Response to interpellation 2024/25:310 on vaccination programs for the elderly

Socialministern Jakob Forssmed (KD)

Madam Speaker! Sanne Lennström has asked me if I and the government intend to take the initiative to provide older people with better and more equal conditions for getting vaccinated.

Sweden's well-functioning work with vaccination programs is something I am very proud of. We have had a stably high vaccination coverage in the national general vaccination program for many years, and the incidence of the diseases that we vaccinate against has decreased sharply and in some cases almost disappeared in Sweden. Good and equal care throughout the country and the protection of the elderly are crucial in a welfare society.

Since 2013, national vaccination programs have been regulated through the Communicable Diseases Act (2004:168), and it is the Public Health Agency of Sweden that investigates and provides the government with a basis for decisions on which diseases should be covered by national vaccination programs. According to the Communicable Diseases Act, a communicable disease shall be covered by a national vaccination program if vaccination against the disease can be expected

effectively prevent the spread of infectious diseases in the population

be socio-economically cost-effective

be sustainable from ethical and humanitarian perspectives.

This thus constitutes the basis for the Public Health Agency's underlying material. The agency also takes a position on whether the entire population should be covered by a program or only certain groups, how many doses should be given and at what age.

The Government handles on an ongoing basis the proposals received from the Public Health Agency regarding which groups and vaccines should be included in national vaccination programs. An example of a proposal in the near term that the Government has handled is the introduction of a national and specific vaccination program against pneumococcal infection. Since 1 December 2022, vaccination against pneumococci has been included in a national vaccination program for risk groups, and according to the vaccination program, vaccination shall be offered to all persons in the year they turn 75 years old. Vaccinations offered in an organized form to all or parts of the population within the framework of national vaccination programs, for example, vaccines against pneumococci, are decided and funded by the state.

There are currently no proposals from the Public Health Agency regarding the introduction of additional vaccinations specifically targeted at the elderly in a national vaccination program.

In addition to vaccine submissions to the government regarding national vaccination programs, the Public Health Agency may issue recommendations for vaccination. In these cases, it is up to the regions to decide whether the vaccination shall be offered and to bear the costs. One such example is the influenza vaccine, which today is recommended for persons who are 65 years and older.

In recent years, the focus in the vaccination work in Sweden has been on securing protection against covid-19, primarily among elderly people and other people with an increased risk of suffering from severe illness. This has been and continues to be a prioritized issue, and the government has ensured that the elderly receive free vaccination and booster doses against covid-19.

The question of vaccinations for the elderly is important, and I will continue to follow the issue closely.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Sanne Lennström (S)

Madam Speaker! I would like to begin by thanking the Minister for the answer. The debate here today is very important.

Vaccinations are one of the most effective public health interventions that exist in our time. After access to clean water, it is vaccinations that have saved the most lives globally. The World Health Organization estimates that vaccinations save between 3.5 and 5 million lives annually.

During the covid-19 pandemic, we saw clearly how crucial vaccines are, just as the Minister has mentioned. During the first year alone, it is estimated that vaccinations were able to save over 20 million lives worldwide.

In Sweden, we have a national vaccination program for children, which has contributed to the fact that many previously common and serious diseases have practically been able to disappear. But for our elderly, who are also particularly vulnerable to infectious diseases, a similar program is lacking. The elderly have a weaker immune system and are therefore to a greater extent dependent on being able to protect themselves against diseases such as influenza, pneumonia, and shingles.

Despite this, many elderly people are forced to pay thousands of kronor to get vaccinated, for example against shingles. In Region Örebro, a vaccination can cost between 1,440 and 3,360 kronor, which is a significant expense for a pensioner who has limited financial resources. This creates an inequality where those who can afford it can protect themselves, while those who cannot may be forced to risk becoming seriously ill.

Madam Speaker! This is not reasonable. We know that the pandemic has shown that it is possible to significantly increase the willingness to be vaccinated, even in hard-to-reach groups, through targeted interventions. A national vaccination program for the elderly would provide everyone with an equal basic protection. Then the elderly would not have to weigh the risk of illness against the size of their wallet. It would not only reduce morbidity but also prevent a need for care, which would be a great advantage for our already overburdened regions, which are in a very difficult economic situation.

The regions are, as is well known, very vulnerable right now. They are in a difficult economic situation, which in this situation requires resources even directed from the state. I can only regret that the government's latest budget did not see the regions and extended the helping hand that had been needed here.

There are, of course, questions to be solved within this subject as well, for example, which vaccinations should be included in a national program and whether a national vaccination register is needed and how this, if so, could be implemented to ensure that the right protection is given at the right time to the person who needs it. Vaccines against covid-19, influenza, shingles and pneumonia are some examples of what could be included in such a program.

