Policy responses for Finland - HSRM

Finland


Policy responses for Finland

5. Governance

5.1 Governance

The GOVERNANCE of the health system with regard to COVID-19 relates to pandemic response plans and the steering of the health system to ensure its continued functioning. It includes emergency response mechanisms, as well as how information is being communicated, and the regulation of health service provision to patients affected by the virus.

Pandemic preparedness measures in Finland are primarily based on the National preparedness plan for an influenza pandemic.(1) This plan was updated in 2010-2012. The purpose of the preparedness plan was to set up guidelines for flu pandemic preparedness at all administrative levels of health care and to support preparations in other administrative branches. The plan has little instruction beyond the health care sector. In the current COVID-19 situation, a multi-sector preparedness model is used in Finland, meaning that each sector is responsible for their respective preparedness. This is reflected in the engagement of several ministries with their own responsibilities. The COVID-19 preparedness model is run as a whole-of-government approach and the pandemic related activities of the Ministries and their reporting are coordinated by the Prime Minister’s Office.(2)

According to the National Preparedness Plan for an Influenza Pandemic, the management relations during a pandemic are determined in accordance with the Government model for Government Civilian Crisis Management. At the municipal level, the agency responsible for prevention of communicable diseases plays a central role in pandemic preparedness and during a pandemic. The hospital district physicians responsible for communicable diseases act as experts in planning at the regional and local levels. The Regional State Administrative Agencies control and coordinate the planning and implementation. MSAH is responsible for providing general planning, guidance and supervision regarding infectious diseases as stated in the Communicable Diseases Act. National preparedness for communicable diseases and cooperation between other ministries are coordinated by MSAH. The Ministry also coordinates cooperation and exchange of information between international organisations and expert institutions and with the European Commission.(3)

THL is the main expert agency advising MSAH and the Government on population health, and it is also responsible for monitoring and assessing the situation together with ECDC and WHO. In addition, several universities have participated in modelling of the epidemic and providing advice to the Government.

Regionally, the five university hospital districts are legally obliged to plan and coordinate care in their catchment areas. According to the Communicable Diseases Act (2016), all hospital districts must prepare to control and manage exceptional epidemics and ensure that the management is developed in the social welfare and health care units in its area. All hospital districts must have a physician in charge of communicable diseases.

As in other EU countries, medicines and vaccines are primarily regulated at the European Union level. Fimea is prepared to expedite approval for relevant medicines and vaccines, but no explicit measures have thus far been made. The same applies to approval of medical devices and ventilators. It is already possible to apply for market authorisation exemption if public health necessity requires access to a medicine, which is not otherwise available.(4) 

Political decisions are made by the Government and the Parliament. In cases, where the government or legislation does not require direct implementation, decisions on implementation and control are ultimately made by local governments, cities, regional governments and hospital districts. This has been reflected in different criteria and judgement on how broadly they have tested or traced people as well as how hospitals have been prepared. MSAH can issue guidelines for preventing and controlling the epidemic.(5)

As one of the first Government level measures for the COVID-19 outbreak, MSAH appointed the Coronavirus Coordination Group (VN COVID-19) on February 13 to plan, manage and coordinate measures in healthcare and social welfare. It supports THL, Fimea, the National Supervisory Authority for Welfare and Health (Valvira), the regional state administrative agencies and the municipalities and joint municipal authorities in their efforts to prevent the spread of the virus. There is also an operational group working under the coordination group, tasked with maintaining situational awareness and coordinating preparedness measures. In both groups there are representatives from the state administration but also from regional authorities and hospital districts.(6)  

The Coordination Group comprises Permanent Secretaries and persons responsible for preparedness from the Ministry of Social Affairs and Health, Ministry of Economic Affairs and Employment, Ministry of Foreign Affairs, Ministry of the Interior, Ministry of Finance and Ministry of Transport and Communications. In addition, the Group has representatives from THL and the Prime Minister’s Office. There have been discussions on the composition and the role of the coordination group and it has been criticized for not including representatives from all the ministries, who have been added to the group later. This group is supported by the Ministries’ Heads of Preparedness and Preparedness Secretaries, who are responsible for operational activities and cooperation.(7)

On March 16th, the Government announced a state of emergency in the country as a result of the coronavirus outbreak. On the following day, the government issued a decree on the use of powers laid down certain sections (e.g. 86, 88 and 93-95) of the Emergency Act. Section 86 of the Emergency Act sets provisions on the functioning of healthcare and social welfare units, section 88 – on healthcare and social welfare services and health protection, section 93 – on derogations from the terms and conditions of employment relationships, section 94 – on restricting the right concerning dismissal, and section 95 – on the obligation to work.

