Sarah Bennett
In Sweden, vaccine uptake is exceptionally high, with more than 97% of children vaccinated at child health care centers according to the schedule at 2 years of age in 2021. This is due to an efficient child immunization program and the key role of nurses in facilitating support for parents to make informed decisions. However, Sweden's government declined to recommend COVID-19 vaccines for children under 12 years old, citing low risk and minimal medical benefit for that age group. While vaccination against COVID-19 is voluntary and free of charge in Sweden, the country has seen high vaccine acceptance overall.
| Characteristics | Values |
|---|---|
| Vaccination uptake | Exceptionally high |
| Reasons for high uptake | Efficient child immunization program |
| Vaccination rate in 2021 | More than 97% of children |
| Age group for vaccination | 1–2 years and 8–12 years |
| Vaccination for COVID-19 | Not recommended for children under 12 years |
| Vaccination for COVID-19 | Voluntary and free of charge |
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What You'll Learn
COVID-19 vaccines are not recommended for children aged 5-11
Sweden has one of the highest vaccine uptake rates in the world, with more than 97% of Swedish children vaccinated. This is due to an efficient child immunization program and the positive attitude of parents towards vaccinations. However, Sweden's Public Health Agency has stated that it will not recommend COVID-19 vaccinations for children aged 5 to 11. The decision was made based on the low risk of severe illness in this age group and the lack of clear benefit for individual children.
Britta Bjorkholm of the Public Health Agency stated that "with the knowledge we have today, with a low risk for serious disease for kids, we don't see any clear benefit with vaccinating them." She further emphasized that while the vaccines are safe and effective, the focus is on the medical benefits for individual children, and the current benefit for those aged 5 to 11 is considered small. The agency also mentioned that vaccinating this age group is not expected to significantly impact the spread of infection within the group or the wider population.
Sweden's decision stands in contrast to some neighboring countries, such as Denmark and Norway, which offer the COVID-19 vaccine to 5 to 11-year-olds, although it is not compulsory. Sweden's approach during the early days of the pandemic also differed from many other European countries, as they opted against lockdowns or school closures. Instead, they implemented targeted measures such as banning visits to elderly care homes and limiting the number of people at public gatherings.
While Sweden has chosen not to recommend COVID-19 vaccines for children aged 5 to 11, they do recommend jabs for children who are at risk and for everyone aged 12 and above. The Public Health Agency continuously assesses the situation and makes decisions based on the best available evidence. The high vaccine uptake in Sweden is also attributed to the key role played by nurses in providing vaccination information and supporting parents in making informed decisions.
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High vaccine uptake due to efficient child immunisation program
In Sweden, vaccine uptake is exceptionally high, with more than 97% of Swedish children vaccinated according to the schedule at 2 years of age in 2021. This high vaccination rate is due in large part to the country's efficient child immunisation program.
The child immunisation program in Sweden is delivered primarily through child health care centres (CHCs). At these centres, nurses play a crucial role in providing vaccination information and building trust with parents. The spectrum of communication and relationship-building between nurses and parents is essential to the program's success. For parents of children aged 1-2 years, the focus is on compliance with the vaccination schedule and ensuring the safety of their children. The nurses at CHCs are the most used source of vaccination information for these parents.
As children grow older, the vaccination decision becomes more complex, and communication needs to be tailored to the situation. For parents of children aged 8-12 years, the focus shifts to the broader impact of vaccination on the individual and society. A foundation of trust established at CHCs lays the groundwork for these more advanced vaccination decisions. Both individual and societal perspectives influence the vaccination decision for this age group.
To maintain high vaccine acceptance in Sweden, it is crucial to provide continuous support and tools to nurses, enabling them to facilitate informed decisions by parents. Additionally, recurring studies are valuable for monitoring vaccine confidence and attitude changes over time. While Sweden's child immunisation program has achieved remarkable success, further studies are needed to understand the perspectives of non-vaccinating parents and adolescents.
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Nurses are the most used vaccination information source
In Sweden, vaccine uptake is high due to an efficient child immunisation program. More than 97% of Swedish children were vaccinated at child health care centres (CHCs) according to the schedule at 2 years of age in 2021. From the age of 6 years, vaccinations are given within school healthcare.
Nurses play a key role in high vaccine acceptance in Sweden. During early childhood, parents have a direct relationship with the nurse at CHCs, but in school, children become the primary transmitters of information about vaccinations. It is therefore crucial to offer information that meets a variety of information needs and provides satisfactory and trustworthy information to limit the lack of information as a barrier to vaccination. Nurses should be provided with continued support and tools to facilitate their support for parents in making informed decisions.
