doctor of the University of Tartu Institute of Family Medicine Ruth Kalda agreed to speak publicly. The family medicine center where she works vaccinates as many people as they have doses for. “The actual situation is that vaccines are only made available in certain regions,” Kalda said. For example, the Health Insurance Fund has only designated [Estonia’s second largest city] Tartu as a high-risk area once – in January when family medicine centers got the chance to order the Pfizer/BioNTech vaccine. According to Kalda, the city has two risk group patient lists one of which was assigned 36 doses in a situation where the lists have a total of 600 people. The university’s medical center has also received 100 doses of the AstraZeneca vaccine that is not administered to elderly people.

It was communicated on Saturday that vaccines for the elderly will be made available to family medicine centers in Harju County, Ida-Viru County and Lääne-Viru County. “We have been waiting for vaccines for risk groups for a long time, while there are family medicine centers in different parts of the country that have not received a single dose of vaccine,” Kalda said.

There are clinics that have not received the Pfizer vaccine in Põlva, Pärnu, Harju and Ida-Viru counties. Estonia has taken delivery of very small quantities of the Moderna vaccine that has so far been made available to family doctors in Tallinn, Saaremaa and Hiiumaa.

Poor exchange of information

Eero Merilind, family doctor at the Meditiim Family Medicine Center, told Postimees that the center received 36 doses per practice list in February. While they have received more doses this week, the center’s need is much greater. We have over 1,200 people in risk groups, while we have inoculated just over 300 today,” Merilind said. He emphasized that some family doctors have not received any doses or been able to start immunization. The doctor also pointed to the problem that family doctors cannot choose which vaccine they are sent.

Orders are placed as soon as the Health Insurance Fund notifies family medicine centers of vaccine availability. However, people cannot be invited to come in for vaccination before the fund has confirmed the shipment.

“Placing orders for vaccines does not guarantee us doses,” Kalda explained. She added that the clinic once fell through when it turned out the fund would be sending a smaller shipment of vaccine after doctors had invited more people to come in. “We learned of the change almost at the very last minute,” Kalda said.

“What this looks like is that family doctors have entire cabinets full of vaccine and are simply holding back,” said Diana Ingerainen (Eesti 200) from the Järveotsa Family Medicine Center. She recalled a situation where the fund told centers to place orders for AstraZeneca – this was done and patients called to come in, while quantities proved smaller than promised in the end.

“It takes time to call people,” both Kalda and Ingerainen said. It is done on top of everything else family medicine centers have to do and while some people agree right away, others want to know about the vaccine’s side-effects.

In a situation where clinics are told that they are not getting enough doses a few days after calls have been made, another round follows. “We need to call the people again, apologize and tell them we cannot vaccinate them right away after all,” Ingerainen said. “This means that we cannot draw up vaccination lists for any meaningful period in advance,” Kalda added.

Eero Merilind echoed the sentiment that family doctors need to work fast as it is necessary to change employee schedules, invite people to come in and change work organization after receiving delivery confirmation from the fund. “Because vaccine deliveries are not constant and regular, plans cannot really be made. A custom solution is required every time so to speak,” Merilind added. “Our freezer does not have a single dose of vaccine waiting,” he said.

State side project

Last weekend, the state launched a test project in Tallinn, Tartu and Põltsamaa that uses the eesti.ee state portal to invite people in the 60-69 age group to come in for vaccination. Ingerainen said that this puts family doctors in a very awkward positions where they have to tell people in their practice lists that they cannot get vaccinated yet, while the state has a parallel project for which there seems to be enough vaccine. “I am not against involving other sectors, but we should know our role and possibilities, as well as how many doses we will get a little more than three days in advance,” Ingerainen said, adding that family doctors no longer know who has been vaccinated and who has not.

A digital registration system is seen as a possible solution. “We are calling people today, while our hopes lie with a digital system,” Merilind said.

People are also forced to wait. “People call us to say that they are willing to come in as soon as doses become available,” Ingerainen said.