Since the section 86 of the Emergency Act is activated by the Government, MSAH and the Regional State Administrative Agencies  in their areas of responsibility may mandate social and health care activity unit: 1) to expand or to change its operations; 2) to transfer all or part of its activities outside its own domain or location or to organize activities also outside its domain; 3) to place persons in need of care or maintenance in their operating unit, regardless of what has been provided, prescribed or agreed upon; 4) to hand over the business unit or part of it to the use of state authorities.

As not all hospital districts complied with the ministry's recommendations, on 1 April, the Ministry of Social Affairs and Health ordered by the powers derived from section 86 of the Emergency Act all of the hospital districts to self-quarantine their staff returning from abroad for 14 days. The Ministry ordered also hospital districts to test their staff whenever they were suspected of falling ill. As April 7 no other decisions based on section 86 of the Emergency Act are not made.(8)

The President of Finland has also proposed to establish a separate group responsible for coordination of COVID-19 response, which the Government has declined. However, on March 30, the Government announced that it will strengthen the composition of the Coronavirus Coordination Group (VN COVID-19) in the Prime Minister's Office.(9) On April 1st the Government announced that it will establish an expert group to coordinate and develop a strategy for preparing measures for the end of the pandemic and economic and social recovery.(10)

The Regional State Administrative Agencies are the regional authorities in charge of directing and overseeing health care. Each Agency directs and oversees public health care services and health care services provided by private actors in its own territory. By performing its tasks, the Agency contributes to implementing national health care policy. The Agency's activities in the field of health care are informed by the legislation, instructions from the Ministry of Social Affairs and Health and cooperation with other actors. The Basic Services and Legal Affairs Units provide information to the Ministry of Social Affairs and Health on the basis of separate assignments received from the Ministry. The Education and Culture Services Units of each Agency forwards current instructions to the municipal field as necessary and, if necessary, compiles a situation report from the areas on behalf of the Ministry of Education and Culture.

The Ombudsman's inspections were suspended when a state of emergency was declared. At the initiative of the Ombudsman, the inspection of care for the elderly was intensified in April. Inspections are carried out by telephone and video conference. Nursing staff play a key role in providing information. The Ombudsman monitors the statutory obligation of staff to liaise with the regional government agency about irregularities. (13)

According to the Communicable Disease Act, the Regional State Administrative Agencies direct and coordinate preparedness and control of communicable diseases in their territories. The Basic Services and Legal Affairs Unit of each Agency monitor that municipalities, associations of municipalities and hospital districts are regionally prepared for health care disturbances, and that social care services and customer safety can be adequately protected even in disturbances. In terms of the COVID-19 epidemic, the Regional State Administrative Agencies raised their preparedness in February. Each Agency has its own Regional Preparedness Committee which co-ordinates the work of each Agency. Most Regional Agencies have informed to have activated the operation of the Preparedness Committees which have started to meet more frequently (2-4 times / month). However, the Regional Agencies have not started situation centres which can be established according to the National Preparedness Plan in order to support the evaluation and steering of the regional pandemic situation and health care operation. As an example of the actions taken by the Agencies the Regional State Administrative Agency of Eastern Finland took over the responsibility for an assisted living unit operated by a private provider and transferred all its operations to public authorities. (12).

Many experts have called for more open discussion on the assumptions behind the decisions made. The Government and the officials in the Ministries and Finnish Institute for Health and Welfare (THL) have, however, been reluctant to publish the epidemiological models and other evidence. Even the Constitutional Law Committee of the Parliament and an expert group appointed by the Government have stated that it has been difficult to attain all the information they would need. Scientific evidence has been underlined continuously by the Government, but because of the lack of openness it is unclear how this has applied to decisions in practice.

