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Background: The overarching aim of the study was to (1) investigate how working with COVID-19 patients has impacted work environment, and (2) to identify how factors in the work environment impact adverse health outcomes among hospital personnel (HP), throughout the four waves of the pandemic. Material(s) and Method(s): In a web-based survey altogether 2472 HP participated from four large university hospitals in Norway, whereof N = 680 in April-June 2020 (T1), N = 1073 in December-January 2020/2021 (T2), N = 818 in April-May 2021 (T3), and N = 972 in December 2021-February 2022 (T4). At each time point participants reported on pandemic related work tasks, work environment and adverse health outcomes. Somatic symptoms, psychological distress, posttraumatic stress symptoms and burnout served as outcomes of multivariable linear regression models. The percentage of responders involved in ICU treatment of COVID-19 patients varied between 21% and 40% from T1-T4. Result(s): Reported stressors altered in strength during the 4 waves. Preliminary results indicate that exposure to patients with COVID-19 was associated with more frequent experience of work environmental factors. Compared to colleagues not working with patients with COVID-19 HP reported challenges related to professional competency and training, predictability in teams and work environment, manageable workload, adequate help and support for work stress management, user-friendliness of Personal Protection Equipment and infection protection safety. Furthermore, these environmental factors were associated with symptoms of psychological unhealth on at least one timepoint. Conclusion(s): The results may help guide organizational efforts to maintain professional competency and to reduce stress more efficiently among hospital personnel at different stages in response to long-term crises.
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The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from wildlife has raised concerns about spillover from humans to animals, the establishment of novel wildlife reservoirs, and the potential for future outbreaks caused by variants of wildlife origin. Norway rats (Rattus norvegicus) are abundant in urban areas and live in close proximity to humans, providing the opportunity for spillover of SARS-CoV-2. Evidence of SARS-CoV-2 infection and exposure has been reported in Norway rats. We investigated SARS-CoV-2 infection and exposure in Norway rats from Southern Ontario, Canada. From October 2019 to June 2021, 224 rats were submitted by collaborating pest control companies. The majority of samples were collected in Windsor (79.9%;n = 179), Hamilton (13.8%;n = 31), and the Greater Toronto Area (5.8%;n = 13). Overall, 50.0% (n = 112) were female and most rats were sexually mature (55.8%;n = 125). Notably, 202 samples were collected prior to the emergence of variants of concern (VOC) and 22 were collected while the Alpha variant (B.1.1.7) was the predominant circulating VOC in humans. Nasal turbinate (n = 164) and small intestinal (n = 213) tissue samples were analyzed for SARS-CoV-2 RNA by RT-PCR. Thoracic cavity fluid samples (n = 213) were tested for neutralizing antibodies using a surrogate virus neutralization test (sVNT) (GenScript cPass);confirmatory plaque reduction neutralization test (PRNT) was conducted on presumptive positive samples. We did not detect SARS-CoV-2 RNA in any samples tested. Two out of eleven samples positive on sVNT had neutralizing antibodies confirmed positive by PRNT (1 : 40 and 1 : 320 PRNT70);both were collected prior to the emergence of VOC. It is imperative that efforts to control and monitor SARS-CoV-2 include surveillance of rats and other relevant wildlife species as novel variants continue to emerge.
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This exploratory study present findings from semi-structured interviews with 15 Norwegian school principals elaborating on their experiences and learning from the school closures, transition to digital education, and educational leadership in the first six months of the pandemic. Three main themes emerged from the interviews: (1) "We took a quantum leap into the digital world” addressing how the school principals supported and experienced a rapid transformation to digital education;(2) "We tried to be close, even if we could not be” elaborating on worries regarding teachers and children with special needs;and (3) "We had to adjust” elaborating on the unpredictable and constantly changing nature of the situation. These themes are detailed and discussed in the context of research in crisis management, organizational change, role requirements, and leadership responsibilities. In closing, we discuss how the transformative experiences from the pandemic may have implications for educational leadership in future crisis situations.