The Minister gave no concrete proposals in his answer to me on how to proceed with increasing the vaccination rate, but instead referred to the Public Health Agency. It is a very competent agency, but the politicians must not abdicate the responsibility to review how the vaccination rate can be increased in the future. Therefore, I want to ask Minister for Social Affairs Forssmed: How does the government intend to ensure that the elderly can afford to get vaccinated against serious diseases?

The speech at riksdagen.se, in Swedish (opens in a new tab)

Socialministern Jakob Forssmed (KD)

Madam Speaker! First, I would like to thank Sanne Lennström for the interpellation and the opportunity to truly emphasize in the chamber of the Riksdag the importance of vaccines and vaccinations and the enormous gains that humanity has made thanks to vaccines.

Unfortunately, we see extensive disinformation regarding vaccines that is potentially very, very harmful. We know that this can save lives, but when disinformation advances with its conspiracy theories regarding vaccines, there are risks. Therefore, it is important that there is a broad consensus in the chamber of the Riksdag that vaccines are effective, important, and beautiful elements in the care and nursing that is provided and very important for public health.

Vaccination is incredibly important, and we are working hard to increase vaccination coverage. This applies in particular to the vaccine against covid-19. Here, I think there is a tendency for us to lean back, that we believe the risks are over. I view this with great concern, not least when it concerns people who have home care and who are frail and vulnerable and who often fulfill part of what the interpellor points out. They may have a weakened immune system or in other ways be frail and vulnerable. There, I see with great concern that we do not succeed in increasing the vaccination coverage sufficiently and that it looks different between regions and municipalities. I do not think that is sufficient.

My State Secretary has spoken with all the country's social chiefs so that we can increase these opportunities. It must not be our organizational division that determines who gets a vaccine and who does not. I think this is something that we have reason to take seriously.

Regarding several of the diseases that the interpellor highlights – covid-19, influenza and pneumonia – I can state that vaccines are available today. For covid-19 and influenza, you receive vaccines free of charge if you are older. It is the same regarding pneumococci – there, you are given a vaccine in the national vaccination program when you are over 75.

The interpellator also raises the issue of the belt rose. There is a possibility for the regions to do this. There is nothing preventing it. The Public Health Agency also provides guidance on how to think regarding the belt rose vaccine specifically.

But I am the first - and I believe the interpellor knows this - to see that we have unequal healthcare in Sweden. That is also why we have a healthcare responsibility committee, which is now considering whether we should have a different primary responsibility for healthcare, entirely or partially, so that we can move away from some of the inequalities that we see. This does not only concern vaccines. It also concerns other treatments.

The treatment one receives in Sweden is largely determined by which region one lives in. It is, of course, not an entirely optimal arrangement. I think that in many ways it is deplorable. Therefore, I am very much looking forward to the Vårdansvarskommitténs report, which will be released this summer.

I naturally hope that many parties see the importance of increasing equality in healthcare and ensuring that there are more equal conditions when it comes to vaccinations but also other treatments. This is one of the tools that the regions have at their disposal to prevent disease or to have effective treatments.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Sanne Lennström (S)

Madam Speaker! I agree with what the Minister of Justice mentioned regarding the fact that we together – in this chamber and in politics in general – must counteract the disinformation that exists surrounding vaccines. It feels reassuring that the government stands behind this, as vaccines are so important, as we have already mentioned.

When major reforms are to be implemented, one must always take a first step. That step has already been taken by our neighboring country Denmark. Vaccines against pneumococci can prevent pneumonia. In Sweden, this vaccine is only free from the year one turns 75. In Denmark, this is free.

How does it affect it if it is free or if it costs money? The Public Health Agency believes that one should be vaccinated against this from the age of 65. In Sweden, the vaccination coverage for those aged 65 and over is today somewhere between 27 and 36 percent - I have seen somewhat different figures on that. I do not know if the Minister is aware of what the coverage is just today in Denmark, which offers this for free. But I have seen the figure 73 percent, which is considerably much higher and better than in Sweden. It is therefore 1-0 to Denmark in that respect.

In Sweden, it becomes a bit of a lottery in this issue. It is about where you live or how much money you have. I know that Denmark is a favorite country for the government in matters regarding crime fighting, but I ask the State Secretary and the government to also consider other issues where we can follow Denmark's example. This is about protecting our elderly from serious illness and, in the worst case, from an untimely death.

Vaccines make a difference. A national vaccination program might sound like a big step to take. But one could start by preventing pneumonia. Arranging vaccines for the elderly against pneumococci would be a big and good step in the right direction. The benefit would also likely outweigh the cost when the diseases are prevented.

The Social Democrats in the Committee on Health and Welfare have been clear. An investigation should be commissioned regarding the possibilities of developing the vaccination program for risk groups, established since 2022, into a broader vaccination program with, for example, vaccinations against influenza and shingles for persons over 65 and in risk groups. Politics is, after all, about wanting something.

I also look forward to the Healthcare Responsibility Committee's report, where perhaps some paths towards more equal healthcare in Sweden will be opened. We will have to see if it will become fully or partially state responsibility in more areas than today.

