In Finland, Respect for Rules is a Major Asset

In a culture accustomed to following rules, Finns have been largely self-regulating in response to coronavirus restrictions.

Sometimes a bit too much, actually, says Mika Salminen, director of Department of Health Security at the Finnish Institute for Health and Welfare, who heads up the country’s epidemiological response to the coronavirus crisis.

Compared to neighboring Sweden—which controversially took a relatively laissez faire approach to the pandemic—Finland went for a stricter tack. With targeted restrictions, the country saw fewer deaths, and took a lighter economic hit than neighbors who’ve suffered worse outbreaks.

But, notes Salminen, virtually no country was adequately prepared—and most of the plans from global health security experts went out the window. 

In the latest installment of our COVID Countries series, Salminen spoke with GHN about how Finnish culture and policies helped fight the pandemic, what has been sacrificed along the way—and why he had to take a step back from Twitter. 

Finland:

• Cases: 84,287 
• Deaths: 891 

—Source: Johns Hopkins

Big Picture

Finland has had the lowest COVID-19 attack rate of all Europe—meaning the lowest proportion of recorded infections per capita.

Being quite sparsely populated has probably protected us a little. But the B.1.1.7 variant first discovered in the UK is now dominant in the south, where much of the epidemic is concentrated in the larger cities.

Earlier in the pandemic, milder restrictions were enough to turn the tide of rising cases; that’s no longer true. Lately, young adults aged 20–30 have been the major driver of the epidemic; a recent 6-week crackdown on bars and restaurants led to a major decline in cases in this age group.

We have a good testing system and a low testing threshold—but these massive testing efforts take resources away from primary health care, creating built-up demand that we’ll have to deal with eventually.

Surprises

The major realization that struck me is how woefully unprepared Western countries were. Even with Finland’s advantages, COVID-19 threatened to overwhelm the health system.

Also, we who have been working this area (global health security) for a long time were a bit naive about how scared people would be when this hit. Plans were not sufficiently tied into the current media and information climate, which is really fast moving and totally saturated with information both good and bad.

Another surprise: Our first lockdown, in spring 2020, had no curfew—just strong recommendations to self-restrict activities. Shops and bars closed, institutions closed, universities went virtual. Overnight, Helsinki was empty.

In Finland, rule of law is generally well respected. But people self-isolated very efficiently and quickly adjusted to working and learning from home—a response that would be difficult to predict in advance.

In the fall, we introduced masking recommendations with a tiered system, which was very well observed. I don’t think we could achieve much better coverage by making it mandatory—that might even backfire.

Lesson Learned

In some ways our recommendations were maybe a bit too strong.

For example, we advised older people to be very careful and limit their activities as much as possible.

Older Finns especially listen closely to authority, and in hindsight we had to modify that messaging because it was taken very literally. Some of them really self-isolated totally—so we had to remind them, please keep moving and go for walks.

Scariest Moment

In March and April 2020 the epidemic started in Finland, there was a lot of uncertainty and a rapid growth in cases.

We couldn’t know how the spring or even summer would look. But luckily we had rapid decline in May and during summer we had very few cases.

But then after Christmas, case numbers crept up and followed exponential growth. That was scary because up to then we’d had fairly limited numbers.

Government Response

One of Finland’s strengths: The government follows the situation very tightly and listened to public health officials. Responses to case clusters, when needed, have been relatively quick.

Another asset: Finland has a tradition of working across sectors.

We had a stockpiling system—a remnant from World War II—which includes things like food and fuel as well as PPE. It’s not brand-new PPE, and not enough to last a very long time. But as a result we never ran out—which happened in many European countries.

Belgium at one point sent a stress message that they would run out of PPE within a week. They’d disbanded their stockpiling agency a couple of years ago.

Vaccine Situation

To maximize coverage, we've switched to a 12-week interval between doses instead of 21 days. After UK results showed that first doses give good protection, our modelers calculated we could save more lives by increasing the interval.

The European Union negotiated a joint purchasing agreement with multiple producers including Pfizer, Moderna, AstraZeneca, and Johnson & Johnson. 

Each country gets the same amount of vaccine, in proportion to their population, delivered at the same time.

In principle all European countries should be able to vaccinate at the same speed—but in practice there are differences.

We are in third place when it comes to administering first doses. 

Over 25% have received their first dose. Among over-70s, 82% have.

Media Environment

I was involved in the response to the swine flu pandemic in 2009/2010—and this media environment has been very different. So much faster and hyper-critical.

I used to be very active on Twitter—during the pandemic I went from 3,000 to 17,000 followers. I had even got some awards for Twitter use. But at the end of May I stopped using Twitter almost totally—it became a bit of a circus and the  negativity got so tiring. People started to look at the science without understanding the laws of epidemiology or virology, and doing very simplified analysis and thinking they could present or interpret patterns.

If I said schools aren’t that huge of a risk, I got attacked. If I said there is a risk in bars, I got attacked.

Economic Lessons

We learned from the 2008 financial crisis that responding with a tight fiscal policy was a mistake. It would have been better to spend more, even if it means debt. And this left-leaning government provided quite a lot of subsidies to keep the economy going. But our cultural industries are doing quite poorly, and finding ways to subsidize the growing “gig economy” has been difficult.

We’re not as dependent on tourism as other European countries, but certain regions struggle. Lapland, in the North—famous for reindeer safaris and husky sledding—usually draws about half a million foreign tourists each winter. The pandemic completely stopped that.

But I heard during Easter break they were full with Finnish people who couldn’t go abroad!

What’s happening in your country? To be part of GHN’s COVID Countries series, email Brian at bsimpso1 [at] jhu.edu.

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