In a study of mothers in Tehran, Iran, it was found that mothers' concerns over immunising their children could be addressed by nurses reducing communication barriers and providing appropriate and adequate information. Another study found that nurses need greater awareness of how service users receive and respond to health information and how health stories are reported. Closer engagement between health journalists and nurses through 'journalist-in-residence' programmes could enable nurses and journalists to gain greater insight into each other's areas of expertise.
In Sweden, school nurses and vaccination providers work together to decide when and how COVID-19 vaccinations will be administered to children aged 12-15. Children with severe allergies will be referred by the school nurse for a medical assessment or an appointment at a vaccination centre, healthcare centre, or specialist clinic.
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Vaccination decisions become more complex as children age
In Sweden, vaccine uptake is exceptionally high, with more than 97% of children vaccinated according to the schedule at 2 years of age in 2021. This is due to an efficient child immunization program and the key role of nurses. Nurses at child health clinics are the most used vaccination information source for parents who are vaccine acceptors.
However, as children age, vaccination decisions can become more complex. For parents of children aged 8–12 years, the themes expressed in a focus group study were "vaccinate to do good for the individual and society" and "a foundation of trust is built at CHCs for decisions later on". It was noted that communication changes as children get older and needs to be explicit and tailored to the situation. Both individual and societal perspectives were shown to influence the vaccination decision for childhood immunizations.
While Sweden has a high vaccine acceptance rate, there are still parents who question certain vaccines. For example, one in five parents questioned the HPV vaccine but still agreed to the NIP. The HPV vaccine has been a topic of discussion in Sweden, with some media outlets reporting on it in 2022 when Sweden decided against recommending COVID-19 vaccines for children aged 5 to 11, citing a low risk of serious illness and a small medical benefit for individual children in this age group.
To maintain high vaccine acceptance in Sweden, it is important to provide nurses with continued support and tools to facilitate their support for parents in making informed decisions. Additionally, recurring studies are valuable for monitoring vaccine confidence and changes in attitudes towards vaccination.
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Herd immunity is affected when parents refuse vaccines
In Sweden, vaccine uptake is generally high, with more than 97% of children vaccinated. This is due to an efficient child immunization program and the positive attitude of Swedish parents toward vaccines. However, one in five parents still question vaccines, particularly the HPV vaccine, and vaccine refusal remains a concern.
Herd immunity is a situation in which a significant portion of a population is vaccinated, thereby reducing the chances of contracting and transmitting a contagious disease. When parents refuse to vaccinate their children, they are making a strategic decision to exploit this herd immunity by relying on the vaccination decisions of others. This is often referred to as "free riding." While it may be rational for individual parents to avoid the slight risks associated with vaccines, it is also selfish, as it undermines the social benefit of herd immunity.
The refusal to vaccinate can have serious consequences for vulnerable children who cannot be immunized or develop an immune response. These children rely on herd immunity for protection. For example, during the 2011 measles outbreak, many of the affected children were unvaccinated due to parental concerns about the measles, mumps, and rubella (MMR) vaccine. Similarly, an outbreak of pertussis occurred in Boulder when the percentage of immunized children fell below the threshold necessary for herd immunity.
To address vaccine refusal, it is essential to understand parents' concerns and provide them with the necessary information to make informed decisions. Healthcare providers should engage in open and frank conversations with parents to address their questions and concerns without making them feel attacked or judged. Education and awareness can empower parents to make responsible immunization choices and protect their children's health.
In summary, when parents refuse vaccines, it undermines herd immunity and puts vulnerable children at risk. To improve vaccine uptake, healthcare providers should work collaboratively with parents, addressing their concerns and providing evidence-based information to support their decision-making process.
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Frequently asked questions
No, vaccination is voluntary and free of charge in Sweden. However, Sweden has an efficient child immunization program, resulting in high vaccine uptake, with more than 97% of Swedish children being vaccinated according to the schedule at 2 years of age in 2021.
Parents in Sweden generally have confidence in and positive attitudes towards vaccinations given within the NIP (National Immunization Program). Parents of younger children tend to follow the recommended vaccination schedule, while those with older children (aged 8-12 years) consider the benefits of vaccination for both the individual and society.
Anyone living in Sweden, including non-citizens, asylum seekers, and those without permits, is offered free vaccination. Before receiving the vaccine, individuals must fill out a health declaration form. The vaccine is administered by a nurse in the upper arm, and individuals are monitored for 15 minutes afterward to ensure they don't have an allergic reaction.
Yes, Sweden's government declined to recommend COVID-19 vaccines for children under 12 years old, citing low risk and minimal medical benefit for that age group.
High vaccine uptake contributes to herd immunity, protecting those who cannot be vaccinated due to medical reasons or age. It also helps prevent the spread of infectious diseases and reduces the burden on the healthcare system.
