Expert Statement
Hanna Nohynek, MD, Chief Physician

Law firm Merilampi Oy / lawyer Jussi Ikonen has requested an expert statement from me in mycapacity as Chief Physician at the Finnish Institute for Health and Welfare (THL) and as a vaccine
researcher regarding the ongoing legal proceedings at the Helsinki District Court in case L
706/2022/1504. I haven't reviewed the trial material related to this case, but I've been informed that it
pertains to a situation where an individual was denied access to a restaurant due to a missing COVID
certificate (COVID pass).
In the expert statement, I've been asked to provide a substantiated opinion on the purpose of theCOVID certificate and its efficacy concerning the intended benefits. Additionally, I've been asked toexpress THL's view on the effectiveness of the COVID vaccine when preparing the legislation related
to the COVID pass and thereafter.
My statement addresses questions necessary for understanding and potentially resolving the matterbut does not include a statement regarding the ongoing trial otherwise.
I respond to the questions presented to me as follows:

1. What was the purpose of the COVID pass, or what benefits were aimed to beachieved with it?
In 2021, the COVID pass was considered as one of the measures to combat the COVID-19
pandemic, aiming primarily to restrict the spread of the SARS-CoV-2 virus and to impact thepreservation of healthcare capacity.
From an individual perspective, it was thought that the COVID pass would increase willingness tovaccinate, which, if realized, would enhance individual protection against viral infections, severe
COVID-19, and potential death. From a societal perspective, the COVID pass was expected to reduce
hospitalizations, especially among high-risk groups, and to help keep society's functions and services
open, thereby promoting the health and livelihoods of the population. It was well understood that
Finland did not have enough intensive care unit beds if the epidemic had escalated in the fall of 2021
as it did, for example, in China and Italy in early 2020.
The background to the technical implementation of the COVID pass was also influenced by theEuropean Commission's longstanding desire to create national and even EU-level standardized digitalvaccination certificates: the COVID pass was considered a pilot for such a certificate, which, if
successful, would encompass all vaccinations of the population, regardless of age or vaccine antigen.
A digital vaccination certificate had long been desired by both citizens and various stakeholders. The
lessons learned from the pandemic were expected to bring broader societal benefits than justcombating COVID. Another motivating factor was also preparedness for future pandemics caused by
new diseases.

2. In hindsight, how effective a tool was the COVID pass in achieving the intended
benefits?
No official impact analysis of the effectiveness of the COVID pass in terms of benefits and drawbacks
has been conducted in Finland. When the pass was being planned and promoted, the prevailing virus
variants were various pre-Omicron variants including Wuhan, alpha, beta, and delta, for which it wasknown that vaccines had a significant protective effect against both infections and severe disease anddeath.
Internationally, it has been estimated that the protection against transmission by vaccination was
about 40–50% for the mRNA-based Comirnaty vaccine (manufacturer BioNTech-Pfizer) against acontinuation infection against delta virus, but it decreased to 25% after three months. The decrease intransmission by the adenovirus vector vaccine Vaxzeria (manufacturer AstraZeneca) was less thanthat of the Comirnaty vaccine, but the protection provided by the Spikevax vaccine (manufacturerModerna), which contains a higher amount of mRNA, was probably longer-lasting than that of theComirnaty vaccine. Taking into account both infections and transmission reduction, during the firstmonths of the delta variant's dominance, vaccination reduced the overall potential for transmission by
about 90%. Later, i.e., 3-6 months after the second dose, vaccination reduced the overall potential fortransmission in long-interval vaccinated individuals by about 75%. With such figures, it was expectedthat the COVID pass would have significance both in terms of epidemic control and the adequacy ofhospital capacity.
However, the fall of 2021 was challenging as the COVID-19 pandemic was in a highly dynamic state.
After the Omicron variant arrived in Finland in late 2021, displacing the pre-Omicron variants, it
became clear that due to mutations in the virus, the ability of available vaccines to prevent infections
by the circulating variants at the time had significantly diminished, although the protective efficacy
against severe disease remained excellent. As a result, even vaccinated individuals could
unknowingly become infected with the coronavirus and be contagious to others, albeit with mild or nosymptoms. Of course, the contagiousness of the unvaccinated was still higher and more persistentcompared to the vaccinated.