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BackgroundPatients with chronic inflammatory diseases (CID) have an increased risk for contracting infections. For patients with rheumatic diseases EULAR recommends protecting them from vaccine-preventable diseases.ObjectivesTo assess the knowledge and awareness of common vaccinations and extent of immunization among patients with CID in Denmark, Finland, Norway, Sweden (Nordics), and to identify gaps between the existing EULAR vaccination recommendations and current practice as experienced by patients.MethodsA structured anonymous online survey for patients with CID ((rheumatological disease (RD), inflammatory bowel disease (IBD) and dermatological diseases (DD)) was conducted in 2022.The survey was answered by 1748 respondents (1031 patients with RD, 543 with IBD and 563 with DD).ResultsAmong respondents, 89% were female and 58% had disease duration of above 10 years. In total, 56% were treated in specialised and 32% in primary care. Majority had ongoing systemic immunosuppressive treatment (IT) (65%). Majority of RD (59%) and IBD (66%) patients were treated in specialised care whereas minority of DD patients (38%) were treated in specialised care.Forty-nine percent (49%) responded that their healthcare professional (HCP) did not inform them about the increased risk of infection – however, 55% of the respondents believed they are somewhat or much more likely to suffer from infections than those without CID or treatment, 33% thought there is no difference and 13% did not know there is a difference.In total 68% of respondents considered it important to get vaccinated due to CID or IT. The number was particularly high in RD group (74%), although 63% stated they had not received any information regarding vaccinations at the start of their treatment.Commonly recommended vaccinations by the HCP were COVID 19 (66%), influenza (63%) and pneumococcal (45%) vaccination. When comparing respondents ≥65 and <65 years, there was a difference in how often the influenza (71% vs. 57%) and pneumococcal (57% vs. 38%), but not COVID 19 vaccination (68% vs. 65%), were recommended. In addition, 74% and 75% of respondents receiving IT were recommended influenza and COVID 19 vaccination, respectively.In total, 22% had their vaccination status checked before initiating treatment;the lowest percentage was in DD (16%) and the highest in RD (25%). However, 44% of respondents received influenza vaccination before initiation of treatment. Moreover, 62% and 74% of respondents received influenza and COVID 19 vaccination while on treatment, respectively.Eighty-six percent (86%) did not receive a vaccination plan in relation to their CID and treatment. Moreover, 64% of the respondents (RD 57%;DD 71% and IBD 66%) did not have vaccination status assessed on a regular basis. Forty-three percent (43%) were dissatisfied with the follow-up of vaccination status by their HCP. Respondents of age ≥65 years were more satisfied than the younger ones (34% vs. 25% very satisfied) and respondents with RD were more satisfied than those with IBD or DD (33% vs. 25% vs. 20%).Forty-four percent (44%) responded that the information on vaccinations related to their CID and treatment was difficult to find and 71% would like to receive more information.The respondents with RD had different level of awareness regarding EULAR vaccination recommendations. The degree of awareness among patients with RD treated with IT are presented in Figure 1.ConclusionThis Nordic survey provides insights on patients' information needs, information sources and own experiences related to recommendations on vaccinations in relation to their CID and IT. The results confirm a gap between patients' expectations and needs vs. the information they actually receive. Our findings demonstrate a need for increased awareness among patients, providers and HCP regarding EULAR vaccination recommendations in patients with RD.Reference[1]Furer V, et al. 2019 update of EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis 2020;79: 9–52.Acknowledgements:NIL.Disclosure of InterestsMeliha C Kapetanovic Grant/research support from: Received independent research grants from Roche and Pfizer, Randeep Mandla Shareholder of: Pfizer, Employee of: Current employee of Pfizer Norway, Maria Seddighzadeh Shareholder of: Pfizer, Employee of: Current employee of Pfizer Sweden, Susanne Thiesen Gren Shareholder of: Pfizer, Employee of: Current employee of Pfizer Denmark, Maaria Palmroth Consultant of: Employee of MedEngine Oy and contractor for Pfizer Oy, Employee of: Contractor for Pfizer Oy, Finland, Dan Henrohn Shareholder of: Pfizer, Employee of: Current employee of Pfizer AB, Sweden, Anne Grete Frostrup Shareholder of: Pfizer, Employee of: Current employee of Pfizer Denmark, Anna-Maria Hiltunen Consultant of: Pfizer. Employee of Nordic Healthcare Group, Jussi Ranta Consultant of: Pfizer. Employee of Nordic Healthcare Group, Anna-Kaisa Asikainen Consultant of: Pfizer. Employee of Nordic Healthcare Group, Veli-Jukka Anttila Speakers bureau: Lectures for Pfizer, MSD, Astellas, Roche, GSK, BMS, Biogen, Sandoz, Gilead, Unimedic Pharma, Boehringer-Ingelheim, Astra-Zeneca, Consultant of: Consultant for Pfizer and MSD.
