THL has detailed medical risk groups for coronavirus vaccines

Publication date 5 Feb 2021

The Finnish Institute for Health and Welfare (THL) has drawn up a priority list for use in determining the order in which coronavirus vaccines are offered to persons under the age of 70 with different underlying illnesses – i.e., to risk groups for coronavirus – disease. 

The ranking is based on a medical risk evaluation and it supports the Finnish coronavirus strategy, which is aimed at reducing the loss of years of potential life, and of deaths caused by coronavirus disease, and to maintain the carrying capacity of the health care system. The National Advisory Committee on Vaccines (KRAR) was consulted in the drafting of the list.

Underlying illnesses divided into two groups

Age is the most significant risk factor for severe coronavirus disease. Certain underlying factors also affect the risk of a severe disease, and those who have them are also at a greater risk of hospitalisation, intensive care, or death from the disease than the rest of the population. 

“The high-risk groups on the list also include persons whose illness or treatment of an illness weaken their immune defences, who have a long-term and serious cardiac or renal disease, or whose chronic pulmonary disease itself makes breathing more difficult”, notes THL Chief Physician Tuija Leino.

The person may also have many illnesses or attributes that increase the risk all at the same time. For example, type 2 diabetes, hypertension, and obesity often occur together. However, hypertension on its own does not significantly increase the risk of a severe disease in an otherwise healthy person.

Underlying illnesses are divided on the list into two groups according to the degree to which the illness makes a person more susceptible to severe coronavirus disease. The first group includes illnesses that increase the risk of severe coronavirus disease to a very great degree, and the second includes diseases that increase the risk of severe coronavirus disease.

Of these groups, the coronavirus vaccine is offered first to group 1 and then, to group 2. Within the groups all of those with underlying conditions are vaccinated at the same time.

“The purpose of the listing is to offer coronavirus vaccines according to a medical evaluation of risk in as fair a sequence as possible. Basing the vaccination order on the risk of severe disease results in the greatest possible impact. With the amount of vaccine that is available it is possible to prevent as many severe cases of the disease as possible”, Leino observes.

Decisions based on Finnish research material 

For purposes of priority listing of the at-risk groups, THL has examined the underlying illnesses of more than 45,000 persons who have tested positive for coronavirus. Information from the Care Register for Health Care and from electronic prescriptions have been used to help in the task. This has allowed researchers to ascertain the risk that persons infected by coronavirus who suffer from a specific disease have of being hospitalised or placed in intensive care, and to compare it with the risk of those of the same age who do not have the illness in question. 

Comprehensive international research literature has been used with the kinds of rare illnesses for which data is not available in Finland.

The Finnish policy has been to offer coronavirus vaccines to all adults who want to be vaccinated. The new listing now contains underlying diseases that have been shown by research to contribute most to severe coronavirus disease. The first group on the list includes about 280,000 people and the second group has about 630,000. Details of the vaccination order of persons under 70 who have other diseases, or who are completely healthy, will be given later.

Priority sequence for risk group for coronavirus vaccinations

Group 1: Persons with an illness or condition that poses an extremely great risk of severe coronavirus disease.

  • Organ transplant or stem cell transplant
  • Cancer under active treatment
  • A severe disturbance of the body's defence system
  • A serious chronic renal illness
  • A serious chronic pulmonary illness
  • Type 2 diabetes involving drug therapy
  • Down syndrome (adults)

 Group 2: Persons with an illness or condition that poses a risk of severe coronavirus disease.

  • Asthma requiring continuous medication
  • A difficult cardiac disease, including insufficiency (but not mere hypertension)
  • Cerebral infarction or other neurological illness or condition affecting respiration
  • Pharmaceutical treatment for autoimmune disease that weakens immune defences
  • Serious chronic liver disease
  • Type 1 diabetes or adrenal insufficiency
  • Severe sleep apnoea
  • Psychosis
  • Morbid obesity (body mass index 40 or more)

Priority sequence for risk group for coronavirus vaccinations (in Finnish).

Further information:

Tuija Leino
Finnish Institute for Health and Welfare
Chief Physician

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