3. What was THL's view of the effectiveness of the COVID vaccine when preparing theCOVID pass legislation, and did that view change later?
THL supported the COVID pass in the preparation phase based on its estimated individual andpopulation-level benefits. However, in November-December 2021, THL's view changed with thearrival of the Omicron variant in Finland and its ascension to dominance. In its memoranda andstatements, THL highlighted the changed epidemiological situation and its implications for what could
be expected from the use of the COVID pass.
When preparing the COVID pass legislation, in a situation where the original virus variants, whichwere very similar to the delta variant in structure, were dominant, THL saw that with widespread use,
the COVID pass could significantly flatten the epidemic curve, i.e., slow the spread of the virus in
Finland, thus easing the burden on healthcare in a situation where there was a shortage of hospitaland intensive care beds for severely ill patients.
THL stated that the COVID pass targeted restrictions to that small portion of the adult population thatwas unvaccinated and therefore produced significantly more hospital burden per infection than thebroad vaccinated majority. Therefore, there was much more to gain per restricted person than withgeneral, blanket restrictions. By intervention effectiveness, THL meant achieving the goal with thesmallest input possible. The aim of all restrictions was also to generally reduce infections, and for allof them, it applied that to effectively reduce the hospital burden, it was necessary to reduce infections
among those most likely to require hospitalization, i.e., the elderly and those belonging to medical risk
groups.
THL also noted that unvaccinated individuals could have been protected even more effectively with avaccination pass than with the COVID pass. The COVID pass could be obtained with a negative test
result, which led to the situation where individuals could access restricted events without vaccination
protection. While vaccination reduced the likelihood of infection in the vaccinated populationcompared to the unvaccinated population, it did not confer sterile immunity. A vaccinated individual
could still transmit the virus, but any infection within the vaccinated population would not contributesignificantly to hospital burden. In contrast, an unvaccinated person without vaccination protection
could become infected by a vaccinated person, which could lead to a severe disease.
When the Ministry of Social Affairs and Health (STM) requested a statement from THL at the turn of2021-2022 on whether the COVID pass should be continued with the requirement for three vaccine
doses or laboratory testing, THL took a negative stance. This was influenced by both the availability
and targeting of vaccines to different risk groups and the increasingly clear evidence that the Omicron
variant, which had become dominant, evaded both the immunity generated by vaccination andinfection, and that infections and transmission among both vaccinated and hybrid-immunity (i.e.,vaccine and infection-induced immunity) individuals were possible.
In January 2022, THL stated that in a situation where the vast majority of the population had thevaccinations required for the COVID pass, but with Omicron being dominant, vaccines did noteffectively prevent the onward transmission of infections in situations where the COVID pass would
be in use, but the risk of severe illness among vaccinated individuals was significantly reduced.
Unvaccinated individuals with a negative test certificate were also at risk of infection, and they did nothave the protection against severe hospitalization provided by vaccinations. Therefore, in the current
epidemic situation, the COVID pass, which could be obtained with a negative test certificate, could not
be seen to promote the control of the epidemic's severe consequences, protect the lives and health ofunvaccinated citizens, or maintain healthcare capacity. Thus, THL considered that the pass should
only be granted based on vaccination or a history of the disease. If pre-testing had been an option forunvaccinated individuals to use services, their risk would have been practically similar to if theservices had been open to everyone without any restrictions or pass requirements. For thevaccinated, this would have been only a slight increase in risk.
At Helsinki 30.8.2023
Hanna Nohynek

MD, Chief Physician