Vaccination rates against COVID and influenza during pregnancy remain low in Norway

A study of more than 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 well below the recommended targets. The study was published in Eurosurveillance and conducted by Stecher et al. from the Norwegian Institute of Public Health.

Vaccination against COVID-19 and influenza is recommended during pregnancy by the World Health Organization (WHO) and Norway, as pregnant women and their newborns are at 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 highlight the need for more targeted strategies and better integration of vaccinations into routine antenatal care for pregnant women in Norway, together with comprehensive follow-up of maternal vaccination.

In Norway, the flu vaccine is provided during the flu season, while the COVID-19 vaccine is available year-round. In general, both vaccines are recommended for pregnant women in their second and third trimesters. Pregnant women in Norway have access to these vaccines through appointments with health professionals. The flu vaccine is provided at a cost, while the COVID-19 vaccine is free.

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

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

A total of 53,161 women were included in the study. The researchers drew data from two Norwegian national registries, with the study population including all women who gave birth in Norway between October 1, 2023 and September 30, 2024, as identified in the Medical Birth Register of Norway (MBRN). Records and birth data from the MBRN were then linked to data from the Norwegian Immunization Register (SYSVAK).

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

For the flu vaccine, 22.3% of women were vaccinated in the second or third trimester. Coverage rose from 16.4% in October to 26.4% in November and then leveled off. It was highest among women who gave birth in February at 50.8%, falling thereafter. Coverage for the COVID-19 vaccine followed a similar pattern to the flu, 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 significant differences between 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 or younger. Regionally, the counties of Oslo and Vestland 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 sources of vaccine information that women trust to address hesitancy. The authors also report international evidence supporting the integration of free vaccination into routine antenatal care, with pertussis vaccination coverage in pregnant women improving when the vaccine was introduced into the Norwegian maternal immunization programme.

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