The Estonian Society of Colposcopy contacted the Chancellor of Justice to bring to her attention several flaws in the organization of schoolchildren's vaccinations.

Gynecologists who study cervical cancer and precancerous conditions are concerned that the number of children vaccinated against HPV (human papillomavirus, which is linked to cervical cancer and many types of other cancer) is lower than it could be.

Chancellor of Justice Ülle Madise wrote in a memo to Health and Labor Minister Peep Peterson that "part of the problem lies in the fact that school nurses do not vaccinate children at the age of discretion, even if the children themselves wish to be vaccinated."

In June 2022, the Office of the Chancellor of Justice convened a meeting with school nurses, the Health Board, and the Ministry of Social Affairs to discuss vaccination policies for schoolchildren.

It was discovered that school nurses lack guidelines for evaluating children's discretion, which discourages them from administrating vaccines.

Chancellor of Justice Madise said that minors who are able to exercise discretion may ask their family physician to vaccinate them, so they are not completely denied the opportunity to receive vaccinations.

"Vaccination at school is usually more convenient and accessible for children than vaccination at a doctor's office. One reason for administering national immunization in schools is to improve service accessibility. In some areas, the distance between the local clinic and child's home may make the service less accessible," Madise explained.

"Because the child and parents often agree on health-related topics, testing the child's decision-making ability for vaccination purposes is largely unnecessary," Madise said. "School nurses, however, have indicated that they are prepared to assess the child's discretion, if necessary. Of course, it would be easier to do this with the help of guidance materials and training. Then, a child who is able to make a decision and wishes to receive vaccination will not face undue hurdles."

School nurses need more information

The fact that parental consent is required on paper could be one of the causes for the low vaccination rate.

"The majority of vaccine information is distributed to parents on paper, and parental consent is also sought in this format," Madise said. "With this approach, it cannot be ruled out that the parent will not receive immunization information or a reminder."

Madise said that in the future, information on schoolchildren's vaccinations could be shared with parents via a patient portal.

To be willing to vaccinate children at their discretion, school nurses must understand the legislation governing the evaluation of a child's capacity to exercise judgement.

Madise proposed amending the existing regulation to make it clear under what circumstances a school nurse may vaccinate a minor student at school. In his response to the Chancellor of Justice, Minister Peep Peterson recognized the need to tackle this problem and promised to provide legislative amendment suggestions by the end of the year.

Since 2006, HPV vaccinations have been used worldwide. Hundreds of thousands of people have taken part in clinical trials to determine the efficacy of the vaccine. The results confirm the vaccine's safety and effectiveness. Girls aged 12 to 14 receive free vaccinations as part of Estonia's national immunization programs. Vaccination is voluntary.

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