Vaccine technology has experienced explosive development. When the covid-19 pandemic started, it did not take many weeks before the first vaccine candidates had been made, and within a year mass vaccination could begin. The pandemic showed that when there is financial ability and political will, we are fully capable of carrying out a vaccination programme. In 2018, the Norwegian Institute of Public Health (FHI) sent a proposal to the Ministry of Health and Care for a vaccination program for adults. In addition to the flu and pneumococcal vaccine, it was proposed to update the children’s vaccines: diphtheria, tetanus, whooping cough and polio, and the MMR vaccine for those who have not received the measles vaccine before and have not had measles. Through two governments, FHI’s proposal has not yet been adopted. Since 2018, there have been three new and expensive vaccines aimed at the older part of the population: A new vaccine against shingles A new vaccine against the 20 most important pneumococcal types A vaccine against RS virus for people over 60 Shingles is a very painful infection that affects approx. a quarter of the population after the age of 50. It is particularly serious if you get it in the eye region. The pain often lasts for a month, and in some cases for the rest of your life. Much suffering could have been avoided if everyone over the age of fifty, and everyone with a weakened immune system, had received this vaccine. But you have to expect to pay approx. NOK 2,200 per dose, and two doses are needed. Pneumococci are the most common cause of bacterial respiratory infections outside hospital (ear infections, sinus infections, bronchitis, pneumonia). Invasive pneumococcal infection (meningitis and blood poisoning) has a high mortality rate. The new vaccine is a so-called conjugate vaccine, which makes it much more effective. After the conjugate vaccine against the 13 most important pneumococci began to be given to infants, such meningitis has almost disappeared in infants, and the types covered by the vaccine have declined sharply, also in adults, due to herd immunity. The pneumococcal vaccine for adults that was recommended in 2018, and which is still recommended by FHI, has no effect against pneumonia, and does not provide herd immunity, as the conjugate vaccine does. But the conjugate vaccine is much more expensive, approx. NOK 1,200 included the around NOK 200 you have to pay to get the vaccine. RS virus is a major problem in children’s wards in hospitals, but it is also the third most important cause of hospitalization for viral respiratory infections in the elderly, after covid-19 and influenza. We do not have good figures for RSV infection in Norway, as the disease is not notifiable, but in Denmark 287 people died of RSV in the 2022/23 season. The vaccine should be considered in those with heart and lung disease, and diabetes. It costs approx. NOK 2,500 to get a vaccine against RSV. There is no law that says that a vaccination program must be free, but the purpose of having a vaccination program for adults is to reach as many people as possible, and thus improve public health. Society may save something from reduced sickness absence and less pressure on the health care system, but that does not come close to outweighing the costs of giving all these expensive vaccines to a million people. Especially with the shingles vaccine, the most important benefit will be reduced symptoms for the individual. If these expensive vaccines are included in a mass vaccination programme, the price can probably be negotiated down somewhat, but hardly so far that the vaccines can be given cheaply by the public. The dilemma facing the health authorities is thus whether to recommend a vaccination program that many cannot afford. There is a good academic basis for recommending, for example, the vaccine against shingles, but it is so strongly against our social democratic spirit to recommend something that many people cannot afford, that we cannot expect any such recommendation from FHI. The offer for the poorest will not deteriorate if those who can afford it get vaccinated. The individual must assess this for himself. The best solution would have been to give the vaccine free of charge to everyone at high risk of shingles, and I believe that Norway can afford that.
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The vaccines we don’t get – Speech
