”Why should I pay for this vaccine?” – Norwegian adolescents views on meningococcal vaccination

BACKGROUND: As one of few countries in Europe, Norway does not offer vaccination against invasive meningococcal disease (IMD) as part of the National Immunization Program for Children (NIP). Instead, adolescents aged 16-19 are recommended to consider having the meningococcal ACWY conjugate vaccine (MCV4) if they participate in activities that increase the risk of IMD. Meningococcal vaccination rates in Norway are low compared to vaccines offered through the NIP. Whereas all vaccinations in the NIP are free and organized through schools or municipal health clinics, there is no uniform system in place for the meningococcal vaccine. On the contrary, both administration practices and cost of vaccination vary nationally, with some counties offering the vaccine for free, while others offer the vaccine at a cost of $40-80. The aim of this study was to explore adolescents' awareness, knowledge, and decision-making processes related to meningococcal disease and vaccination. METHODS: Using a semi-structured interview guide, we conducted 18 focus group interviews in the fall of 2022, involving a total of 126 high school seniors in Norway. The participants were asked to share their views, knowledge and experiences regarding invasive meningococcal disease and vaccination. We used NVivo 14 to facilitate the thematic analysis and a codebook analysis approach was conducted to identify themes and patterns in the data. RESULTS: The analysis identified three central themes emerging from the discussions with the adolescents. These emphasize how information, cost, and location and guidance impact the adolescents' decision-making and ability to get vaccinated. CONCLUSIONS: The current organization of MCV4 vaccination in Norway do not meet the needs identified by the adolescents in this study. This results in unequal access to a highly effective vaccine that protects healthy adolescents against a deadly disease. The present study highlights the need to address vaccination disparities and accessibility, as well as increasing awareness and knowledge about meningococcal disease and vaccination to ensure equal access for all adolescents.