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Family physician: The government should not act on emotions

Eero Merilind.
Eero Merilind. Source: ERR

Family physician Eero Merilind said in an interview with ERR that doctors need far more money to hire additional staff to restart the vaccination process. The doctor prefers persuasion in getting people to get vaccinated as the use of restrictions is not sustainable.

Why is the vaccination process in Estonia standing in one place from the perspective of a family physician?

Vaccinations have been a difficult topic in Estonia, we have always stood out in Europe in terms of flu vaccines. The influenza vaccination rates in the Netherlands and Belgium are almost 95 percent, it was 3 percent in Estonia before the coronavirus crisis.

If we take a look at the coronavirus vaccinations now, there are many beliefs and convictions, which need to be solved. But this will also take time.

And it needs the perspective of different people, as Marju Lauristin noted in an interview with ERR.

First, the question of trust: Does the person trust their family physician, neighbor or what is said in the paper? The second question is about persuasion. These attraction actions have not worked in Estonia, the State Agency of Medicines (Raviamet) has also been opposed to some actions. Then there is the tactic of fear, in which papers publish ugly stories about the suffering of hospitalized patients.

I personally prefer the option of teaching, where people themselves understand why vaccinations are necessary and how society will open as a result, life will get easier and less people will go to the hospital. The correct choice for each person must be chosen then.

If family doctors were to be given more money for vaccinations, would it be enough to at least restart vaccinations? Is the question about money?

It is always a question of money.

Today, the price of vaccination of vaccination is €5.3. Can we hire additional staff for that money? Estonia is missing some 8,000 medical nurses. We conducted a lot of vaccinations in our physician center in the spring, but this meant we took a few people from our team to only work on vaccinations. The burden on other nurses got so big that I have to admit that many quit in August. They said they no longer have the energy to do this work.

What should be the price of one dose for family physicians to want to deal with vaccinations?

[Tallink CEO] Paavo Nõgene has calculated and also proposed that one vaccine dose should be around €50. This would allow us to hire additional staff and approach people individually. We mostly need more workers.

The capabilities of physicians vary. We have so-called star physicians in major cities who do a great job. Another category is physicians in smaller regions that are overburdened by elderly people and are unable to do their job. Is this one of the reasons why vaccinations rates in Northeast Estonia and Ida-Viru County are low?

An alternative to that would be vaccination centers and vaccination buses.

It is certainly easier for physicians to reach people. In the current phase, you must convince and motivate people to get vaccinated, this is a tough job.

A physician working in a rural area often only has one nurse. If they have to allocate this nurse to vaccinations, can the physician continue their practice daily? These are fundamental questions, which need solutions. It is not just as easy as demanding the family medicine system to get to vaccinations now.

The Agency of Medicines has said getting people to vaccination centers by offering them lotteries and money is not correct. But we are in almost a war situation, perhaps we can change our attitude a little? There are 100,000 unvaccinated risk group people, a simple calculation shows giving them €100 each would get things done in €10 million! It is undoubtedly an influential motivator for most?

This question should go to the State Agency of Medicines.

In a regular situation and in peaceful conditions, there are certain rules that apply, but we are currently in hybrid warfare, which affects international relations, the economy and education. We should step out of our comfort zone and think outside the box.

These lotteries were quite successful in the U.S. I would prefer a method of teaching and motivation, not fear.

But Estonian society is again falling to fear. The same demands are being repeated as during the first and second waves. How sustainable is increasing vaccinations with restrictions?

It certainly is not sustainable. I just read an article, which speaks about how the coronavirus has affected European politics. It pointed out three possible solutions and what are people's expectations.

For example, polarization is taking place in Poland. They do not trust the government and do not understand the necessity of restrictions, they only see it as a threat to freedom. Germany is another case with its consensus democracy - people understand the need for restrictions and agree with the government's explanations. France is a third case, where the opinion depends on what party someone supports. Macron's supporters want to close down the country, for example.

The attitude toward restrictions has also polarized in Estonia, it has changed from a health problem to a problem of political power, economic well-being and money distribution.

We have an acute issue with unvaccinated people in risk groups, especially those who are elderly. Most restrictions are meant to cut off simple pleasures, you cannot go to cafes, spas or theaters. A majority of the elderly does not care about these restrictions, however. They need stores and pharmacies to be open and to be able to go to a friend for some coffee. Do restrictions like those in Latvia have any effect on risk groups?

We have to understand why people make decisions.

If a person has had a coronavirus case or death in their family, they look at restrictions in a completely different light than those that have not had an accident in their family. The people that have lost their jobs, income or well-being, they look at these restrictions from another perspective.

The ideology of coronavirus passports is that we give vaccinated people certain privileges, which help us keep society open. The vaccination rates in Scandinavian countries are high, you can keep society open there. We must start thinking about closing our society, however. It is a matter of choice if we should go by the way of Latvia.

We are currently saying unvaccinated people are the greatest danger because they overburden our healthcare system. But the healthcare system is also affected by those that are overweight and are not eating healthy. In terms of health behavior, there is a case to be made against everyone. Where do we draw this line? The prime minister's statement on Tuesday, perhaps unvaccinated people should pay back their medical costs?

I read an article from lawyer Ants Nõmper, in which he describes the legal options written in the Health Insurance Act to make people pay for their own medical costs. It is a little difficult to understand for me as a doctor, because everyone is equal to me, whether they be vaccinated or not.

But we need discussion about the right for unvaccinated people to work in healthcare or as teachers. And in other fields. But I fear our society is not open for discussion today.

Polarization has gotten to a point where people do not listen to arguments, but rather stay firmly at their previous position.

What is your prediction for what is to come next? Will there be a repeat of what happened in the spring of this year and last year's spring?

It might repeat. But the situation has changed, we have vaccines today. We did not have vaccines previously and restrictions were quick to come.

I think the government will still listen to the scientific council and they are not just acting on emotions, but will rather make scientific decisions.

I mostly fear that there will be political decisions, which are not in tune with medical steps. I would prefer a Scandinavian approach, where we vaccinate fast and keep life, economy and schools open.

If the government goes implementing restrictions again, should schools be left open? I understand it is complicated for everyone, teachers, children and parents. But we are keeping schools open no matter what?

The coronavirus is an illness of the elderly and those in risk groups. The virus is not dangerous to children, they can spread it, however.

But on the other hand, if they recover lightly, they will also have antibodies.

If it is possible to keep schools open, it will actually be possible to keep the economy open and maintain people's incomes, I would choose to go down that path.

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Editor: Kristjan Kallaste

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