On April 8 2020, the Prime Minister’s Office appointed a working group tasked with preparing a plan for Finland’s way out of the COVID-19 crisis and deciding on measures to deal with its aftermath. The  expert group is led by the permanent secretary of the Ministry of Finance Martti Hetemäki. The preparation group was to draw up a plan for exit strategy by 1 May 2020. The report (17) was published on 5th May 2020 and on 6 May, the Government adopted a resolution on a plan for “a hybrid strategy” to manage the COVID-19 crisis (15). That means moving from extensive restrictive measures to more targeted restrictions. The “hybrid strategy” extensively rests on “test, trace, isolate and treat” approach. The goal is to target restrictions and protective measures at:
- Large public events.
- Restaurant operations deemed to be at the highest risk level, particularly nightclubs and restaurants with the largest customer capacities or very confined premises.
- Preventing the spread of the virus from resuming in Finland due in particular to travel from higher-risk countries.
- Protecting the elderly and other people belonging to risk groups.

Maintaining the practices related to hygiene, social distancing and consideration for others adopted during the epidemic. The public authorities will continue to support this by providing guidance to people.

Reopening: Schools (e.g. primary, higher education, etc.): Decision on 29.4 to re-open primary and secondary schools in stages with infection control measures from 14.5 onwards.
Businesses (SMEs, restaurants, etc.): Restaurants will be allowed to open as of 1 June 2020
Travel (local, cross-border, etc): Essential travel to be allowed and work-related travel between Estonia and Finland to resume as of 1 June 2020
Gatherings (events, informal gatherings, religious services, etc.): Allowing for less than 50 person’s gatherings as of 1 June 2020

On 7 May the Ministry of Social Affairs and Health and the Ministry of Economic Affairs and Employment appointed a high-profile group for strengthening wellbeing and equality in the aftermath of the coronavirus epidemic. The aim is to produce proposals on how to prevent persistent problems, social exclusion and an increase in inequality during the exit and reconstruction phase following the lifting of the restrictive measures used to tackle the coronavirus epidemic. (16)

On 14th May the Chancellor of Justice announced that it has started to investigate whether MSAH and THL have published all relevant data and evidence that have been behind the Government’s decisions and justifications if they have not published all relevant information. MSAH and THL have to report to the Chancellor of Justice by the mid-June. (18.) Also after announcement of the investigation by the Chancellor of Justice there have been difficulties in gaining information from different authorities.  For instance, the Prime Minister’s office refused to publish documents of the national COVID-19 response coordination group when asked by the media. The Prime Minister, however, stated later that all non-confidential documents need to be published. 

On 19th of May, the Government submitted to the Parliament a proposal for an act on temporarily amending the Communicable Diseases Act. The act lays down provisions on necessary restrictions concerning food and beverage service businesses that would allow them to be open to customers while also preventing the spread of COVID-19. The Parliament and the President approved new temporary amendments to the Communicable Diseases Act on 29th of May, which made possible for restaurants, bars and cafes to open again for business from 1st June. Businesses are able to serve alcohol until 22:00 and food until 23:00 and as a coronavirus precaution they are only allowed to take in 50% occupancy, with everyone seated – no standing at the bar. The restrictions include also:
- instructions on how to avoid contracting the virus have to be provided to customers
- adequate cleaning of all surfaces and objects that customers touch
- a general obligation to arrange the structures, service practices and furniture of indoor and outdoor facilities in such a way as to prevent customers’ exposure to the virus.
- individual customers or groups of customers are not permitted to be placed too close to one another
- customers could pick up purchases from, for example, a counter but they would not be allowed to serve or dish out their own food or drinks, for example at a buffet table

