Auditor general criticizes vaccination process

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Auditor General Janar Holm. Source: Priit Mürk/ERR

Estonia's Auditor General Janar Holm has sent a letter to Minister of Health and Labor Tanel Kiik (Center) listing a number of critical observations on the organization of the vaccination drive so far and inquiring about the further plan for immunizing school students and children.

Holm's questions to the minister concerned the scheme for decision-making and accountability in the vaccination effort, the legal basis and the tasks of the parties involved. He also inquired about the long-term organization of vaccination starting from fall 2021 or the coming year.

Holm noted that the plan for vaccinating against COVID-19 on the government's website merely contains the principles of vaccination instead of a clear action plan. An order signed by the secretary general of the Ministry of Social Affairs on November 19, 2020, however, laid down that the vaccination plan must include the development of a system for monitoring vaccination coverage and a plan for re-vaccinations. These activities have not been included in the vaccination plan dated January 19, 2021.

Pursuant to the same order, a steering group led by the head of the department for public health at the Ministry of Social Affairs has been formed for leading the organization of vaccination. In this order, the said group is referred to as the central organizer of vaccinations in the COVID-19 vaccination plan, on the basis of which the auditor general concludes that the head of the ministry's department for public health must be the leader of the vaccination process in Estonia.

The said order and the way practical problems are resolved in Estonia prompt questions about the tasks of other public authorities involved in the process. The order does not present the role or tasks of the Health Insurance Fund regardless of the latter actively participating in the organization of vaccinations. The auditor general thus calls for a clear model for leadership and accountability in the vaccination plan.

Holm also proposes to introduce a system for at-home vaccination or to provide an opportunity for people to receive the shot near their home to prevent a situation where people are unable to go to the vaccination center due to illness or mobility problems. People in at-risk groups have also pointed out that they are wary of using public transport due to a heightened risk of infection.

Holm said that people have also turned to the National Audit Office over confusion caused by the way vaccination lists are compiled, particularly in relation to vaccines being administered to people who are neither part of at-risk groups nor providers of vital services, whereas many people in at-risk groups wishing to receive the shot have not been able to get it. It is important that the organization of vaccinations be fair and understandable and that the people, committee or establishment making the decisions concerning the schedule of vaccinations and groups to whom the shot is to be administered be publicly known.

A government-approved action plan dated February 23, 2021, says that vaccination against COVID-19 will be made available for everyone wishing to receive the shot near their home and free of charge starting from May. The vaccination plan says that the vaccination of the general public will start in May and reach 50-percent coverage by the end of October. The prime minister has said that the aim is to vaccinate 70 percent of people by the end of summer. The Cabinet decided on March 4 that the Ministry of Social affairs must present a plan for the vaccination of the general population at the earliest opportunity in March 2021. No such plan has been submitted by April 7.

In relation to the government having submitted on March 18 to the Riigikogu a draft regulation granting a legal basis for ensuring data exchange between national registers, which is necessary for the Health Board to be able to perform its tasks, the auditor general wants to know if technical preparedness will be available for such data exchange as soon as the draft is approved by the parliament.

A plan for vaccinating school students and children is also needed in case sufficient information is collected on the efficiency of coronavirus vaccines in this age group by fall 2021, for instance, Holm noted.

The auditor general also seeks to learn the long-term plan for vaccinating against COVID-19 after the so-called first vaccination round, for instance starting from fall 2021 or the coming year.

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Editor: Helen Wright

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