Estonia moves to make school vaccinations opt-out, not opt-in
Estonia is moving to make school vaccinations opt-out, not opt-in, as nurses emphasize letting students have a real say in their health-related decisions.
The Ministry of Social Affairs is proposing changes to make school vaccinations for minors easier and give students more say in their own health.
Under the amended Communicable Diseases Prevention and Control Act, parents would no longer need to submit written consent — vaccinations would proceed unless a parent formally opts out.
With school vaccinations sometimes missed due to logistical or communication hiccups, the switch from opt-in to opt-out aims to prevent missed shots for these reasons rather than parental refusal.
Vaccine coverage in Estonia has dropped in recent years: over a third of students skipped or missed scheduled measles-mumps-rubella (MMR) vaccines in 2024, up from about 10 percent in 2019. HPV vaccination rates that same year stood at just 60 percent for girls and 50 percent for boys.
The law would also clarify what happens in cases where minors want to be vaccinated but their parents refuse: healthcare professionals would assess the student's ability to make an informed choice and ensure the decision, either way, is voluntary.
Külli Reinsalu, chief nurse at the Tallinn Healthcare at School Foundation, said she sees daily that kids and teens are often far more engaged with their health than adults assume, Delfi reported (link in Estonian). She said it's crucial that students can participate in decisions affecting their health.
"That aligns with what school nurses see every day, as young people ask for guidance on both physical and mental health, including vaccination," she said, noting that for many children, the school nurse is often the first healthcare professional they confide in.
Nurses want more student say, informed decisions
She pointed to a statement by the Estonian School Student Councils' Union (EÕEL), saying that youth voices and judgment should be taken into meaningful consideration when it comes to their health-related decisions.
Involving kids and teens in these decisions is a core part of health education, she explained, which starts early — and vaccination is no exception, as it directly affects their bodies and well-being.
Kids capable of informed judgment should have a voice, added, and in some cases, the ability to make decisions themselves.
Even so, the chief nurse stressed that greater autonomy doesn't remove parents from the process. Cooperation between children, parents and healthcare professionals remains essential.
"Our role is not to force anyone [to vaccinate], but to educate, answer questions and support informed decisions," Reinsalu said.
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Editor: Mari Peegel, Aili Vahtla