The legislation has taken longer than anticipated to get through the parliamentary process because the original draft from the Government was halted by the Constitutional Affairs Committee which demanded amendments. The Government issued a temporary government decree on restrictions which would apply across the country as of 1 June 2020. However, the structure of the decree allows the Government to ease the restrictions by region, if necessary. (19.) When the President approved new amendments, the Chancellor of Justice acting as his constitutionally set position as the official legal advisor of the president, stated that the constitution forces government to explain on regular basis why the restrictions are applied across the country. He stated that the government is obliged to give its first explanation in late June. On 3rd June MSAH reported on the work of the advisory panel on the societal effects of COVID-19, highlighting that previously marginalised groups were likely most affected by the crisis. The group stated that the pandemic will change society, but the effects are not yet clear. The group recommended developing national models and criteria for following these effects, that the Statistics Finland would follow wellbeing indicators, and that there should be an independent evaluation committee of Finnish welfare policies with sufficient resources (20).

On 1st June 2020 the crisis follow-up group chaired by Permanent Secretary of the Ministry of Finance Martti Hetemäki and consisting of the Ministries’ Permanent Secretaries submitted the second part of its report to the Government. The report addressed the societal impacts of the COVID-19 crisis in the short and long term. The report also presented a plan for a post-crisis management and reconstruction strategy. (22)

On 1 June 2020 also the scientific panel appointed by the Government with the task to support the crisis follow-up group published their report on how to prevent and mitigate the negative impact of the pandemic on health, well-being, society and the economy and at the same to adhere to the principles of sustainable development. (21)

Based on the situational assessment received on 15 June 2020, the Government determined that the COVID-19 epidemic can be managed using the regular powers of the authorities. The Government issued decrees repealing the use of powers under the Emergency Powers Act and announced that the current situation in the country no longer constitutes a state of emergency. The decrees repealing the use of powers under the Act and the end of the state of emergency entered into force on 16 June 2020. (23)

The mandate and role of different organizations has emerged as a challenge for the “hybrid strategy”. Regional administrative agencies have a more prominent role, but not adequate capacity in developing guidance. The Finnish Institute for Health and Welfare has remained a key agency in guidance and approval processes for new tests and guidelines for masks. Furthermore, Finnish Institute for Occupational Health is responsible for guidance on use of masks in work-places (24). The challenges of centralized vs regional guidance after the cessation of the emergency powers have become evident.

The overall situation concerning COVID-19 measures at the national level is monitored by the Ministry of Social Affairs and Health and the Government’s COVID-19 Coordination Group. At the level of the Government, the primary focus is on the overall effectiveness and functionality of the hybrid strategy and on the prerequisites for regional action. (26.)

As an example of regional measures, on 30th August 2020 Kuhmo, a town in North Eastern Finland reported 13 Covid-19 infections and 130 exposures. Previous infections in North Eastern Finland had been low. Based on this, the city implementd strong containment measures between 31.8 and 6.9. The measures included:
- closures of reading rooms, children play areas (including in libraries), museums and youth centres, swimming pools, gyms, and ice rinks, adult education centres and music schools.
- Working remotely is recommended. High schools are in remote education until 29th September to secure university entry exams and give space for primary education. Youth services, rehabilitative work activities switched to remote operations. Students from Kuhmo who study in other areas are recommended to study remotely until 6th September.
- All city organised hobby activities and events have been cancelled, as well as external meetings in the city hall. All external events are cancelled in primary education spaces.
- School taxi drivers are instructed to have a mask, as are all over 15 year old travellers.
- Recommendation to put more space into restaurants and stop serving buffets until 6.9 is in place.
All residents are asked to limit their contacts during this period.

In its meeting on 3 September, the Government authorised the Ministry of Social Affairs and Health to adopt an action plan to manage COVID-19 (26). The aim of the action plan is to use the Government’s hybrid strategy to prevent the spread of the virus in Finland, safeguard the resource capacity of the healthcare system and shield and protect people, especially those in risk groups. The action plan divides the epidemiological situation into three general stages:
- The base level corresponds to the situation in Finland in mid-summer 2020. The incidence of infections is low and only a small proportion of infections originate in Finland.
- At the acceleration stage, the regional incidence of infections is > 10–25 per 100,000 persons over a period of 14 days. Local and regional transmission chains are largely traceable and there is sufficient capacity to respond to the need for hospital care without special measures.
- At the spreading stage, infections are spreading at the regional level or more broadly throughout the population with an incidence of > 18–50 infections per 100,000 persons over 14 days. The number of cases is growing at a daily rate of more than 10 per cent. Fewer than half of the sources of infection are traceable, and the need for hospital care and intensive care is growing sharply

