COVID and flu vaccination rates during pregnancy remain low in Norway

A study of over 50,000 pregnant women in Norway during the 2023/24 influenza season found that only 29.9% were vaccinated against influenza and 12.1% against COVID-19 during pregnancy, remaining far below recommended targets. The study was published on Eurosurveillance and conducted by Stecher et al. from the Norwegian Institute of Public Health.

Vaccination against COVID-19 and influenza are recommended during pregnancy by the World Health Organization (WHO) and Norway, as pregnant women and their newborns have an increased risk of severe outcomes from these diseases. For at-risk groups, the WHO recommends a vaccination target of 75% for both infections.

These findings emphasise the need for more targeted strategies and better integration of vaccinations into routine pre-natal care for pregnant women in Norway, along with comprehensive surveillance of maternal vaccination.

In Norway, the influenza vaccine is provided during the influenza season, while the COVID-19 vaccine is available year-round. Generally, both vaccines are recommended to pregnant women during the second and third trimester. Pregnant women in Norway access these vaccines through self-initiated appointments with healthcare professionals; the influenza vaccine is provided at a cost, while the COVID-19 vaccine is free.

Significant variation in coverage depending on month of delivery and timing during pregnancy

Stecher et al. looked at how many pregnant women received the influenza and COVID-19 vaccines during the 2023/24 influenza season, at what stage of pregnancy they received the vaccine, and whether uptake differed by age group or region.

A total of 53,161 women were included in the study. Researchers drew data from two Norwegian national registries, with the study population comprising all women who delivered in Norway between 1 October 2023 and 30 September 2024, as identified in the Medical Birth Registry Norway (MBRN). The records and birth data from MBRN were then linked to data from the Norwegian Immunisation Registry (SYSVAK).

Despite universal recommendations for vaccination during pregnancy, coverage in the influenza season 2023/24 was low at 29.9% and 12.1% for influenza and COVID-19, respectively, while only 11.4% of pregnant women received both vaccines.

For the influenza vaccine, 22.3% of women were vaccinated in the second or third trimester. Coverage increased from 16.4% in October to 26.4% in November, and levelled off thereafter. It was highest among women delivering in February at 50.8%, declining afterwards. Coverage for the COVID-19 vaccine followed a similar pattern to influenza, with 10.1% of women receiving the vaccine in the second or third trimester.

Low vaccination rates despite high trust in health authorities

There were considerable differences across regions and age groups, despite the population's high level of trust in health authorities and recommendations, and the authors point to practical and psychological barriers to vaccination. The lowest uptake was among women aged 25 years or younger. Regionally, the Oslo and Vestland counties had the highest vaccination coverage, while the lowest coverage was found in Northern Norway.

Stecher et al. suggest removing financial barriers, improving accessibility, and exploring information sources on vaccines trusted by women to address hesitancy. The authors also cite international evidence supporting the integration of free vaccination into routine pre-natal care, with vaccination coverage for whooping cough among pregnant women improving when the vaccine was introduced into Norway's maternal immunization programme.

Similar challenges globally, including limited surveillance systems and inconsistent integration, highlight the importance of coordinated efforts to promote maternal immunisation in Europe and worldwide.