A million doses of different coronavirus vaccines are scheduled to arrive in Estonia in the coming months and vaccines are set to be administered to all applicants starting in May.
If the city of Tartu had received their desired shipment of vaccines for Easter weekend, the first vaccination center in the city would have been opened. Only 2,000 doses arrived in Tartu and more than half of those were left untouched as there were not enough people wanting the AstraZeneca vaccine.
"There are people who have generated a preference of some vaccines but there is no objective reason for this," said Marje Oona, a family physician in Tartu.
Andres Merits, a virology professor at the University of Tartu, said there is no substance to the claim that one vaccine would be more suitable for the elderly than another as their efficacy is about the same.
"There is absolutely no reason to wait for a specific vaccine to arrive, especially for the elderly. Older people are at risk and their vaccination is justified by them having a much greater risk than younger people," Merits said.
Marje Oona is one of the doctors who is helping draw up the Estonian vaccination plan. She notes that part of the distrust against the AstraZeneca vaccine stems from the several changes and recommendations made in regards to the vaccine.
"If we had good research data about the effectiveness of the AstraZeneca vaccine for the elderly from the start, we would not have given a recommendation to begin inoculating people under the age of 70," she said.
So the committee's and councils in charge of drawing up the vaccination plan waited for more detailed data. The distrust against the vaccine among the elderly was also strengthened by a possible risk of thrombosis, however.
"The elderly fear it at times or want to take aspiring. What has occurred among younger people after an AstraZeneca injection is an extraordinarily rare reaction and is in no way a regular blood clot. It is not affected in any way by taking aspiring," Oona said.
If the elderly can be convinced in April and the distrust for AstraZeneca disappears, there is hope for middle-aged people to get inoculated. For that to happen, 70 percent of people aged over 70 must have received their first injection.
"We will certainly not wait for 70 percent to be reached in all 15 counties. The vaccination plan, now on a coordination round, has established clear visions - if we achieve a certain level in about half of the counties, we will gradually decrease the age limit," said Minister of Health and Labour Tanel Kiik (Center).
Centers to be created for younger people vaccinations
400,000 doses of AstraZeneca and Pfizer/BioNTech are scheduled to arrive in Estonia in the coming months, accompanied by 100,000 of both the Moderna and Jansen vaccines - a million doses, enough for every applicant. While elderly vaccinations are mainly the land of family physicians, younger people will be vaccinated in vaccination centers, whether they be aside healthcare establishments or specifically created for the purpose.
"The question is more about if they will be temporary, four will be opened for five consecutive days until a large capacity of vaccines are finished, for example. If we see that there are enough vaccines and there are enough people interested, the centers can be opened for longer," Kiik said.
If promises made by vaccine producers hold up, injections will pick up in May and June because along with vaccinating everyone who wishes, second injections for those vaccinated in the spring will also arrive. Time will tell if there is any reason to reopen large vaccination centers in Tallinn sports centers, as was done to start April.
"If we were to receive doses in the 100,000 range on some weeks, which we cannot rule out, it is likely reasonable to do both, meaning, use smaller and larger centers to carry out vaccinating," Kiik said.
Family physicians and hospitals can handle 30,000-40,000 weekly doses as well. It is still unclear if there will eventually be a more modern option to register for a vaccine than the digital registry and calling via telephone. But a vaccine applicant list, similar to Latvia, will certainly not be drawn up.
"There is no point to create this central database where people can just register themselves, it needs to have practical value - how can this data reach healthcare establishments, how does it help accelerate vaccination tempo in a situation where we are going by age groups. We can assume that younger people would register more actively," Kiik noted.
What will happen to AstraZeneca?
Kiik said that no country can allow themselves the luxury of putting certain vaccines aside at this moment. Family physician Marje Oona said it is still too early to say when the nationwide immunoprophylaxis committee will change their recommendation to not use the vaccine for people under the age of 60.
"If there is supplemental data, we will certainly convene. What we will decide, it is hard to say," Oona said.
Another option on the table is that people under 60 could still receive the vaccine if they take risks into consideration but this requires expert guidelines on risks and side effects.
"If the person has consciously made it clear to themselves, consulted with a healthcare worker, wishes to use [AstraZeneca], I think it can be a future option. A detailed information sheet, notification form, must be agreed upon by the state immunoprophylaxis expert committee," Kiik said.
Until the 60+ AstraZeneca age limit is in force in Estonia, frontline worker vaccinations have also been suspended. Virology professor Andres Merits said it is extremely important that vaccinations are not delayed.
"Any actions or assumptions or confusion about possible vaccine side effects causes much more damage than the side effects themselves," the professor said.
Every fourth adult in Estonia has now received a vaccine. Merits said that it is far from enough to exit the pandemic and at least 75 percent coverage is required. "It is clear that the higher coverage we achieve, the better this pandemic can be controlled. It also lowers the chance of virus mutations spreading," Marje Oona said.
If vaccine manufacturers keep their word, there will no longer be a vaccine deficit in Estonia. Merits said there should be nothing stopping the development of herd immunity apart from human reluctance.
"So the message here is vaccinate, vaccinate, as soon as you get the option, do it," Merits concluded.
Editor: Kristjan Kallaste