Abstract
The World Health Organization recommends inclusion of rotavirus vaccines in national immunization programs (NIPs) worldwide. Nordic countries are usually considered comparable in terms of demographics and health-care services and have comparable rotavirus disease burden. Nevertheless, the countries have reached different decisions regarding rotavirus vaccine: Norway and Finland have already introduced rotavirus vaccines into their NIPs and Sweden is currently changing its recommendation and vaccines will now be introduced on a national scale while Denmark has decided against it. This study focuses on the selection and interpretation of medical and epidemiological evidence used during the decision-making processes in Sweden, Norway, Finland, and Denmark. The so-called “severity criteria” is identified as one of the main reasons for the different policy decisions reached across the Nordic countries.
Highlights
Two oral, live, attenuated rotavirus vaccines, RotarixTM and RotaTeqTM, are used internationally; and both vaccines are considered highly effective in preventing severe gastrointestinal disease [1]
Rotavirus vaccines have been available for purchase at private vaccination centers for several years prior to this decision, and one of the vaccines available on the market is subsidized by the Dental and Pharmaceutical Benefits Agency, TLV
Decisions regarding inclusion of new vaccines in the Swedish national immunization programs (NIPs) are taken by the Swedish government [14]
Summary
Live, attenuated rotavirus vaccines, RotarixTM (derived from a human G1P[8] rotavirus strain) and RotaTeqTM (a reassorted bovine–human rotavirus), are used internationally; and both vaccines are considered highly effective in preventing severe gastrointestinal disease [1]. There are no uniform guidelines for decision-making processes or policies for introduction of new vaccines, individual countries usually consider disease burden, health care and vaccine-related costs and safety and effectiveness of vaccine candidates [4]. Surveillance and research studies on rotavirus hospitalizations and deaths [5] have demonstrated that the incidence of rotavirus does not vary much across countries worldwide, but the risk of dying from rotavirus disease is much higher in low-income countries, and there is general agreement on the rationale for Vaccine Introduction: Decision-Taking Processes and Policies the need for prevention of rotavirus disease in such settings [6]. In high-income countries, where rotavirus-associated mortality is generally low, there has been more debate on the need for and cost-effectiveness (CE) of the vaccines [7]. The Nordic countries are usually considered similar and com parable in terms of demographics, disease burden and healthcare systems with tax-based funding, publicly owned and operated hospitals, universal residence-based access, and comprehensive coverage [8]
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