Vaccinations - overview
Icelandic vaccination policy
-Automatic translation
Vaccination in Iceland is governed by regulation No. 221/2001 based on the Act on Health Security and Communicable Diseases, No. 19/1997.
Types of vaccinations
Vaccinations offered free of charge to all inhabitants of Iceland are called general vaccinations. According to the vaccination programme and Article 2 of Regulation No. 221/2001, these are usually vaccinations carried out during childhood. The Chief Epidemiologist is responsible for Iceland's vaccination programme and pays for vaccines from a particular budget section. Changes to the vaccination programme and regulation are made according to a decision by the Ministry of Health, generally after discussion by the Epidemic Prevention Council on the initiative of the Chief Epidemiologist.
For the use of vaccines for general vaccination to be considered, the following specific requirements apply:
A disease against which vaccination is directed is likely to cause widespread and severe illness and is, therefore, a threat to public health.
Vaccines reduce the impact of the disease on the vaccinated individual and the community.
The vaccine is safe. At a minimum, it must be less dangerous for a vaccinated individual than the disease and cause less damage in widespread use than outbreaks of illness in the community.
When the maximum effectiveness of vaccination has been achieved, the estimated cost of vaccination does not exceed the cost of the disease on a community basis before vaccination begins.
If a vaccine is part of a general vaccination programme, the Chief Epidemiologist pays for the vaccine for persons covered by the programme. Vaccine contracts are made for two years or more following a public tender to maximise efficiency. The vaccine contracts also ensure the availability of vaccines in Iceland. However, the contracts are usually framework contracts; therefore, the same price is paid regardless of whether less or more is purchased than planned when the contract was drawn up.
If a vaccine meets the criteria for specific groups within society, it may be appropriate to recommend vaccination for risk groups rather than generalising it. The Chief Epidemiologist issues recommendations on vaccinations of risk groups for specific diseases, which Articles 3-4 of Regulation No 221/2001 cover. They are either done at the expense of an individual, the Chief Epidemiologist or an institution that vaccinates. Sometimes, applying to Icelandic Health Insurance for a medication card for certain at-risk groups is possible. The Epidemic Prevention Council also discusses recommendations for the immunisation of risk groups. The Ministry of Health must approve the participation of the Chief Epidemiologist in such vaccinations, which falls under the budget section mentioned above. The definition of risk groups is based on the fact that the epidemiology of diseases vaccinated against in a specific group differs from the general population's epidemiology. Such analysis often originates from foreign organisations such as the World Health Organization. Still, the definitions are discussed by the Chief Epidemiologist, the Epidemic Prevention Council and in consultation with medical specialists. If the epidemiology in Iceland requires a change from the WHO guidelines, this is done.
The Chief Epidemiologist pays for vaccines for high-risk groups | An organisation that vaccinates pays for vaccines for high-risk groups | An adult person in a risk group pays by himself |
|---|---|---|
Influenza vaccination | Hepatitis B vaccination | Pneumococcal vaccination |
Pertussis vaccination during pregnancy | Meningococcal vaccination | |
Haemophilus influenza B |
If an epidemic occurs for which vaccination is available, vaccination must be offered to a person free of charge according to Article 4 Regulation No. 221/2001. This applies to pandemic vaccinations. Since December 2020, according to government contracts, COVID-19 vaccinations have been free of charge to individuals who need them. In the fall of 2023, these vaccinations will move to the category of vaccinations for high-risk groups. Vaccinations in the winter of 2023-2024 will be carried out with vaccines according to government contracts as in recent years.
According to Article 5 of Regulation No 221/2001, vaccinations shall also be offered due to travel at the expense of the person planning to travel. Health institutions and companies that vaccinate provide recommendations regarding these vaccinations. The Chief Epidemiologist does not address such vaccines in detail and is not involved in ensuring access to them. However, the Chief Epidemiologist issues general recommendations for travel vaccinations and draws the attention of vaccinators and the general public to epidemics.
Specifics on the prerequisite of general vaccinations
An illness is likely to cause widespread and severe illness and, therefore, a threat to public health.
The epidemiology, including the incidence of severe illness or death, provides the basis for assessing this. The use of epidemiology in Iceland is preferable, but it might be necessary to use foreign research on epidemiology and apply the results to Icelandic society.The vaccine reduces the impact of the disease on the vaccinated individual and the community.
The market authorisation of a vaccine in Europe is also dependent on the fact that it is accompanied by a reduced impact of the disease on the individual. Research by vaccine manufacturers is generally based on this. Still, if a vaccine has been introduced in other countries before, information from these countries should be available. It is important to monitor the impact of vaccination on disease rates after vaccination; sometimes special instructions are needed for the use of vaccines for certain groups, e.g. higher or lower doses than are commonly used, etc. An additional requirement that the impact of a disease on society is reduced by universal vaccination is met if widespread vaccination significantly changes the epidemiology. In most cases, less risk of transmission remains in the unvaccinated population due to a lower spread of infection in the community. Although vaccination of individuals to the unvaccinated virus may not have a significant impact on the risk of infection, for example from environmental exposures such as tetanus, a recommendation for general vaccination is warranted in exceptional cases.The vaccine is safe.
Research by vaccine manufacturers is generally based on this, but if a vaccine has been introduced in other countries before it is considered in this context, information from these countries should be available. Monitoring of adverse reactions after vaccination in Iceland is necessary, but insufficient numbers of adverse reactions occur to any significant extent in Iceland, and therefore studies abroad must be continued even when vaccines are used in Iceland. If a disease disappears in the community, adverse events may cause a modified strategy to mitigate the effects of the adverse events to rebalance the adverse impact of vaccination with the community-based disease.The cost of vaccination, once the optimum vaccination success has been achieved, does not exceed the cost of the disease on a community basis before vaccination begins.
National feasibility studies are not always done before vaccines are introduced in Iceland and no cost-effectiveness thresholds for general vaccines have been published. The actual cost of a vaccine is usually not clear in advance, so prices are often used to overestimate the cost of vaccination. Estimates of the cost of a disease either include only direct costs, or both direct and indirect (social effects), which may be difficult to achieve in Iceland if the disease has many different presentations or serious presentations are rather rare. Therefore such epidemiology plans are used from abroad because the epidemiology is to some extent comparable to the Icelandic ones and tries to adapt them to our society. If the effects of vaccination are slow to show, costs may increase temporarily, while costs for both the disease and vaccine may be incurable.
Criteria should be carefully considered before vaccination is added to the plan or guidelines for at-risk groups are prepared and revised regularly.
New vaccines must be examined when they are marketed and reviewed if they do not soon become part of the programme here if new data emerge on their effects abroad or epidemiology here. At a minimum, new data should be considered every 2-3 years.
The review of vaccines that are scheduled should be carried out at a minimum of time for each new tender.
The guidance for risk groups needs to be reviewed at least when new data are available on the impact of these vaccinations, new vaccines of the same category are introduced, etc. A check should be made to ensure that changes in the guidelines are warranted every 2-5 years.
Service provider
Directorate of Health