Estonia looking for vaccine donation recipient

First doses of the coronavirus vaccine arrive in Estonia.
First doses of the coronavirus vaccine arrive in Estonia. Source: Raigo Pajula

Estonia's vaccine shortage of a year ago is turning into a major vaccine surplus. Interest in vaccination is waning, while factories are working at full power and warehouses being filled with vaccine doses.

The government decided to donate 265,000 doses of vaccine three weeks ago. Doses of Janssen and Pfizer are on offer, including a number for children.

Estonia has donated vaccines using a bilateral contract once before when it gave Ukraine 50,000 doses, with three ministers quoted in the press release.

But finding recipients is becoming harder. "There is less demand and a lot more supply today," Heli Laarmann, head of the public health department of the Ministry of Social Affairs, said.

It is not enough for an African country to want the vaccine. "To make sure the doses are properly handled and effective, the cold storage chain must not be broken," Laarmann explained. It makes no sense to ship the vaccines to where this cannot be ensured.

Another 2.5 million doses on the way

The Health Board's warehouse already holds roughly half a million doses of vaccine, with healthcare services providers in possession of another 150,000 doses. Estonia is looking at another 1.2 million doses this year and 1.3 million next year. To put this into perspective, just 850 initial vaccinations have been administered in April.

"We are in talks with manufacturers over whether deliveries could be postponed. To bring in doses when the need is greater," Laarmann said.

The need to negotiate is urgent as Moderna has pledged 54,500 doses every month, with Pfizer looking to deliver over 100,000 doses in May, 60,000 in June and roughly 230,000 doses in July, August and September.

Laarmann added that it is too late to divert Pfizer's May and June deliveries as talks would take too long. The incoming shipments already are smaller because major quantities were postponed until the second half of summer.

"Therefore, the negotiating process has had some success," the department chief said. "We are working on missing the July delivery, while solutions need to be found on the wider EU level."

Because vaccines have been procured via a joint tender, it is difficult for tiny Estonia to secure an exception. Luckily, Estonia is not alone in having this problem as the epidemic and demand for vaccination has fallen everywhere in Europe in a situation where pharmaceutical companies are pumping out doses and expecting payment for compliance with contracts.

Pfizer doses good for up to one year

COVAX has managed to keep the situation under control until now. The organization coordinates vaccine donations, with necessary doses flown direct from the factory to their destination. The state that pays for vaccine quantities simply has to tell COVAX how much it wants to give away and the organization will do the rest. Around half a million doses have been delivered in such a way with Estonia's help.

"But even COVAX has not managed to mediate donations quickly and effectively enough in recent months," Laarmann said.

The reasons are largely the same as what our officials now face. Many countries say they no longer need vaccines, while those who do need them cannot guarantee proper handling before the doses are administered.

Manufacturers will not wait. Once the date arrives, doses that have not been diverted are delivered to the Health Board warehouse. "For example, the doses we wanted to donate to COVAX in April ended up coming to Estonia," Laarmann admitted.

Pfizer doses are good for up to one year if stored properly, while those in the hands of healthcare providers will probably not keep that long.

All in all, Estonia has done well. So far, the country has been forced to discard 120,000 doses of vaccine, half of them spoiled when the Health Board's cold storage malfunctioned last summer.

No fourth shot decision yet

Laarmann said that greater losses are by no means out of the question, which fact was realized when the colossal vaccine contracts were first signed. Ensuring diversity of manufacturers and technologies was paramount. "To manage the risk of missing out on new vaccines or not having enough doses."

Existing contracts allow Estonia to order more doses on top of 2.5 million it is yet to receive. "Because we do not know what the future will bring," Laarmann said.

At least one shot of vaccine has been administered to 65 percent of people in Estonia. This is 10 percent lower than the European average.

"Our activities are largely focused on inviting elderly people in for vaccination," Laarmann said, adding that Estonia should keep aiming for better immunization coverage.

Laarmann could not say whether Estonia will urge its citizens to get a fourth vaccine shot at some point. He explained that it requires looking at other countries' experience in terms of how effective fourth booster doses have been. We know that immunity wanes over time, meaning that vaccine shots need to be timed right.

"We need to know when administering them would be effective should fourth doses be approved," Laarmann offered.


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Editor: Marcus Turovski

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