Response to interpellation 2024/25:154 on water-borne disease vaccination in the national general vaccination program
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
The debate concerns the introduction of the chickenpox vaccine into the national vaccination program for children. S considers it important that the government introduces free vaccination as soon as possible to reduce healthcare disparities, prevent disease-related complications, and create significant socio-economic savings 1. S emphasizes that the Public Health Agency has already assessed that the criteria for inclusion are met 2. KD notes that the measure is socio-economically efficient and that there is support to implement it 3. KD argues, however, that the basis must be properly prepared, undergo a referral process, and be weighed against other measures as resources are not unlimited 3 4 5. KD emphasizes the importance of protecting children and providing equal life chances 5.
Written by AI in advance and may contain errors. The numbers lead to the speech a statement builds on; check against the text below.
Socialministern Jakob Forssmed (KD)
Mr. Speaker! Ewa Pihl Krabbe has asked me whether I intend to, within my area of responsibility, in accordance with the Public Health Agency's recommendation, as soon as possible introduce chickenpox vaccination into the national general vaccination program for children as well as catch-up vaccination for children up to 18 years of age who have not previously had chickenpox.
The Swedish childhood vaccination program has contributed to the fact that morbidity in common infectious diseases has decreased significantly or ceased entirely. Within the framework of the current Swedish childhood vaccination program, all children are offered protection against eleven diseases.
Since 2013, national vaccination programs have been regulated in the Communicable Diseases Act (2004:168) and the Communicable Diseases Ordinance (2004:255). On September 30 this year, the Public Health Agency submitted a decision basis to the government regarding vaccination against chickenpox in the general vaccination program for children. The Public Health Agency has, among other things, conducted an analysis of the disease burden, the vaccine's effectiveness and safety, cost-effectiveness and ethical aspects, and made a collective assessment of whether the vaccination meets the Communicable Diseases Act's criteria to be included in a national vaccination program.
The Public Health Agency assesses that vaccination against chickenpox meets the criteria for a national vaccination program and proposes that vaccination against chickenpox should be included in the national general vaccination program for children. The agency also proposes that catch-up vaccination be carried out among older children up to 18 years of age who have not had chickenpox.
The Vaccination Inquiry, which was appointed in July 2022, has been tasked with reviewing the national vaccination programs and the national vaccination register. In January 2024, the inquiry submitted the report A coordinated vaccination effort - for more efficient management of upcoming vaccines to the government (SOU 2024:2). The report has been subject to consultation and is currently being prepared in the Government Offices.
The Public Health Agency's decision basis and the committee's report together constitute an important basis in the ongoing work on the question of whether vaccines against chickenpox should be introduced into the national general vaccination program for children.
Ewa Pihl Krabbe (S)
Mr. Speaker! I thank the Minister for Social Affairs for the answer.
The Public Health Agency has submitted a proposal to the government that vaccination against chickenpox should be included in the general vaccination program for children. The investigation has been ongoing since 2018. It was paused during the pandemic, for natural reasons, before being resumed in 2022.
Vaccination against chickenpox not only prevents disease but also entails significant cost savings for society. Inclusion in the national childhood vaccination program will also reduce the healthcare gaps between those who can afford to be vaccinated privately today and people who cannot. It is therefore why we Social Democrats believe it is important that the government introduces free chickenpox vaccination as soon as possible, backed by a national budget - in our budget proposal, it is set at 135 million for the year 2025 - which covers the cost for the coming year.
Why do I think then that one needs to hurry? One reason is that the investigation has taken a long time - which naturally is not strange, given the pandemic - and that children also continue to be affected entirely unnecessarily by a disease which in some cases causes complications requiring hospital care. Unfortunately, the disease takes about eight lives per year, which is not so well known.
This would be a very profitable business for the state, because according to the Public Health Agency's calculations, an investment of approximately 300 million kronor in general water-drop vaccination would yield 440 million kronor back already after five years. After 15 years, the savings would amount to almost 2 billion. If catch-up vaccination were included, the savings would be even greater. Furthermore, the circulation of the virus is expected to disappear completely within six to eight years. This is a time span that is halved with the addition of catch-up vaccination, which is naturally desirable.
Mr. Speaker! Another aspect of chickenpox's impact on society is that the virus never disappears from the body of the person who was once infected. In adulthood, the latent virus can lead to the disease shingles, and that too can cause serious complications, especially for older people. The virus contained in the vaccine has a lower tendency to reactivate in the form of shingles than the virus that remains in the body after one has had chickenpox. This means that the number of cases of shingles can be expected to decrease in the long run, even though I am well aware that it takes many years. Shingles is not infrequently a very troublesome disease to suffer from.
Parents who want to vaccinate their children against chickenpox have until now had to pay out of their own pockets - I believe two injections cost approximately 1,600 kronor. This leads to healthcare disparities. If one looks at Region Stockholm, for example, one sees large socioeconomic differences. Within the region's socioeconomically strong areas, there is a growing group of parents who have their children vaccinated and pay out of their own pockets. One example is Täby municipality, whose estimated vaccination coverage rate of 89 percent is the highest in Sweden. In Salem municipality, the vaccination coverage rate is approximately 1 percent. Including chickenpox vaccination in the general vaccination program in Sweden would therefore contribute to reducing also the healthcare disparities in our society.
