The European Scientific Working group on Influenza (ESWI) has been setting up Country Influenza Stakeholder Networks since 2003. The aim of the networks is to strengthen national public health activities by bringing together influenza stakeholders in order to jointly develop flu vaccination action plans. In Finland, the vaccination coverage of seasonal influenza vaccinations has been low. About half of elderly people are vaccinated. The vaccination coverage of this group has been at the same level for several years, since vaccinations started in 2002. The vaccination coverage of people at risk is even lower, even though the vaccines have been on offer to this group since 1980. Only one out of three of those at risk receives the seasonal influenza vaccination. Setting up an influenza stakeholder network in Finland was therefore considered an opportunity for ESWI to help increase flu vaccination levels of the elderly and at risk patients.

Initial situation The National Institute for Health and Welfare (THL, former KTL) is responsible for the procurement and distribution of seasonal influenza vaccines in Finland. Also, vaccination coverage and safety issues are monitored by THL. The vaccines are given mainly by public health nurses in the local authority Health Centres and Baby Welfare Clinics. It is the responsibility of the local authorities to organise the seasonal vaccinations locally and then report the given doses to THL.

In Finland, the seasonal influenza vaccinations are free of charge and voluntary to everyone aged 65 and above, to people aged 3-64 who belong to specified medical risk groups and to all children between 6 and 35 months of age (this has been the case since season 2007-2008).

Influenza stakeholders Representatives of THL (the leading public health authority in Finland) and ESWI first met in April 2008. THL immediately saw the setting up of a national influenza stakeholder network as an opportunity and a way to promote seasonal vaccination. THL and ESWI agreed to prepare a list of influenza stakeholders and to plan the first stakeholders’ meeting.

The aim was to invite the main umbrella organisations to the meeting. No less than twenty different organisations were thought to be important for the first phase of building up the Finnish network:

•          Patient organisations (heart and pulmonary diseases, diabetes etc.)
•          Organisations of health professionals (HPs)
•          Organisations of elderly people
•          Representatives of local authorities and vaccination contact persons
•         Ministry of Social Affairs and Health
•         Organisations that have an educational role for HPs

Joint process The first meeting was held in December 2008 and was hosted by THL and ESWI. More than half of the listed stakeholders were represented. They were given the opportunity to profoundly analyse the existing flu situation in Finland, and to detect possible limitations and gaps. As a next step, possible ways to enhance the situation were debated in a joint process. The most significant needs were listed and it was agreed to initiate several concrete action plans.

Specific needs The first need listed was to have more exact information on vaccine uptake in different groups. The problem is that Finland doesn’t have a vaccination register. THL promised to find out more detailed data about the size of different medical risk groups and to requisition more accurate vaccination data from the local authorities. The more accurate data would help to show how large and important the influenza issue is.

The second necessity was to convince the individual members of different target groups that flu vaccination really is important. For this purpose it was decided that the stakeholders should list their communication channels and highlight their needs to THL. THL and the stakeholders agreed to prepare educational tools.

The third need listed was to convince the HPs to recommend the vaccinations more actively. One way to achieve this is to give the organisations of HPs a wake-up call to publicise this issue. It was decided that recommendations and guidelines should be promoted in a close collaboration between expert groups and patient organisations. For this purpose also, plans were made for the development of educational material by THL and the stakeholders.

The last need specified was that the regional and local authorities should be convinced about the importance of influenza vaccinations. Enough resources should be allocated for communication purposes. Flexible immunisation process should be promoted. For this purpose, it was decided to draft a position paper by THL and have this adapted and endorsed by the stakeholder network. Twelve of the stakeholders originally invited to the network would participate in generating the paper and all of them agreed the six key recommendations. The position paper was to be distributed through the channels of the stakeholders.

All the stakeholders present at the first meeting either participated in the second meeting in May 2009 or responded by e-mail to the next steps that were chosen. Two new stakeholders joined the meeting. The vaccination coverage and estimated size of medical risk groups were presented. The current situation of the network and the planned actions were checked. It was decided to undertake a few concrete actions and also the Position Paper was on the table.

Conclusion Due to the pandemic outbreak of H1N1 some of the concrete actions were postponed. But in conclusion we can say that the Finnish Influenza Stakeholder Network is again working hard to reach the official vaccination coverage targets. In this third year, yet another important stakeholder has joined the network to contribute to this initiative’s success. The key to this success is surely the collective approach, which incites national stakeholders to cooperate and to take personal initiatives. It is the fit way to draw up action plans that get the entire network’s approval and support.