Auditor general: Estonia lacking up-to-date vaccination plan

TALLINN - In a letter to Prime Minister Kaja Kallas, Estonia's Auditor General Janar Holm points out that the government does not have an up-to-date vaccination plan, the goals set in the vaccination plans are not clear and measurable, and the organization of vaccination has been rigid.

At a Cabinet meeting on June 17, the prime minister asked the auditor general for an opinion on the management of the crisis during the second wave of the coronavirus and proposals based on the lessons learned so far. In the letter, the head of the National Audit Office sets out his observations and proposals concerning the organization of vaccination in Estonia.

Specifically, the auditor general notes that lack of vaccine has not been an obstacle to increasing the proportion of vaccinated people for several weeks.

There has been a stock of vaccine, but it has not been injected, Holm said, noting that the amount of unused vaccine was over 170,000 doses on July 22, plus unused doses of the AstraZeneca vaccine.

"In each week of June, unused vaccine exceeded at least 80,000 doses, plus unused AstraZeneca vaccine doses, and in May, unused vaccine exceeded at least 66,000 doses every week, plus unused AstraZeneca vaccine doses. While one of the aims of maintaining a stockpile in the spring was to mitigate supply risks and maintain a stockpile for the second dose of the vaccine for at least one week, the number of unused doses already back then significantly exceeded the need for second doses in the following week," the letter reads.

The auditor general notes that the government did not have an up-to-date published vaccination plan between April 1 and 19, and does not have one as of July 1.

"A valid vaccination plan must be ensured throughout the COVID-19 vaccination process. A new vaccination plan should be agreed and approved before the expiry of the old plan," the letter reads.

Holm added that Estonia was lacking a relevant vaccination plan also at the beginning of March.

"The existence of a plan that is clear and understandable both to the organizers of vaccination and to society as a whole is a precondition for the purposeful and systemic organization of vaccination," the auditor general wrote.

Holm also observed that not all of the objectives set out in vaccination plans are clear and measurable, which means that it is not clear what is being sought.

"The objectives set out in a vaccination plan need to be set in a clear and measurable fashion," Holm said.

The auditor general pointed out that the objectives of the new vaccination plan submitted by the minister of health and labor to the Cabinet meeting on July 8 do not cover all critical target groups, such as minors and residents of areas with low vaccination rates.

"Vaccination targets must cover all critical target groups, and this document should be supplemented," Holm said.

The head of the National Audit Office described defining the objectives of the vaccination of 12 to 17-year-olds as very important because, in terms of the quality of education and other parameters, it is essential to ensure the on-site operation of schools.

"Otherwise, we risk having irreparable gaps in the knowledge and social skills of students of several years. It should be clear by now how the vaccination of schoolchildren will be handled, and practical preparations for vaccination should already be underway," the letter says.

The auditor general also highlighted the problem of low vaccination coverage in East-Viru County.

"It would be sensible to set clear targets on how to increase the vaccination coverage of the population of East-Viru County," he said.

Holm recommends making the vaccination plan more compact by excluding extensive background information from the plan and focusing on vaccination goals and how they are going to be achieved. 

Holm described it as strange that the weekly vaccination reports submitted to the government do not contain the most important information -- information about the achievement of the goals agreed in the vaccination plan.

"The government should agree on what information is important for the strategic management of the vaccination process on the level of the government and require information to be provided in a clear and perceivable format," the letter reads.

According to the head of the National Audit Office, the vaccination plan does not set intermediate targets for long-term vaccination goals and does not set numerical vaccination targets for the  weeks to come.

"The arrangement of vaccination has been rigid, and various flexible options to increase the number of vaccinated people have either not been used or have been implemented with unnecessary delay," the auditor general said, adding that more opportunities still should be created for vaccination near home, which would increase the availability of vaccination. 

For example, in addition to having vaccination stations at shopping malls and in town squares in larger cities, Holm believes that a similar approach should be used in smaller locations, by operating vaccination buses in small rural areas, villages and settlements, and by vaccinating in small towns and villages.

"Various options for increasing vaccination opportunities have been offered in public, but  in many cases they have been rejected by national level decision-makers. While there have been some proposals that are not suitable, many of the rejected proposals have been implemented after some time. The delay, however, has resulted in loss of time and trust," Holm said.

"The crisis caused by COVID-19 is a problem for society as a whole. Business operators are motivated to contribute voluntarily in order to avoid large-scale restrictions on economic activity and to keep society free of restrictions. The private sector has possibilities, resources and ideas to expand vaccination opportunities, and this resource needs to be used for the benefit of society," Holm argues.

According to Holm, representatives from the private sector should be included in the vaccination steering group to participate in the decision-making process, bring fresh ideas, show how the process can be improved, and help link public and private sector resources. Decision-makers should not be locked in the closed mindset that can be seen sometimes in the public sector, and defending of their own turf, but be open to different approaches, he added.