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"Frustrated and disappointed": One father asks why Finland won’t make childhood vaccines compulsory

Childhood vaccines in Finland are not mandatory, so when parents disagree on immunisation children may miss out on recommended inoculations.

File photo. Image: AOP
Denise Wall

Paul*, a young father with joint custody of his infant child, says he is concerned that the youngster will grow up without getting routine childhood vaccines because the child’s mother opposes inoculation.

The situation poses a dilemma, because vaccinations in Finland are not compulsory - authorities will not force parents to take their youngsters in for regular jabs. In cases like Paul’s where the parents have separated, there is no simple solution when they disagree on the importance of childhood vaccines.

Three years after Paul met his partner, they welcomed their new baby into their family in 2015. Soon after the birth, Paul found that getting the young child vaccinated -- something he assumed would be a no-brainer -- proved to be an obstacle that would aggravate tensions between the parents.

“My child has not received any kind of vaccinations apart from the first ones. Vaccinations are just suggested in Finland, not compulsory like in other countries. Even though we have joint custody and I want my child vaccinated the mother says no and since the child lives with the mother the child won’t be vaccinated,” Paul said.

Paul told Yle News that he doesn’t understand why Finnish health care and child welfare authorities will not intervene to ensure that his ex-partner gets the child immunised.

“I feel frustrated, disappointed in every way. I really don’t think that people understand this situation. People are always coming back to the point that vaccinations are dangerous, they cause autism and disease but the reality is different.”

Anti-vaxxer sentiment in parts of Finland

Finland has a comprehensive national vaccination programme that offers children under the age of 15 a schedule of shots to protect them from a host of communicable diseases. Although childhood vaccinations in Finland are voluntary -- parents can decide whether or not to take their little ones for regular jabs -- officials say that overall vaccination coverage in the country is reassuringly high at around 95 percent.

That’s the level the National Institute for Health and Welfare (THL) targets to maintain ‘herd immunity’ against measles, mumps and rubella.

But cases like the young family’s are a cause of concern for public health officials who have noted that in some parts of the country, coverage has dipped as low as 70 percent as parents opt out of taking their tots in for their roster of shots. These trends have been especially evident in the Ostrobothnia region and the Åland Islands, Pietarsaari hospital pediatric specialist Markus Granholm told Yle News.

“One reason is that nowadays we have a lot of possibilities to read stuff on the internet. We get a lot of news and a lot of fake news. If you have an idea that something is wrong or right you can find information that speaks the same language you do.”

Granholm added that in the immunisation-shy regions, low vaccination coverage rates eventually weaken herd immunity and increase the likelihood of outbreaks of long-forgotten diseases.

“It’s very important for communities that a lot of people are vaccinated. At 95 percent everyone is safe and we have been under that for a number of years now and this creates a risk for an epidemic. If we don’t change these numbers we won’t have to wait and see if it happens, but when it happens,” Granholm cautioned.

According to the pediatrician some communities appear to have been influenced by the growing reach of the “anti-vaxxer” movement that sees vaccinations as harmful.

The movement gathered steam following a now-debunked study by a discredited British doctor, Andrew Wakefield, who wrote a paper linking the MMR (measles, mumps and rubella) vaccine to autism. Feverish media coverage of the claims fueled fear and mistrust of the vaccine that lingers to this day.

The paper, published in 1998, was withdrawn in 2004 by the Lancet, the prestigious medical journal that originally published it. Wakefield was eventually struck off the British medical register over the affair.

Health officials call in child welfare

For Paul, the warning signals that his former partner might be experiencing what experts now term “vaccination hesitancy” emerged when the couple learned that the expectant mother had been diagnosed as a carrier of a viral infection. They were told that the baby would need a course of treatments -- including vaccines -- soon after birth.

When doctors pressed the case, the infant received the initial treatments, but pediatricians were forced to involve child protection officials when the mother once more refused the vaccinations and medication. Social workers intervened to escort mother and child to have the second round of inoculations. Health care workers justified the intervention by citing the perceived risk to the child’s health of not getting the required vaccination.

In Finland, it falls to the National Institute for Health and Welfare, THL, to develop vaccination programmes and to help local authorities ensure they are implemented. Poor uptake of the vaccines is not only a concern for the organisation, it also bears responsibility for addressing the issue.

“We have been concerned about the measles mumps rubella -- MMR -- vaccine coverage in the Ostrobothnia region on the western coast. Recently we have observed an increase in the numbers of pertussis [whooping cough] in that very same area,” Nohynek said.

“When you look back to 2011 - 2012 and 2013 - 2014 it seems that the booster doses were not taken as frequently as elsewhere in Finland so that might be reflected in the increased cases of pertussis that we are seeing now - but we don’t know for sure,” she added.

Voluntary vaccination system here to stay

Sari Ekholm, medical chief of staff at the Ministry of Social Affairs and Health, said that the ministry’s position on the debate is clear - for now at least, Finland will stick to voluntary vaccinations. While that remains the case, it’s up to organisations like the THL to ensure that parents fall in line and take their kids for recommended shots.

“We negotiate with the THL and with them we try to get the message through and try to encourage vaccinations. We support those who take action. The ministry’s main task is to draw up legislation and support execution of legislation and that is where we focus,” Ekholm commented.

Still Paul insisted, if the role of social and child protection workers is to safeguard the child’s best interests, why don’t local officials intervene in cases like his family’s to ensure that infants are vaccinated?

“They know that it’s not compulsory, since it’s not compulsory they let the mother decide. It’s like the mother has full custody of the [child’s] health,” he charged.

Social worker Natalja Ugbah said that child welfare workers must balance their duty to ensure children’s best interests with the law. She noted social workers rely on the expert opinions of health professionals in such cases.

“If we receive a child welfare notification from the hospital or health clinic that the parents don’t agree on vaccination we can discuss with the parents to find out why they don’t agree. That’s the main thing we can do because it is the health professionals who can evaluate how necessary the vaccination is for the child’s health and how big the risks are for the child’s health,” Ugbah explained.

According to the health ministry’s chief physician, Parliamentarians have also raised concerns about lower vaccination coverage rates in some parts of the country and have even pondered ways to address the problem:

“Members of Parliament have been asking questions that the ministry has answered. Sometimes they have asked about compulsory vaccinations and about sanctions for parents who do not vaccinate but general vaccination acceptance is very good in this country. So we still think we’d rather stay with free choice because otherwise it may stiffen those who oppose vaccines. We should try to address the issues that cause this hesitance.”

Vaccine crackdown in parts of Europe

Officials in other European countries are also grappling with the re-emergence of diseases such as measles as parents demur from inoculating their children. In light of rising vaccination hesitancy, some European countries have turned to mandatory vaccination programmes, including penalties for non-compliance.

In France, new laws that took effect from the beginning of this year now make it mandatory for parents to vaccinate their children against 11 diseases. The move followed a rash of measles deaths across Europe. Meanwhile in Italy, as of September last year, new rules call for children to receive 12 shots if they want to be enrolled in school, while in Germany although no legal mandate exists, parents now face a hefty fine of 2,500 euros if they don’t immunise their children.

Back in Finland the official position of local authorities offers no comfort to Paul, who said he has seen the vaccination dispute escalate. With both parents locked in a stalemate on either side of the now-radioactive issue, Paul said he sees little only hope for safeguarding the health of his toddler -- and that of other children -- with a full course of childhood vaccines.

Yle News contacted the mother of the child for comment, but she declined an interview.

*Names changed to protect the identities of the individuals involved. In addition to interviews, the story is based on official documentation from healthcare and social services.

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