Finland: No jab, no job?

While it remains to be seen how the law is implemented after it comes into effect in March 2018, it is viewed as a de facto requirement for many health professionals – and students – to be vaccinated if they work in hospitals, residential institutions and in social care settings.

Many doctors have welcomed the move as a patient protection measure but some health and social professionals are uneasy, particularly when it comes to flu vaccination.

High vaccination rates

Vaccination rates in Finland are among the highest in Europe, although some regions have lower vaccine uptake than others. No vaccines are mandatory but public perception and media coverage of the National Immunisation Programme is generally positive.

Although there is no hard data on vaccination rates among health professionals, experts say most hospital staff are vaccinated. There is some concern about vaccination uptake among other staff in health and social care settings – which is why the government introduced the new legislation.

Where there are objections to vaccination, flu vaccines are the focus on most complaints. This can be traced by to the H1N1 flu pandemic (2009/2010). One of the pandemic flu vaccines was linked to a small increase in narcolepsy in Finland. The legacy of this, along with perceptions that flu vaccines are less effective than other vaccines, may lead to some resistance of the new law when it comes into force. The safety profile of seasonal flu vaccines is excellent but some confuse it with the pandemic vaccine.

What does the new law say?

The updated law will not make vaccination mandatory for health professionals. However, it will require employers in social and healthcare organisations to (a) define areas where vulnerable patients are cared for and (b) ensure that staff working in these areas are immune from measles, varicella, pertussis and flu – either through vaccination or (for measles and varicella) through prior exposure to the disease.

To do this, it is likely that occupational health departments in hospitals and residential institutions, as well as student health centres, will check the vaccination status of staff and students going on practical training.

However, data protection law means individuals are not obliged to share this information. In practice, employers will have to presume that employees of unknown vaccination status are not protected against the four diseases named in the law. In that case, they will need to move them to another unit.

Many hospitals have determined that at-risk patients are treated in all areas of their institution, making it difficult to reassign staff members. Whether employees would be fired – or prospective employees overlooked – because of their vaccination status is not yet clear.

There are no specific penalties for healthcare institutions defined in the law but it is expected that the government agency supervising health facilities would seek written explanations from non-compliant hospitals.

Common sense will apply

A ‘common sense’ approach will be taken to institutions where vaccination rates are low, provided that a clear commitment is given to complying with the law. For example, if a care home had just 30% vaccine uptake among nursing staff, the facility could be given time to reach full uptake – rather than close its services. In the end, however, the government could revoke the license of an institution that repeatedly fails to engage or that intentionally defies the new law.

The new law is the subject of some criticism but experts in transmissible diseases welcomed the measure. ‘Infectious disease specialists are very supportive and see it as a good way to improve vaccination coverage among healthcare personnel,’ says Dr Taneli Puumalainen, Chief Physician, Head of Infectious Diseases Control and Vaccinations Unit, National Institute for Health and Welfare, Department of Health Security. ‘Medical doctors generally don’t have a big problem with it but vaccination coverage is quite low among assistant nurses in mental health facilities or in social sector institutions. There has been a lot of discussion centred on those cases, including some opposition.’

The law already allows for some exceptions where individuals have medical reasons for not being vaccinated; where an institution urgently needs staff and cannot find a vaccinated person with the required qualifications; or where services would be compromised if the rule was strictly applied.

Further debate on the implementation of the law is expected in the coming months but the real test will come after March 2018. The onus will be on employers in the health and social services sector to comply with the law in a way that is also compatible with employment and data protection legislation.