Nearly all Finnish children are vaccinated – thanks to the child welfare clinic system

Professor Harri Saxén’s international colleagues are sometimes sceptical of Finland’s excellent immunisation coverage of more than 95%.

Millions of Finns have had chickenpox. But soon the disease may be a thing of  the past, much like measles, a common ailment as recently as the early 1970s. Since autumn 2017, all children in Finland have received free vaccinations against chickenpox. There will come a point at which chickenpox will be eradicated, for all intents and purposes.

We often relegate breakthroughs in immunisation to history, such as the eradication of smallpox in the late 19th and early 20th centuries, and polio in the 1950s and 60s. As recently as in the 1950s, hundreds of people contracted polio every year.

However, the 2000s have been a real boom period for vaccinations. In Finland, vaccination against influenza (2007), rotavirus (2009), pneumococcal diseases (2010), HPV which causes cervical cancer (2013) and chickenpox (2017) have been added to the national vaccination programme during this century’s opening decades.

HEALTH AND ECONOMY AT RISK

Before Finland begins to offer vaccines free of charge, the National Advisory Committee on Vaccines (KRAR) will issue a statement on the topic. The Committee is tasked with preparing presentations and recommendations on vaccines and deliberating on the development of the vaccination programme.

Professor Harri Saxén from the University of Helsinki has served as the chair of the Committee since 2014.

“Traditionally, an infectious disease paediatrician has been selected as the chair, as most of the vaccinations are given to children.”

The Committee includes physicians and experts in health economics. Before a vaccine is added to the national programme, an expert panel at the National Institute of Health and Welfare (THL) drafts an extensive report, pondering the health effects and economic impact of the vaccine while evaluating its safety.

After that, the National Advisory Committee on Vaccines issues its statement. If the Committee approves the vaccine, the proposal will be sent to the Ministry of Social Affairs and Health, and then on to the Ministry of Finance, which will finalise the funding.

When children with chickenpox no longer have to be taken to health centres and hospitals, health care costs go down. When their parents do not have to miss work to care for them, workplaces become more efficient.

 It is estimated that the rotavirus vaccine has already paid for itself. It is administered orally to children 6 to 31 weeks of age

“The rotavirus vaccine has been a real success. It prevents a particularly severe diarrhoea disease, which has often led to children being hospitalised.”

CHICKENPOX IS THE LATEST ADDITION

According to Saxén, the approval of the chickenpox vaccine for use in the national vaccination programme was a particularly memorable moment. Since last September, children aged between 18 months and 11 years have been vaccinated against chickenpox free of charge at school or a child welfare clinic. Previously it was available for a separate fee.

The decision was preceded by years of lobbying. The vaccine was developed in the 1990s, and an expert panel recommended its addition to the Finnish programme in a report issued in 2008. But the vaccine had to wait for nearly a decade.

Says Saxén: “Maybe one reason for the delay is that chickenpox is not a particularly dramatic illness. It is usually not fatal.

Japan and the United States introduced chickenpox vaccinations already in the 1990s. The pneumococcal vaccine was also added to the Finnish national programme later than in many other countries.” 

COVERAGE MORE THAN 95%

While vaccination is voluntary in Finland, vaccine coverage is at a very good level, with some regional variation. Nearly 99% of Finnish children have received the pentavalent vaccine which protects them from diphtheria, tetanus, pertussis and Hib infections such as meningitis. Approximately 95% of children receive the MMR vaccine against measles, rubella and mumps.

“Sometimes my international colleagues ask me if such high numbers, around 95%, can be correct.” So far, Finland has had relatively few “anti-vaccine” people.

Finnish children typically get their shots at the child welfare clinics. Saxén praises the Finnish child welfare clinics as a particularly strong aspect of the nation’s vaccination system.

“Everyone goes to them, regardless of income level, and the staff are outstanding.”

ROOM FOR IMPROVEMENT?

But there’s always room for improvement. For example, Saxén points out that the coverage for the HPV vaccine among girls is only 60-70%. In Finland, girls aged between 11 and 12 can get the HPV vaccine free of charge.

Saxén believes that people somehow associate the HPV vaccine with sexually transmitted diseases and that this association makes them less enthusiastic to have their children get the vaccine. However, the HPV vaccine is highly effective in preventing the preliminary stages of cervical cancer.

The vaccine has been estimated to prevent approximately four out of every five cases of cervical cancer.

Another problem is the low coverage of the influenza vaccine among small children. That is probably due to the events in 2009 and 2010, in which a number of Finns aged between 4 and 19 fell ill with narcolepsy after receiving the pig flu vaccine, and the risk for narcolepsy among older people was also elevated. Many remember these cases well.

“Unfortunately it is impossible to predict very rare side effects, such as narcolepsy, as this would require extraordinarily broad studies involving tens of thousands of children,” Saxén explains.

WILL SHINGLES BE NEXT?

More vaccines may be added to the programme. There has already been some public debate regarding whether people over the age of 65 should receive a vaccine against pneumonia. The cost of such a vaccination will be compared to the associated savings, and the matter will soon be debated by the National Advisory Committee on Vaccines.

According to Saxén, another interesting prospect is the shingles vaccine.

“A new kind of vaccine is on its way from the United States to Europe, and it looks very promising. It could help prevent a difficult disease among the senior population, associated with extended periods of pain,” says the professor.

At the moment, the Committee is deliberating whether the HPV vaccine should be administered to boys in the vaccine programme in addition to girls. The human papilloma virus, or HPV, causes not only cervical cancer, but also a variety of different cancers of the mouth and throat. 

MAKING THE RIGHT INVESTMENT

Many calculations and official statements are required before any of these new potential vaccines can be brought into the national programme and made available to citizens. Political decisions on funding are also required.

However, vaccinations are not particularly expensive. The current vaccine programme for children costs approximately €25,000 annually.

In the governmental budget for 2018, overall vaccine expenses amount to approximately €28 million. This sum includes vaccine-related reports and the opportunity to hire staff for the development of monitoring systems.

According to Saxén, paying for vaccines is an excellent use of government money.

“Vaccines are worth it in every indicator.”

The article has been published in Finnish in Yliopisto magazine 02/18.

 

 

 

Harri Saxén

Professor of pediatric infectious diseases

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