On 3rd September, the Government appointed an independent investigation team in connection with the Safety Investigation Authority to look into the measures taken in Finland as a result of the COVID-19 pandemic (25). The investigations launched under the Security Investigation Act concern a very serious event (not accident) which has resulted in death or threatened or seriously damaged the basic functions of society. The investigation team will focus on examining the following issues during the period from 1 January to 31 July 2020:
- recognition among public administration and other responsible agencies of the need to address the situation, measures taken, and flow of information;
- legislation applied in the situation;
- preparedness for the crisis, contingency plans and other documents;
- communications affecting people's safety and security;
- consequences of the measures taken.

Two separate inquires have assessed the decisions-making and leadership in a crisis on governmental level during the first wave of the pandemic. One inquiry was conducted by an independent investigation team appointed by the Government in the connection to The Safety Investigation Authority (37) and another by the Finnish Innovation Fund Sitra, an independent thinktank operating under the Finnish Parliament (38). According to the results leadership and governance functioned fairly well in Finland, nevertheless there is a need for improvement in the division of responsibilities and communication between different stakeholders. Clear models of leadership and organisation are needed.

The challenges of centralized vs. regional guidance emerged again when the THL updated on 24th of September the mask recommendation according to the new action plan emphasizing regional authorities’ possibility to complement or limit more the recommendations within their region based on their own risk assessment (27). The same day, the Greater Helsinki area cities with the Regional State Administrative Agency of Southern Finland and Helsinki University Hospital reported the area entering the acceleration phase and plans to initiate the implementation of the updated recommendations (28). Nevertheless, Helsinki University Hospital announced on 25th of September a strong recommendation to use masks in indoor public spaces and events (29) before the cities announced their recommendation on 29th (30). Too complicated set of restrictions and recommendations from several channels and actors may lead to decreased acceptability and adherence.

The COVID-19 infection rates have risen throughout the country in November 2020. Consequently, the Government held a meeting on 25th November to discuss further measures that may need to be taken by the Government if the situation gets worse. Currently the epidemic is governed in the framework of normal regulation. That is the executive powers are in the regional and local authorities. However, the Government and the Ministry of Social Affairs and Health have throughout the autumn criticized especially the greater Helsinki area for not acting proactively enough in terms of restrictive measures. As the epidemic situation has gotten worse in November the Prime Minister ordered a briefing from the Counsellor of Justice on the possibilities to declare the state of emergency and to activate the Emergency Powers Act. Based on the report and the negotiations the Government concluded that there are not yet enough grounds for declaring the state of emergency but that the Government does not hesitate to use the extreme measure if needed. The President of the Republic has also stated that he is ready to declare the state of emergency if the Government need the powers of the Emergency Powers Act.

On 10th December, the Government published a memorandum of three development scenarios of COVID-19 epidemic in Finland to guide their strategic decisions-making. The scenarios explore the development of the epidemiological situation and its economic and social impacts in short interval from December 2020 to the end of June 2021. The first scenario contains sufficiently strong and repeated restrictions that prevent the burden on the health care system. In the second scenario the implemented restrictions slow down the epidemic, yet do not prevent its progressive acceleration resulting in implementation of more extensive and stricter restrictions. In the third scenario, the impact of the restrictive measures is initially limited, and the epidemic continues to accelerate rapidly resulting in implementation of extensive and significant restrictive measures by the Government at later stage. One significant conclusion is that the development of the epidemic and the resulting burden on the health care system have a greater impact on economic development than the restrictions imposed in order to manage the epidemic. (35)

On 4th  of December the Chancellor of Justice gave their resolution on whether the preparedness in terms of PPE and ability to purchase PPE from international market was sufficient. According to the resolution there were apparent problems in coordination of activities across various ministries and also between Ministers. The Chancellor emphasised the importance of clear distribution of responsibilities and tasks across different actors and the role of cooperation in the governance of the crises. (36.)