But my question to the Minister is whether the Minister is willing to meet the Social Democrats halfway to improve the health of the country's elderly in this regard.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Socialministern Jakob Forssmed (KD)

Madam Speaker! Thank you again, Sanne Lennström, for the interpellation and also, naturally, for the international perspective! I think it is extremely important that we learn from each other, between countries, both bilaterally and multilaterally. We do this within the WHO, which is an incredibly important actor in this area. I naturally view with concern that countries such as the USA seem to be on the way to leaving such an important organization. It could mean a hard blow for health work in the world. It is in that case very worrying both when it comes to pandemic management and when it comes to precisely the learning between countries, which is extremely important.

I am very positive about the pneumococcal vaccine. Now this is happening for everyone who turns 75. I think that is very good. Then one can always consider whether to take further measures to increase coverage and opportunities. I am always open to measures that improve people's health. One has to consider this and weigh measures against each other and see what one can return to. But just that we have introduced this, I think is very good and important. I am glad that I have been involved in pushing forward such a decision.

Then it is, as Sanne Lennström points out, in many cases up to the regions to handle this, just as is the case when it comes to other treatments. When it comes to the shingles vaccine, the assessment is that it does not meet the criteria for a national vaccination program. But it is, of course, nothing that prevents the regions from introducing it, as it is an effective treatment. Then, of course, one needs to weigh this against other types of treatments and other interventions that can be made.

I am glad that Sanne Lennström and I share the view that there is an inequality in Swedish healthcare and that we need to act in different ways to counteract this. I hope, of course, that the Social Democrats also stand up for that position in the Healthcare Responsibility Committee so that we can come forward with reforms that make the inequality decrease, that the state's role becomes clearer and that we get a more national management of healthcare. I have noted such openings from the Social Democrats. I think it is important that we discuss this further, because it is clear that it is good if there is a broad consensus around those types of issues.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Sanne Lennström (S)

Madam Speaker! The Minister mentions that there is nothing preventing the regions – except for a very strained economic situation, which we have previously mentioned. This is somewhat of the common thread in the two interpellations that I have submitted to the Minister and which we are debating today.

The regions are in an extremely strained position. Therefore, one needs to review exactly what we are debating today. What responsibility should the state have? What responsibility should the regions have? When do the regions need support and help so that we can provide care that is as equitable as possible? But, as said, we have a committee looking at this. We look forward to the result, which will arrive by the summer.

I would like to conclude by saying something about the normalizing effect that a vaccination program would have – if we were to introduce such a program in Sweden for the elderly. When it is up to each region to decide on issues regarding fees, automatic summons, whether the doctors they employ are engaged in the health of the elderly, and so on, it is difficult with the information gathering. Such things play a very large role when one visits the regions and learns about vaccinations for the elderly. When there are such enormously large differences, it also complicates the information gathering for the elderly. If we have a national vaccination program for the elderly, the information gathering for the patients becomes simpler, and the signal also becomes clear.

With this, I would like to thank the Minister for the agreement on very large parts of these issues and hope that the government will be able to give positive news regarding good vaccines in the future for our elderly.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Socialministern Jakob Forssmed (KD)

Madam Speaker! Thank you, Member, for this important discussion!

I think it is incredibly important that vaccinations are used. If we have the opportunity to protect lives and health, we should do so, and I therefore view with concern the disinformation occurring around vaccinations which actually threatens lives and health. I am glad that we together actively counteract it, among other things with the discussion we have today. It shows that there is, of course, a strong consensus regarding vaccinations and the opportunities we have to save lives.

I also view a low vaccination coverage with concern, not least when it concerns covid-19 vaccines for the elderly, frail, and vulnerable, and I believe that society has a special responsibility to assist people so that they can receive their booster doses of covid-19 vaccine. It is not a disease that is over. It is a disease that still threatens people's lives and health, and the government has ensured that there are free opportunities to receive these booster doses if one is elderly or in a risk group.

I also want to point out that it is the Public Health Agency of Sweden that provides the basis to the government regarding which vaccines it considers should be included in the national vaccination programs. The government has, based on the Public Health Agency's basis, introduced vaccination against pneumococci for persons from 75 years of age.

There is currently no proposal from the Public Health Agency regarding the establishment of a national vaccination program for the elderly. That being said, I will follow and be active in these important issues. Significant progress is also being made in the field. We, for example, very recently received an RSV vaccine that can play a very large role even for the elderly.

It is very important to follow these issues, and it is important that as many as possible receive vaccines based on the Public Health Agency's recommendations. My view regarding the regions is, of course, that they should listen to the Public Health Agency and ensure that opportunities are created for people – the elderly and others – to get vaccinated against serious diseases.

The interpellations debate was hereby concluded.

The speech at riksdagen.se, in Swedish (opens in a new tab)