Prime Minister Kaja Kallas (Reform) is behaving as if she cannot hear the recommendations of the best experts in Estonia. Behavioral scientist Andero Uusberg, advising the government on the coronavirus situation, has convincingly shown that the punitive and menacing approach fails to produce results among [vaccine] doubters. Or rather, it is producing results opposite what is sought: instead of better vaccination coverage, we get umbrage and even less confidence in the state. Little wonder then that support for the Conservative People's Party (EKRE) is rising.

We could tune in to more meandering management from Kallas on Tuesday when instead of a systematic and carefully considered vaccination plan, we were treated to a series of proposals some of which were unconstitutional (leaving people without treatment), some unfair (demanding the return of thousands of euros for treatment because people have failed to assess health risks) and some just pointless (such as not accepting a negative test result in place of Covid certificate).

What it all means is that the PM is panicking, having brought us to the brink of disaster for the second time in two years. In this light, attempts to divert attention from the state's failings to mistakes people have made themselves is entirely understandable. The prime minister failed to make a single – not one! – positive proposal for boosting vaccination.

However, she did once more urge Jevgeni Ossinovski to present his proposals. I would like to thank the PM for this credit! It saddens me to learn that the PM has not managed to create a system to involve the best available expert knowledge in administration, sending Kallas asking for my help. Perhaps the Social Democrats' proposal of finding a more effective health minister should be considered once more.

However, allow me to make five concrete proposals as per the prime minister's request.

Communication

The state's voice needs to be confident, clear and one in a crisis. I have been saying it since this spring, with the sentiment recently echoed by Auditor General Janar Holm. The recent such faux pas concerned booster doses the state said would not yet be available to teachers and medical staff on one day, while the opposite statement was made two days later.

Another example is the prime minister's Tuesday radio interview that was full of harebrained whims her own health minister immediately challenged (as they should!).

Of course, we also need more operative, forceful and diverse communication on vaccine safety. As suggested by Uusberg and Marju Lauristin, communication should also be different depending on the target group. If that sounds like common sense, that's because it is.

But we do not currently have high-quality crisis communication. If the problem was lack of coordination at first, it mainly boils down to lack of human resources today.

At most, five people are in charge of the coronavirus topic at the social ministry's communication department. Often fewer still. All are good people who know what needs to be done, I know them personally, but cannot possibly expected to do the work of a hundred people.

Proposal: To immediately quintuple the ministry's communication department. Experts from other state agencies need to be diverted there and put in charge of doctors, behavioral experts and communication strategists capable of drawing up and executing a professional communication plan. The latter should include a Russian communication operative group as we have most to gain (and have done the least) there.

Family doctors' mission and rewards

The government has failed to communicate society's expectations for vaccination to family doctors. Le Vallikivi, head of the Estonian Family Medicine Association, said in the Riigikogu on Monday that no one has told family physicians whether to prioritize [coronavirus] third doses or the flu vaccine. Or suggest what other obligations could be dropped as there are only so many hours in a day.

We have told family doctors that they can vaccinate people and get paid. We need to completely rephrase their mission.

Such as follows: Dear family doctors. We know you have a lot of work and a limited time in which to do it all. But immunizing the elderly against the coronavirus is the most important task Estonia faces today. Absolutely the most important task on which the lives of thousands, jobs of tens of thousands and the education of their children depends. We believe in you and give you all the support you need in this task of foremost urgency.

Furthermore, we should hike family doctors' performance pay for helping achieve a high level of vaccination among the elderly. Convincing elderly people is hard work and needs to be additionally motivated. The Health Insurance Fund's summer proposal of €500 per practice list is laughable.

Proposal: To pay all practice lists that achieve over 80 percent vaccination coverage in the 80+ age group €10,000. Both per initial coverage and booster doses.

Paying vaccinators more per injection

The current price per vaccine administered usually covers normal expenses, which is why private service providers have created vaccination opportunities in convenient locations (usually major cities).

But we need more. We need to test new solutions (that might fail), contribute to awareness and offer mobile vaccination in smaller places. It is currently only possible to get vaccinated in a few places in some counties, while major immunization centers in cities are largely empty.

Proposal: To double the pay per shot for new service providers, consider paying more based on age group and/or region.

Involving local governments

The National Audit Office said in its letter that the state fails to cooperate systematically with local governments. My contacts with local government heads confirm as much. Messages suggest that vaccination is the central government's business and that local governments can stay out of it. That is insensible.

Many potentially infectious places are run by local governments: schools, cultural centers, care establishments. We should have local government-based vaccination targets and activity plans put together with the latter's help.

For example, in a situation where Saaremaa has vaccinated half the students Tartu has, the state should work with the local government to lay down concrete goals, offer the necessary logistical solutions and share good practice from other counties. The local government can in turn offer additional human resources for organizing vaccination.

Proposal: To involve local governments and their departments, human resources and local information in the immunization process.

Giving every retirement-age first-time vaccinee and booster dose recipient a free dental care voucher

Considering that protecting people most vulnerable to the virus is also in the public interest (avoiding measures, keeping hospitals open etc.), financial motivation should also exist for those who agree to be vaccinated.

It is not customary to hand out cash in healthcare, and I do not support such practices. Not to mention all kinds of raffles and other measures the effects of which have not been proven. But we could offer the elderly something the healthcare system has not offered enough in the past. Yes, while I think that the €85 dental benefit introduced in 2017 is necessary, it is not enough.

Proposal: To give every retirement-age person who is vaccinated €250 for dental expenses to be used in the next three years. Both those who come in for their first shot and those who get a booster shot should be eligible.

In closing

I have proposed another ten or so ideas for boosting the effectiveness of vaccination in the past six months, while the interest of Kaja Kallas and [Minister of Health and Labor] Tanel Kiik in them has been just as lukewarm as it has for observations by entrepreneurs and municipality leaders.

Kaja Kallas was right about one thing in her interview. The opposition is more constructive in the Nordics. However, it stems from having a government that aims for broad-based consensus in crisis management and has therefore involved the opposition. In Estonia, the Riigikogu hears about government decisions on ERR. Something to think about.

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