The MSAH updated the action plan to manage COVID19-epidemic for January and February due to accelerated global pandemic situation. The updates emphasize the importance of taking into consideration the epidemic situation in surrounding regions and in the whole country. The measures of the acceleration phase may be justified at a basic level if the epidemiological situation in the surrounding areas is difficult. (39)

On 26th of January the action plan was complemented with three action tiers to prevent the acceleration of the epidemic and, in particular, the spread of virus variations:

- Tier 1:  Maintenance of the current restriction level and full implementation of all the defined measures in the areas that are in the spreading phase. It is recommended to keep all the current restrictions in effect, until the spread of the virus variants and the effectiveness of the measures taken to prevent it are further evaluated.
- Tier 2: Control for the periodic and extensive implementation of the measures of the spreading stage. Recommendations and measures for the spreading stage are introduced on a large scale if the epidemic accelerates rapidly or the virus variant is found regionally so that immediate measures are required to prevent the spread of the epidemic. The goal is a rapid and sharp decline of contacts across the country. Measures implemented include maximal remote work recommendation and extensive face mask recommendation throughout the country including regional measures. Additional measures such as enhancing the enforcement of quarantine and isolation under the Infectious Diseases Act, tightening the gathering restrictions or remote teaching in secondary school can be implemented regionally or nationally if necessary.
- Tier 3: Declaring the state of emergency and imposing restrictions on movement.  State of emergency and the restriction on movement can only be introduced if the previous measures are insufficient and the health systems capacity is exceeded.

The plan was further extended on 2nd February through a letter to municipalities on the general guidelines concerning the leisure activities of the children and the adolescent putting forward several recommendations concerning organization of leisure activities (41).

The Ministry of Social Affairs and Health has given also a number of other guidance letters to the municipalities, State Regional Administrative Agencies and hospital districts since the beginning of 2021. These have concerned for instance preventing COVID-19 in cross-border travel, vaccination roll out and preventing the spread of mutated virus variants. (41)

Health Care Act and Social Care Act was amended in order to prepare the sector better for future crises. The law was passed on 11.2.2021 and the amendments will come into force as of 1st March. The aim is also to harmonise the preparedness planning processes and criteria across the country so that they would be based on same national level principles. The preparedness planning will be organized around and led by the five university hospital districts. The basis of the preparedness planning is provided in the national risk assessments that will be updated every three years. The national risk assessment will address crises that link to health security, technology and logistics and societal stability. The need to update the legislation has been acknowledged already before the COVID-19 pandemic but the acute crises has accelerated the process and emphasized the importance of preparedness. (42)

The process of amending the Communicable Diseases Act has been on-going since the autumn 2020. The amendments are needed in order strengthen the possibilities of local and regional authorities to take proactive and swift measures to prevent the spread of COVID-19. On 22nd February the amendments were approved by the Parliament (43). Most of the amendments will remain in force until 30 June 2021 (see below).  More permanent amendments were made to the regulation on isolation. In future, isolation could take place in the person’s own home, for example, instead of a health care unit. The amended Act also specifies the regulation on the right of the authorities to obtain information and on executive assistance. The Ministry of Social Affairs and Health will update the action plan for implementing the Government’s hybrid strategy to take account of the new powers at different phases of the epidemic. The Ministry will guide and support the regional communicable disease authorities in the application of these powers. (43.)

Under the amended Act, the authorities can introduce regional restrictions on business and leisure activities when this is necessary to prevent the spread of the epidemic. In line with the action plan for implementing the hybrid strategy to curb the COVID-19 epidemic (see above), the measures are introduced gradually so that obligations and restrictions can be tightened again if earlier measures prove to be insufficient (43).
• At the baseline of the epidemic, general hygiene measures are binding in all areas where customers and participants are present. Customers or participants must have the opportunity to clean their hands, and enhanced cleaning measures must be put in place. Customers and participants must also be provided with guidelines on how to prevent the spread of infections.
• In the acceleration phase, regional authorities can decide that activities must be arranged in such a way that no close contacts are created. To ensure that their activities are safe, businesses can choose the best way to operate so that customers can avoid close contact with one another in practice. This can mean space arrangements, staggered timetables or, alternatively, restricting the number of customers. The Finnish Transport and Communications Agency can also decide to restrict the number of passengers by a maximum of 50 per cent during the acceleration phase.
• In the community transmission phase, the municipality or the Regional State Administrative Agency can close businesses or other facilities that are intended for customers and participants for a period of two weeks. This can only be applied to those facilities and spaces defined in the Act that may generate significant infection chains. These include indoor and other sports facilities, public saunas and swimming pools, dance halls, amusement parks, indoor playgrounds, and public space in shopping centres.

