A baby with a toy in the mouth.

Childhood vaccines: Nordic countries have widely diverging practices

Measles, mumps and rubella are three of the most well-known diseases to feature on childhood vaccination lists in the Nordic countries. The health authorities in the Nordic countries recommend that children be vaccinated against diseases which can be serious, cause lasting damage or, in the worst case scenario, be life-threatening.

But which diseases should children be vaccinated against, and what unintended effects can the vaccines have on other infectious diseases? This has been the primary focus of a Nordic research project titled “Childhood morbidity and potential non-specific effects of the childhood vaccination programmes in the Nordic countries”.

Christine Stabell Benn from the University of Southern Denmark is leading the project, which has received funding from NordForsk and which, in addition to researchers from Denmark, also has the participation of researchers from the Norwegian, Swedish and Finnish public health authorities. Using health data from Norway, Sweden, Finland and Denmark, they have investigated the differences and similarities between the Nordic countries’ vaccination programmes. As Christine Stabell Benn explains, the results have been startling:

“It isn’t set in stone why and when you should vaccinate your children. To most people it comes as a surprise that, especially in the Nordics, there are great variations in the vaccination programmes. Each country has its own rules. Already here we can see an indication that there isn’t any one single solution,” she says.

Although diseases such as measles, mumps and rubella are included in the vaccination programmes of all the Nordic countries, there are several diseases that not all countries vaccinate against.

Portrait of Christine Stabell Benn
Christine Stabell Benn, professor at Syddansk Universitet. Photo: Lone Mørch.

There is controversy with regard to the rotavirus vaccine

One example is rotavirus, which children are vaccinated against in all the Nordic countries except in Denmark. This is because in Denmark, rotavirus, which is a diarrheal disease, is considered to be less serious and unnecessary to vaccinate against.

“Children often get the disease and frequently infect their parents. Although it can be unpleasant and perhaps cost a day or two of sick leave for the parents, it isn’t considered to be serious in Denmark. Children are vaccinated against it in Finland, Norway and certain regions in Sweden, but not in Denmark”, explains Christine.

In Denmark, the so-called severity criteria form the basis for which diseases children are vaccinated against. If you assess that an illness could potentially become serious for the child, then you vaccinate against it. However, Christine explains that Denmark made an exception to the severity criteria during the COVID-19 pandemic because children were vaccinated due to transmissibility in the rest of the society and not only for the well-being of the child. In Finland, they also emphasise a socio-economic aspect, which means that they also vaccinate against childhood diseases in order to save money for society. This includes vaccinating children against rotavirus to prevent them from getting sick, and in turn parents having to stay home off work.

Here is an overview of the Nordic countries' vaccination programmes for children.

Vaccines can affect children’s susceptibility to other diseases

The researchers in the project have also discovered that vaccines, in addition to the usual purposes, can have non-specific effects which can be very positive for certain vaccines. This means that if a child is vaccinated against measles, for example, it may be that the vaccine not only protects against measles but also against other infectious diseases.

“In Denmark, the MMR vaccine (vaccine against measles, mumps and rubella, edit.) has previously been tested. It was found that it actually also protects against other types of infections than those intended. The effects have been particularly evident when we looked at respiratory infections such as bronchitis and pneumonia. That’s why in our project we’re focusing on investigating whether the same was the case in the other Nordic countries and whether other vaccines can have similar effects. This has never been investigated before, because it’s not traditionally done.”

Norway is top of the class in the Nordics

The researchers in the project have also investigated the risk of children with infectious diseases being hospitalised in the Nordic countries, and how much antibiotics are prescribed to children. Christine calls the results surprising.

“The figures are very interesting because we normally consider the Nordic countries to be similar, but our results show that there are highly significant differences. We can document that the figures for hospital admissions and antibiotic consumption vary, and based on that we can guess why. Norway is top of the class, both when it comes to the total number of hospital contacts and consumption of antibiotics because children in Norway don’t come into contact with their GP especially often compared to the other four countries.”

In Denmark, the number of children who have contact with a hospital has increased from being the lowest among the Nordic countries to being the second highest. Among other reasons, this is due to the fact that in the capital area in 2013 the decision was made to send children not to the Emergency Medical Service, but to send them directly to a hospital.

“Children may be sent to a hospital, even though they may just be snotty and not in real need of hospitalisation. That’s why we saw a sharp increase in the number of children who’ve been to a hospital from 2013 onwards, but when we looked at the number of children admitted to hospital, we haven’t seen the same jump which would cause Denmark to be consistently higher on the list than the other countries. If, on the other hand, we look at the number of children who spend one or two nights in hospital, the differences between the Nordic countries are substantially smaller. So, there are many interesting numbers to take away from these results.”

Consumption of antibiotics is high in Finland

“The Finns have a high consumption of antibiotics among children – especially broad-spectrum antibiotics – which are otherwise reluctantly given because of the risk of developing resistance.”

On the other hand, Christine adds that Finland is somewhat lower on the list than Denmark in terms of hospital admissions.

“One may wonder if this is because the health staff have a greater focus on treating the children with antibiotics in order to prevent hospitalisation. We don’t know that for sure,” she says.

The consumption of antibiotics among children differs widely in the Nordic countries.

“There’s been a significant drop of between 35 and 50 percent in the consumption of antibiotics in all the countries between 2006 and 2017. This suggests that all the Nordic countries have become aware of the need to lower antibiotic consumption. However, some countries remain more liberal in prescribing antibiotics than others. Finland and Denmark rank high, while Sweden has significantly lower consumption, and then there’s Norway, which is top of the class with the lowest antibiotic consumption and hospital contacts,” she says and sums up:

“There’s a lot for the four countries’ health authorities to look at if they want to minimise both children’s hospital visits and the consumption of antibiotics, and there’s much to be gained, because children’s infectious diseases are a huge financial expense for society.”

The Nordic countries should conduct joint test studies

The researchers in the project recommend that more joint studies of childhood vaccines be carried out at the Nordic level, because it’s important that we look at each other and see what works best in relation to childhood vaccination programmes. The studies which the researchers have conducted are reinforced by being conducted at the Nordic and not just national levels, because they’ve had access to much more data.

“There’s a huge advantage in working together and comparing our otherwise fairly homogeneous welfare states. We’ve had exemplary co-operation with public health institutions and health boards in Sweden, Norway, Finland and Denmark. We’ve also run into some challenges in terms of getting access to health data, but we’ve also had great pleasure in working across the Nordic countries.”

Read more about NordForsk’s research projects in health and welfare.


Marianne Knudsen. Photo: NordForsk

Marianne Knudsen

Senior Communications Adviser