As recent developments around a coronavirus vaccine have shown promise, Estonia has put together a preliminary plan for the distribution of the first vaccines to potentially reach Estonia in expectedly small quantities.
In 1958, all citizens in Estonia were vaccinated for polio, the first region in the world to do so for the entire country. A similar mass vaccination could be conducted in Estonia next year, if a vaccine for the novel coronavirus (COVID-19) becomes available.
In late-July, Estonia signed an agreement with pharma giant AstraZeneca for 1,330,000 doses of a coronavirus vaccine which can be used by 665,000 people - close to half the population of the country. A supplementary order of 300,000 doses from developer Johnson & Johnson is also being discussed.
Considering the small population of the country and the magnitude of vaccinations, Minister of Social Affairs Tanel Kiik (Center) said the order might not even be enough.
The minister said: "The issue is that we do not know how long the vaccination will last. If we are talking of the period of immunity, a person might have to be vaccinated multiple times in a certain period. We also do not have any knowledge of which vaccine will reach the market first ."
Kiik said the actual demand for the vaccine will depend on the effectiveness and decisions regarding travel restrictions in other countries.
"There are certain vaccination obligations for many other countries, primarily in Africa and Asia. What might happen is that in the future, it will be said in Europe that if you wish to travel without self-isolation, you must be vaccinated," he noted.
Although clinical trials are still ongoing, countries are already drawing up plans for distribution as it has become clear that there will not be enough for everyone.
Kiik said Estonia's plan is already finished: "Primary risk groups are care home clients, healthcare employees and people with certain chronic conditions whose infection brings a risk of serious illness and death. And for that reason, the priority will also be elderly people, in our assessment."
Vaccinations for children will depend on the specific vaccines' indicators, but a situation might arise where only partial permits for sales will be given - for example, if the vaccine can only be used for people aged 18-55.
Triin Suvi, head of the Agency of Medicines' (Ravimiamet) biological medicines department, said the older a person gets, the less chance for immunity to the disease to develop. Some vaccines might not be suitable for elderly people for this reason, as they could be ineffective.
Currently, the agency has received two types of vaccines for assessment but a sales permit has not been issued yet. "The peculiarity of these vaccines is that they are simple to develop. After the nucleic acid was published, development took off," Suvi said.
Older types, using killed coronavirus particles, take longer to develop at first, which is why development has fallen behind a little. Suvi said current data shows that only 10 to 15 percent of vaccines in development receive a permit, others simply drop out for ineffectiveness or serious side effects. After an increase in narcolepsy cases during the swine flu epidemic in 2009, no risks will be taken.
Suvi noted: "In that context, we must certainly think of the importance of clinical trials and most side-effects will show during the trials."
Vaccines can not be made mandatory
While vaccinations were mandatory for Estonian citizens during Soviet times, there is no way to make them mandatory in the modern Republic of Estonia.
Medical lawyer Maret Kruus said it is only possible to set vaccinations as a precondition for certain situations. For example, Kruus said vaccinations could be made mandatory for hospital employees to avoid situations where all staff members are out because of the virus.
She does not consider a nationwide order reasonable, but to simplify the decision-making process for employers, the Labor Inspectorate and the Health Board should draw up concrete guidelines and directives for vaccinations.
Kruus noted: "I really hope they will not go the way of ordering or prohibiting, but instead assess which methods are most efficient. Making something mandatory or prohibiting something might not always lead to the desired result of protecting as many people as possible."
But as Joosep Toots told Kiir in Oskar Luts' "Kevade" ("Spring"), a beloved piece of Estonian literature - this is all theory, practice will follow.
When will it be possible for regular people, who are not care home residents or healthcare workers, to get vaccinated for the novel coronavirus?
Social minister Tanel Kiik hopes it will be possible next year: "But if you are asking if it will be the first, second, third or fourth quarter, then optimists are hoping for the second quarter, pessimists are saying fourth quarter at best. Then we can conclude that realists are depending on the third quarter (of 2021 - ed.)."
If Estonia were to buy out each dose of the vaccine allocated to the state, it would cost some €30 million. Kiik said this sum is much smaller when compared to the costs of coronavirus alleviation to date.
Editor: Kristjan Kallaste