On 24th Feb 2021 the Government decided on immediate transition from tier 1 to tier 2 – in other words, from regional approach to wide adoption of the community transmission phase restrictions (44). This decision expands the community transmission phase of the epidemic from the regions already in this phase to also cover those still in acceleration phase of the epidemic. The tighter restrictions of tier 2 (such as extensive recommendation on both remote work and the use of face masks as well as closures of public premises) need still to be locally introduced by Regional State Administrative Agencies. The Government recommended that regions would restrict gatherings and private events to maximum of 6 persons – and that municipalities and joint municipal authorities would intensify their monitoring of quarantine and self-isolation.
 
On 1st March 2021 the Government in cooperation with the President declared a state of emergency as referred to in the Emergency Powers Act (section 3, paragraph 5) (45). The state of emergency enables stricter measures to slow down the rapid increase of infections due to mutated Covid-19 variants – and eventually to prevent significant strain on hospital and intensive care capacity. The wider powers of the Emergency Powers Act applied in Spring 2020 (to restrict the fundamental rights of citizens) were not yet adopted. Subsequently, the Government submitted to Parliament a proposal for an Act on the Temporary Amendment of the Act on Accommodation and Catering Operations, which would temporarily close restaurants and other food and beverage service businesses to customers (excluding takeaway and delivery) between Mar 8th and 28th. Moreover, during this three-week period the Government recommends also temporary distance learning for upper grades of comprehensive school and suspension of group activities for young people over 12 years of age. On Mar 8th the Parliament approved this proposal, thus temporarily closing all bars and restaurants (with the exception of nursing home canteens and staff restaurants). The closure of bars and restaurants with same conditions was extended until 18th April 2021 and is implemented according to the regional epidemic situation.(48)

On 5th Mar 2021, the Government submitted a proposal to Parliament on introducing some of the powers laid down in the Emergency Powers Act (46). The proposed powers would enable the Government to direct both the operations of healthcare and social welfare units (section 86) and their compliance with the time limits for non-urgent care (section 88) – as well as to direct emergency communications (section 106) and decide on which authority has power in cases of ambiguity (section 108).

In the aftermath of the new restrictions, a debate on the administrative structure of infectious disease control and decision-making powers of different actors emerged. The Southern Finland Regional Administrative Agency decided to allow to gyms to remain open in case they restrict the number of clients to the maximum of 10 during the lock-down imposed by the Government according to the Infectious Disease Act. The decision was criticised by MSAH about not following the Ministry’s guidelines. Also some municipalities have implemented less severe restrictions in terms of the closures of schools and children’s exercise facilities than recommended by the Government. Some experts have pointed out that these controversies are rising from the fragmented legal decision-making powers of different actors in infectious diseases control. The Regional Administrative Agencies (even if a part of the central government) and municipalities have autonomous power to implement higher direction provided that the law is followed. (47)

The municipal elections were postponed from 18th April to 13th June  2021 due to the accelerated epidemic situation which could compromise the health safety and result in decreased voter turnout. It is predicted that majority of the persons belonging to a COVID-19 risk group would be vaccinated by June. Moreover, to facilitate safe voting, the pre-voting period will be extended to two weeks (49, 50) and the Government amended the decree on the voluntary COVID-19 vaccination to enable the vaccination of the electoral service officials who are carrying out home and institution voting (55). Furthermore, the Ministry of Justice provides instructions on safe voting during COVID-19 in the election’s website electionsfinland.fi (54).

