Family physician: Equal distribution of vaccines causes inequality

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A bottle of the Pfizer/BioNTech COVID-19 vaccine during the first vaccinations in Tallinn, Estonia on December 27. Source: Ken Mürk/ERR

As risk group vaccinations do not only depend on the pure number of potential patients, Estonia has reached a situation where some family physician registries have already gotten to younger people while some people aged 70 and up in other locations are still awaiting their first invitation.

"The capabilities of family medicine centers differ greatly and the level of quality is also different, starting from what the information system can manage and what the patients' mindset is," said Tallinn Järveotsa family medicine center doctor Diana Ingerainen.

Her center, based in Õismäe, has called through all their patients aged at least 70. Every other refused the vaccine, saying they would rather wait for Russia's Sputnik vaccine. For this reason, the family physician can say that they have vaccinated all 80+ patients and most of the 70+ age group.

"If you can participate in some campaigns, projects and some people there refuse, you can administer all of your vaccines to risk groups," Ingerainen said.

Two weeks ago, when testing for the digital vaccine registry took place, participating family physicians received an extra 100 doses. More vaccines have also been given to doctors who have conducted vaccinations among childcare workers, social workers and other frontline workers.

Ingerainen received additional vaccines for her chronically ill patients from what was left over from vaccinating the teachers of Ruila School. The AstraZeneca is sent out in batches of 100, but there were only around 50 teaches. According to the family physician, there is an obvious connection between family medicine center quality and the level of vaccinations administered based off the respective registry.

"Those who can offer help better can also organize better vaccinating. But there has never been the correlation of smaller centers being worse than larger ones. There are large ones (family medicine centers - ed) that cannot manage and smaller ones that are doing very well," Ingerainen said.

Madis Veskimägi, a family physician in Pärnu, does not consider the vaccine distribution equal as all medicine centers are subject to shipments of the same size while the size of their registries can differ greatly.

"There are registries with thousands of patients, the number of patients in my registry for example is 2,900 and all physicians received 36 doses. It seemed like teasing to me, that the size of the registry, patient age and the number of patients who are more indicated for the vaccine, is not considered," Veskimägi said.

He added that medicine centers in Harju and Ida-Viru counties seem to be more preferred as well. He said he has vaccinated both local care home residents and teachers and since there were leftover doses from vaccinating at schools, one fifths of his risk group patients are vaccinated.

Külli Friedemann, head of primary services at the Health Insurance Fund, said the current plan is to focus on vaccinating the elderly. "We are moving in the pace of giving more vaccines to those registries that have more elderly people in order to ensure coverage for 70+ and 80+ groups," she said.

Starting Friday, vaccinations for younger people in family physician registries will be put on hold and will only be administered once vaccine shipments pick up in volume. "All Pfizer and Moderna vaccines to arrive currently will go to people aged 70 and up and the AstraZeneca vaccine is meant for 60+ people," Friedemann explained.

The new distribution plan can also decrease the size of vaccine shipments for the aforementioned medicine center in Õismäe and Diana Ingerainen said she does not consider distributing vaccines based on the number of elderly patients reasonable.

"I have this sense that we could go by the way of vaccinating everyone as fast as possible so that we could get as many people vaccinated as we can," the family physician said, adding that too much time is spent currently in calling people up for vaccinations.

"If we can fix the digital registry, then vaccine applicants can register for vaccines and we can only deal with administering vaccines," Ingerainen said.

She said a situation where vaccines are put aside for those who do not want them while eager applicants have to wait would be even worse.

Madis Veskimägi also does not consider distributing vaccines based on patient age a good solution. Since family physicians know their patients best, they should have the right to decide who needs it most. Veskimägi pointed out that a 45-year old cancer patient could use the vaccine even more than a healthy 80-year old person.

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Editor: Kristjan Kallaste

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