In Finland, chickenpox was included in the national vaccination program in 2017, and the number of healthcare visits decreased drastically both among the primary target group and among other children thanks to herd immunity. The number of people treated in primary care in Finland in connection with chickenpox has decreased by 70-80 percent. Within the EU, twelve countries offer chickenpox vaccination to children in general vaccination programs, and more are in the works. The USA introduced this as early as the 90s.
My question is again: Why delay an introduction that has so many good effects?
Socialministern Jakob Forssmed (KD)
Mr. Speaker! I note that it is not the first time Ewa Pihl Krabbe has raised important public health issues in the chamber.
We received the submission on September 30, which is less than two months ago. It appears to be a socio-economically efficient measure, but it is important to properly process the submission and then return with our view on this. Funds must, of course, be secured for it, and it needs to be weighed against other interventions. A referral process is also required to process this in a proper manner. Ewa Pihl Krabbe does, however, raise many important aspects, and there seems to be good support for this being a good measure to implement.
Inequality in vaccination can also mean increased risks for those people who do not receive the vaccine. One can, for example, become infected at an older age than one otherwise would have been, which can also change the course of the disease. That type of aspect must also be taken into account.
We have, as we said, received the basis and will prepare it and get back to you. But as I noted, this must be weighed against other purposes, and one needs to ensure that there are funds. As the regulations currently stand, there also needs to be funds for cost coverage for the regions.
Ewa Pihl Krabbe (S)
Mr. Speaker! I thank the Minister for Social Affairs for the answer.
For children of younger ages, chickenpox can be a very painful disease. Usually, it passes in a few weeks, but in more severe cases, the disease can cause temporary balance difficulties and, in rare cases, affect the brain and cause permanent damage. In Sweden, 300-400 children require hospital care annually due to complications from chickenpox, and as I said earlier, eight people die in Sweden every year as a result of chickenpox. Now that we have a good and safe vaccine, I cannot understand why we do not protect our children from this disease. Children are so important. There are reports from, for example, Skåne about small children who have suffered a stroke from this virus. It is very uncommon, but it happens.
I remember very well when we began vaccinating against the rubella virus, that is, German measles. During my service as a psychologist, I met several people who had been very severely damaged in the womb when the mother was infected during pregnancy, and they had suffered severe lifelong disabilities as a result. In Sweden, the disease has almost completely disappeared, but in low-income countries without universal vaccination, the disease is still common, with fetal damage as a consequence.
My father got polio when I was one year old. I myself received the polio vaccine when it arrived after a fairly long time, and for that I am grateful.
A challenge for many families is that chickenpox involves long periods of sick leave. First one child is affected, and after a couple of weeks the next. If one has two or three unvaccinated children, it can mean absence for many weeks, with subsequent costs for the family and society. According to a Swedish health economics study, chickenpox costs almost 340 million kronor in production loss every year due to childcare, which corresponds to approximately 150,000 lost workdays per year.
In Sweden, the vaccination coverage for chickenpox is a total of 18 percent; I believe that is last year's figure. The most vaccinations are in Region Stockholm and the fewest in Blekinge.
I understand that there are no doubts, but why is it being delayed?
Socialministern Jakob Forssmed (KD)
Mr. Speaker! Let me again thank Ewa Pihl Krabbe for important questions.
The Swedish childhood vaccination program is an enormous success and has meant incredibly much. Vaccination programs in the world are also incredibly important for lifting people out of poverty and giving girls and boys good life chances and securing their opportunity to live a good and healthy life. What is more beautiful than effective vaccines in the world? That is what I sometimes think, precisely based on the enormous significance this has for development in the world. At the same time, we now see conspiracy theories about vaccines flooding the world and such skepticism towards something that has meant so much life for so many, and that makes me deeply concerned. In that case, it is good that we have such a discussion where we highlight the positive and the opportunities that exist with vaccines.
Why is it delayed? We received the basis on September 30, and that was after the budget bill had been submitted to the Riksdag. Now the basis needs to be prepared and referred. We also need to weigh this measure against other measures that are also socio-economically profitable and contribute to health in different ways. Resources are not unlimited, after all. As I noted, however, there are things here that suggest there is a good socio-economy in this. Now a proper preparatory work needs to be done, and sometimes it takes a little time. But we have received a good basis, and I look forward to working further with it.
Ewa Pihl Krabbe (S)
Mr. Speaker! The Public Health Agency has submitted its proposal to the government that vaccination against chickenpox should be included in the national vaccination program, and there seem to be no hesitations from any side. The Communicable Diseases Act stipulates that infectious diseases shall be covered by national vaccination programs if the criteria are met, which the Public Health Agency has assessed to be the case regarding chickenpox. All criteria are thus met.
I understand what the Minister says about this coming in late in the budget process, but I hope that the government ensures that we can together protect our children from a disease that no one actually needs to have. Furthermore, large sums can be saved for the state that can be used for other important purposes. The investigation has understandably taken a long time due to the pandemic. But it is of the utmost importance that the government implements the Public Health Agency's new recommendations as soon as possible.
Socialministern Jakob Forssmed (KD)
Mr. Speaker! I also want to thank you for the debate.
It is extremely important to protect children and give them good and equal life chances, both in Sweden and in the rest of the world.
Now we have received a basis for adding another vaccine to the successful childhood vaccination program, and I look forward to preparing it further. But as I have also said, this needs to be weighed against other measures, and one needs to see if there is or can be space created to do different things.
Many thanks for the interpellation and the opportunity to shed light on an important issue, Ewa Pihl Krabbe!
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.