On 25th March 2021 Government submitted a legislative proposal to Parliament on temporarily restricting the freedom of movement and close contacts and introducing a mask mandate in areas most affected by the pandemic, such as Southern Finland and South West Finland. The restrictions would be introduced by separate government decree and they could be imposed for three weeks at a time. They would allow people to leave their place of residence only for essential reasons or for outdoor recreation with others belonging to the same household or at most two other persons. Children born in 2008 or later would be allowed to do outdoor activities and play outside with other children. Police would monitor the compliance with restrictions on movement. The act was proposed to be set into force as soon as possible and remain in force until May 14th, 2021. (51) On March 31st , the Constitutional Law Committee gave a statement on the proposal stressing that even though the objectives of the proposal can be considered very significant, the chosen underlying solution is contrary to the requirement of proportionality when taking into consideration the epidemiological reasons presented to it in the proposal. Thus, the solution was not considered necessary. Government withdrew the proposal on March 31st. (52)

On 9th April 2021 the Government published a plan with a target timetable on lifting the restrictions imposed due to the epidemic. All interested parties were invited to comment the plan in otakantaa.fi service until 16th April. A separate discussion event was held for the labour market organisations and municipalities. The target timetable aims at transitioning towards normal life in Finland in June and July, if the epidemic is under control in April and May and the vaccinations proceed as expected. The restrictions would be lifted based on the epidemiological situation and in line with indicated timetable. Reassessment of the conditions for lifting the restrictions and update of the timetable would be conducted every two weeks. Lifting of restrictions would begin with activities for the children and young people denoting a transition to contact teaching in comprehensive school education and upper secondary education in April and opening public and private premises such as libraries and museums and allowing outdoor group hobbies of children and young people in May. (53) On April 20th the government adopted the plan to lift COVID-19 restrictions after making clarifications based on the feedback from the consultation round. The targets set in the plan depend on the regional situation and the decisions made by the competent regional authorities. (57)

Target timetable for lifting restrictions and recommendations imposed due to COVID-19, April 2021 (58):
April (provided over 70% of people over the age of 70 have been vaccinated with at least one dose):
- Lifting State of Emergency and ending the use of powers under the Emergency Powers Act ends;
- Reopening of restaurants and bars;
- Transition to contact teaching in elementary and secondary education;
- Restarting outdoor leisure group activities for children and adolescents.
May (provided people in risk groups have been vaccinated with at least one dose):
- Return to regional decision-making process
- Reopening of indoor spaces (libraries, museums)
- Restarting of outdoor leisure group activities for adults
- Commuter traffic reopening for border communities at the land borders.
June (provided half of the working age population have been vaccinated with at least one dose):
- Relaxing restrictions on public gatherings and events;
- Relaxing restrictions on customer seating and opening hours of restaurants and bars;
- Restarting outdoor events and summer camps for children and adolescents;
- Relaxing restrictions on EU member state borders are eased;
July (provided working age population have been vaccinated with first dose, and vulnerable people received their second dose):
- Easing and lifting restrictions on public gatherings
- Restarting indoor leisure group activities for adults
- Restarting commuter traffic on country borders

In April 2021, the Finnish Government published three scenarios for the development of the pandemic and its impact on the society over the next few years. The impacts are described regarding economic, social and health care services, and the population in general and take into consideration the global situation as well. In the first scenario the epidemic will be under control in Finland and globally by summer 2021. In the second scenario the epidemic will be under control in Finland by summer 2021, but it will take until 2022 to gain control of it globally. In the third scenario gaining control of the epidemic will be delayed until 2022 both in Finland and globally. Compounding of problems related to wellbeing and the risk of prolonged need for services are a cause of concern in all the scenarios. (54)

On April 27th The Government ended the state of emergency and the use of powers under the Emergency Powers Act. It was concluded that the current situation in the country no longer constitutes a state of emergency under the section 3 of the Emergency Powers Act, yet the pandemic is not over yet. The epidemic has calmed down considerably during the past weeks and the increasing vaccine coverage mitigates the risk of more serious cases of the disease. The COVID-19 epidemic is now managed using the regular powers of the authorities. (59)