THE PROBLEM

Respiratory infections continue to cause preventable illness and deaths among older adults in Norway. As the population ages, winter surges put more strain on primary care facilities and hospitals. In response, the government launched the Adult Vaccination Program in 2025, creating the country’s first national framework for adult vaccination.

The national program is a promising start, but estimated coverage (66% for the flu vaccine and ~30% for pneumococcal in 2025 among those aged 65+) remains below regional targets. Structural barriers—like patient copayments, which are a substantial share of the cost of adult vaccination, and fragmented delivery—act as disincentives to uptake even when vaccines offer strong value for money. Norway’s primary challenge is determining how to design vaccine financing policies and delivery systems so that economic value translates into higher and more equitable protection for older adults.

THE PHAROS SOLUTION

The Norwegian Institute of Public Health (FHI) engaged Pharos to provide an independent assessment of the economic and policy case for expanding adult vaccination in Norway. We focused on three priority vaccines (influenza, pneumococcal, and RSV) and paired our analysis with an investigation of the system barriers that limit coverage.

The resulting report, Expanding Vaccination of Adults in Norway: Economic and Policy Issues and Opportunities:

• Compares the economic value of influenza, pneumococcal, and RSV vaccination by age group using benefit–cost ratios, showing that influenza and pneumococcal vaccination for adults 65+ deliver strong returns, while RSV vaccination is not economically attractive under current assumptions about disease burden and vaccine cost.
• Finds clear differences across vaccines. For adults 65 and older, influenza and pneumococcal vaccination generate strong economic returns (benefit–cost ratios ranging from roughly 3 to 37). In contrast, RSV vaccination shows consistently low economic value across age groups today, driven by lower estimated disease mortality and high vaccine prices.
• Identifies where the Adult Vaccination Program can make the biggest gains, including higher uptake and the potential advantages of co-vaccination.
• Explains why coverage remains suboptimal despite the economic benefits and describes the main bottlenecks that municipalities, general practitioners (GPs), and national authorities will need to address. These include five barriers that have kept coverage below desired levels: out-of-pocket costs, a complicated contracting environment for GPs, vaccine hesitancy rooted in low perceived risk, insufficient resources dedicated to reaching migrant communities, and limited access to granular municipal data to target outreach.

The Pharos report proposes several next steps:

• Focus public investment where returns are strongest: influenza and pneumococcal vaccination for adults 65+.
• Address the barriers that prevent uptake: reduce copayments, make GP delivery simpler and more routine, invest in tailored outreach (including for migrants), and make data-related tools like KoSy more useful for local action.
• Strengthen RSV surveillance and revisit the case for routine RSV vaccination if burden estimates improve and prices fall.

LOOKING AHEAD

Pharos is continuing to work with the Norwegian government on this topic. Additional analyses are under discussion. Norway is also considering how to put the report’s findings in front of senior policy makers to discuss possible changes in national policies and programs for adult vaccination.

Status: Ongoing; draft report delivered December 2025

Team Members Involved: Michael Elhardt, Sarah Bolongaita, Jeremy Otridge, and Robert Hecht.

For more information, contact Michael Elhardt at [email protected].