Pandemic preparedness and response regulations in Finland: Experiences and implications for post-COVID-19 reforms

The COVID-19 pandemic has plagued health systems in an unprecedented way and challenged the traditional ways to respond to epidemics. It has also revealed several vulnerabilities in countries' health systems and preparedness. In this paper we take the Finnish health system as an example to analyse how pre-COVID-19 preparedness plans, regulations, and health system governance were challenged by the pandemic and what lessons can be learned for the future. Our analysis draws on policy documents, grey literature, published research, and the COVID-19 Health System Response Monitor. The analysis shows how major public health crises often reveal weaknesses in health systems, also in countries which have been ranked highly in terms of crisis preparedness. In Finland, there were apparent regulative and structural problems which challenged the health system response, but in terms of epidemic control, the results appear to be relatively good. The pandemic may have long-term effects on the health system functioning and governance. In January 2023, an extensive health and social services reform has taken place in Finland. The new health system structure needs to be adjusted to take on board the legacy of the pandemic and a new regulatory frame for health security should be considered.

Living through uncertainty: a qualitative study on leadership and resilience in primary healthcare during COVID-19.

BACKGROUND: Resilience is often referred to when assessing the ability of health systems to maintain their functions during unexpected events. Primary healthcare forms the basis for the health system and thus its resilient responses are vital for the outcomes of the whole system. Understanding how primary healthcare organisations are able to build resilience before, during, and after unexpected or sudden shocks, is key to public health preparedness. This study aims to identify how leaders responsible for local health systems interpreted changes in their operational environment during the first year of COVID-19, and to elucidate how these views reflect aspects of resilience in healthcare. METHODS: The data consist of 14 semi-structured individual interviews with leaders of local health systems in Finland representing primary healthcare. The participants were recruited from four regions. An abductive thematic analysis was used to identify entities from the viewpoints of the purpose, resources, and processes of resilience in the healthcare organisation. RESULTS: Results were summarised as six themes, which suggest that embracing uncertainty is viewed by the interviewees a basis for primary healthcare functioning. Leading towards adaptability was regarded a distinct leadership task enabling the organisation to modify its functions according to demands of the changing operational environment. Workforce, knowledge and sensemaking, as well as collaboration represented what the leaders viewed as the means for achieving adaptability. The ability to adapt functioned to comprehensively meet the population's service needs built on a holistic approach. CONCLUSIONS: The results showed how the leaders who participated in this study adapted their work during changes brought on by the pandemic, and what they viewed as critical for maintaining organisational resilience. The leaders considered embracing uncertainty as a principal feature of their work rather than viewing uncertainty as aberrant and something to avoid. These notions, along with what the leaders considered as critical means for building resilience and adaptability should be addressed and elaborated in future research. Research on resilience and leadership should be conducted more in the complex context of primary healthcare, where cumulative stresses are encountered and processed continuously.

"Local cooperation has been the cornerstone": facilitators and barriers to resilience in a decentralized health system during COVID-19 in Finland.

PURPOSE: The purpose of this study was to elucidate facilitators and barriers to health system resilience and resilient responses at local and regional levels during the first year of the COVID-19 pandemic in Finland. DESIGN/METHODOLOGY/APPROACH: The authors utilized a qualitative research approach and conducted semi-structured interviews (n = 32) with study participants representing five different regions in Finland. Study participants were recruited using purposive and snowball sampling. All study participants had been in management and civil servant positions during the first year of the pandemic, representing municipalities, municipalities' social and healthcare services, hospital districts and regional state administrative agencies. All interviews were completed remotely from April to December 2021 and the recordings transcribed verbatim. The authors coded the transcripts in ATLAS.ti 9.1 using directed content analysis. FINDINGS: The findings highlighted a wide range of localized responses to the pandemic in Finland. Facilitators to health system resilience included active networks of cooperation, crisis anticipation, transitioning into crisis leadership mode, learning how to incorporate new modes of operation, as well as relying on the competencies and motivation of health workforce. The authors found several barriers to health system resilience, including fragmented organization and management particularly in settings where integrated health care systems were not in place, insufficient preparedness to a prolonged crisis, lack of reliable information regarding COVID-19, not having plans in place for crisis communication, pandemic fatigue, and outflux of health workforce to other positions with better compensation and working conditions. ORIGINALITY/VALUE: Factors affecting health system resilience are often studied at the aggregate level of a nation. This study offers insights into what resilient responses look like from the perspective of local and regional actors in a decentralized health system. The results highlight that local capacities and context matter greatly for resilience. The authors call for more nuanced analyses on health systems and health system resilience at the sub-national level.

COVID-19 in Finland: Vaccination strategy as part of the wider governing of the pandemic.

Objectives: To analyze the vaccination strategy as part of wider public governing of the COVID-19 pandemic in Finland. Methods: The study provides a synthesis of vaccination strategy and health policy measures, as well as economic challenges, in the COVID-19 pandemic in Finland. The analysis is based on the systematic collection and reviewing of documents and reports. The review was complemented with relevant pandemic and vaccination monitoring data from Finland. Results: The vaccination strategy approved by the Finnish Government in December 2020 prioritised various risk groups and health and social care professionals attending to COVID-19 patients. The Government has purchased COVID-19 vaccines through the EU joint procurement programme. Vaccinations were organised by municipalities and offered free of charge. The Government recommends universal vaccinations, including foreign residents and undocumented migrants. In 2021, the Government adopted a revised COVID-19 hybrid strategy, which aimed to dismantle wide restrictions as a means to control the epidemic. Despite high vaccination coverage, the Omicron variant became widespread in the population. The economic consequences of the pandemic have been less severe than expected. Conclusions: In the approach to manage the pandemic, the vaccination strategy has a central role. Finland has probably benefitted from the EU joint vaccine procurement programme. The rapid launch of the vaccinations was supported by the existing vaccination capacity in municipalities. High vaccine coverage was seen as a key in opening society. Although a relatively high vaccination rate was not able to stop the spread of Omicron in late 2021, it has efficiently curbed serious cases and kept the death rate low.