Richard Robinson explains how Finland’s social contract, and the humility of its health agencies, has staved off anti-vax sentiments, despite a previous scandal over vaccines

With an unprecedented global medical effort moving the needle on COVID-19, vaccine confidence has become an international competition – one in which Europe appears to be lagging. A recent study in The Lancet showed the continent’s trust in vaccines was, in general, far lower than that of South America, Africa and large swathes of Asia.

Fuelling this sense of competition is the constant stream of new surveys measuring the willingness of different nations to take a COVID-19 vaccine. According to these, some of the most vaccine-sceptical countries in Europe are Poland, France and Hungary. Of course, public attitudes can mutate rapidly, depending on the vaccine’s availability and the perceived risk of the virus, but the 2020 Vaccine Confidence Project report of Europe and the UK paints a broadly similar picture: Poland and France are narrowly in the lower half, and Hungary is rock bottom.

Finland, in contrast, ranks fourth in that survey, its 68% vaccine confidence behind only Spain and Portugal (at 70% apiece) and Lithuania (at 69%). As for the COVID-19 vaccine, the latest survey by the Finnish Institute for Health and Welfare (THL) found that 64% of Finns would take it, with 20% opposed.

For the happiest and formerly best-educated country in the world, such figures might appear unsurprising, even underwhelming. In the context of the last decade, however, they are a cause for gentle optimism, and a lesson in maintaining public trust.

For Finland was struck by a vaccine scandal in 2010. Not one framed by air quotes and powered by scare stories, like the infamous claim by doctor-turned-quack Andrew Wakefield that the MMR vaccine caused autism, but one based on amassed evidence from doctors across the country. 

In the months after getting vaccinated against swine flu, children began developing narcolepsy at an alarming rate. Annual cases typically numbered between two and seven, but by late August 2010, 17 had been reported, rising to 40 by the end of the year. If this sample size sounds small, consider that Wakefield’s fraudulent study involved a mere 12 children, and that spawned a worldwide panic. 

To our socially-distanced eyes, it is perhaps hard to comprehend how swine flu constituted a global pandemic. The main cause for concern was its mortality demographic: in juxtaposition to COVID-19, it has been estimated that 80% of those who died of swine flu were under 65

In October 2009, when Finland began its rollout of the Pandemrix vaccine, demand was so fevered that fights broke out in the queues stretching from its health centres. In total, 52% of the population and 75% of children under-15 got the jab, a level of coverage in Europe that was second only to Sweden.

Finland would also end up coming second only to Sweden in the total number of narcolepsy cases. A 2012 study found that the vaccine had resulted in a 13-fold increase in narcolepsy among 4-19 year olds, and by 2020 the Finnish Pharmaceutical Insurance Pool had approved 236 of 359 cases for compensation. The Swedish equivalent had approved 440 of 702 applications. 

Back From The Brink

In the Finnish media, the fallout from the narcolepsy revelations was as bitter as it was tragic. Stories about children debilitated by extreme somnolence and night terrors interspersed a series of recriminations towards and within the medical establishment. Not least that THL had been too hasty in purchasing the vaccine, and too slow in intervening. 

Pandemrix’s manufacturer, Glaxosmithkline (GSK), was noticeably absent from much of the criticism. This was partly by design, as GSK had required EU countries to sign indemnity clauses to get the vaccine doses in 2009. These placed the financial burden of compensation for any side-effects on the state, even if the company was successfully sued. These clauses are still being deployed in COVID-19 vaccine contracts today. 

Finland’s vaccine confidence did diminish, although mainly towards new and seasonal jabs, rather than towards those well-established in the vaccine programme. The proportion of young children getting the annual influenza vaccine fell from 40% in the winter of 2009-10 to a low of 13% in the winter of 2011-12; in contrast, the proportion of children receiving the MMR vaccine remained fairly constant, at 95% in 2014 and 94% in 2018.

Dr Hanna Nohynek, senior physician at THL, was at the forefront of the institute’s response to the Pandremix scandal. She cites its “really open communication” and its careful tailoring of vaccination campaigns as key to rebuilding trust over the last decade. And this appears to have been successful: in the 2019 Finnish Science Barometer, 89% of the 2,125 Finns surveyed had confidence in the information about vaccines provided by authorities and experts.

That overall vaccine confidence did not suffer a more dramatic decline might well be due to Finland’s relatively equal and stable society. Dr Jonas Sivelä, senior researcher at THL, sees societal accord as underpinning positive vaccination attitudes. “A sense of injustice,” he states, “feeds the kind of frustration and confrontation that makes a ‘good’ breeding ground for conspiracy theories.”

The scale of the narcolepsy uproar reflects the high expectations that Finns have of their public and state authorities. Yet, for all the domestic condemnation, Finland’s handling of the narcolepsy outbreak was the most responsive and conscientious in Europe. Indeed, the country was far from the only one impacted by Pandemrix: it was given to 30.5 million people across Europe, and it was also linked to a spike in child narcolepsy cases in France, Norway, Ireland and the UK.

It was Finland, alongside Sweden, that led the way in researching the connection between the vaccine and narcolepsy. THL was the first national health institute to halt the use of Pandemrix, in August 2010, almost a year before the European Medical Authority recommended doing so.

Finland began paying out compensation claims already in 2011, with the Government promising the victims financial support should the pharmaceutical insurance pool run dry. The system is overly bureaucratic and exclusionary, but it is a far cry from the UK, where in 2017 the Department of Work and Pensions was still contesting in court that narcolepsy was not sufficiently severe to merit compensation. It is also a far cry from Ireland, where one hundred people are still suing the state for compensation. 

Nowadays the narcolepsy episode remains part of the Finnish national consciousness, an immediate, if half-remembered, reference point in any discussion on vaccine attitudes. Yet to understand such attitudes, and to engage in meaningful international comparisons, it is not just the scandal that should be remembered, but the aftermath as well.


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