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Body weight and fat content are known to influence the timing of puberty but the association remained after adjustment for pre-pubertal body mass index. [...]a large retrospective study from the US finds that patients who underwent plasma exchange spent a week longer in hospital and were two to three times more likely to die than those who received immunoglobulin (Muscle Nerve doi:10.1002/mus.26831). A case study in NEJM Catalyst identifies early testing (particularly of people arriving from places where the disease was prevalent), rapid mobilisation of microbiological laboratories, and a coherent and consistent national strategy as crucial interventions.
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During the outbreak of the COVID-19 pandemic, Norwegian health authorities introduced social distancing measures in nursing homes. The aim was to protect vulnerable residents from contracting the potentially deadly infection. Drawing on individual interviews with nursing home managers and physicians, and focus groups with nursing staff, we explore and describe consequences the social distancing measures had on nursing home residents' health and wellbeing. The analysis indicates that most residents became socially deprived, while some became calmer during the nursing home lockdown. Nursing home staff, physicians and managers witnessed that residents' health and functional capacity declined when services to maintain health, such as physiotherapy, were put on hold. In conclusion, we argue that although Norwegian health authorities managed to keep the infection rates low in nursing homes, this came at a high price for the residents however, as the social distancing measures also negatively impacted their health and wellbeing.
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AIMS: The over-representation of migrants among those infected by COVID-19 in high-income countries has spurred questions about insufficient distribution of health information to society's subgroups. Our study aimed to shed light on migrants' experiences with information relating to COVID-19 in Norway. METHODS: We conducted 55 semi-structured interviews with migrants from five different countries living in Norway: Somalia (10), Syria (15), Sri Lanka (10), Chile (10), and Poland (10). The interviews were performed by bilingual researchers with a migrant background, audio-recorded, transcribed and thematically analysed. RESULTS: We identified the four key themes of multiple and contradictory information sources, language barriers, conspiracy theories/speculations, strategies for information provision and ways ahead. Participants accessed and combined several often transnational sources of information. Information was perceived as confusing and contradictory and there was a wish for more translated information. CONCLUSIONS: It is important to recognise the specific factors affecting migrants' ability to receive, trust and use health-related information during pandemics and other health crises.
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BACKGROUND: In several countries, district medical officers (DMOs) are public health experts with duties including infection control measures. The Norwegian DMOs have been key actors in the local handling of the COVID-19 pandemic. METHODS: The aim of the study was to explore the ethical challenges experienced by Norwegian DMOs during the COVID-19 pandemic, and how the DMOs have handled these challenges. 15 in-depth individual research interviews were performed and analyzed with a manifest approach. RESULTS: Norwegian DMOs have had to handle a large range of significant ethical problems during the COVID-19 pandemic. Often, a common denominator has been the need to balance burdens of the contagion control measures for different individuals and groups. In another large set of issues, the challenge was to achieve a balance between safety understood as effective contagion prevention on the one hand, and freedom, autonomy and quality of life for the same individuals on the other. CONCLUSIONS: The DMOs have a central role in the municipality's handling of the pandemic, and they wield significant influence. Thus, there is a need for support in decision-making, both from national authorities and regulations, and from discussions with colleagues.
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COVID-19 , Humans , COVID-19/epidemiology , Pandemics/prevention & control , Quality of Life , Health Personnel , Public HealthABSTRACT
Background. The hepatitis C virus (HCV) is often associated with people who inject drugs, and with a reduction in quality of life. While earlier forms of HCV treatment had low treatment uptake, newer HCV treatment integrated with opioid maintenance treatment appears to increase treatment uptake among those who inject drugs. The aim was to explore how people who inject drugs perceive changes in quality of life after treatment of HCV infection. Methods. Four focus group discussions, and 19 individual interviews were conducted with people who inject drugs or who had previously injected drugs and received opioid agonist therapy. All participants were successfully treated for and "cured” for HCV. Data were audio-recorded, transcribed verbatim, and analyzed using reflexive thematic analysis. Results. The HCV treatment helped participants to let go of negative thoughts and break destructive patterns of interaction. This facilitated the restoration of social relationships with family and others. Furthermore, some participants reported a general improvement in their health. Feeling healthy meant fewer worries such as infecting others. Also, interactions with health professionals were experienced as less stigmatizing. These physical, social, and psychological improvements led to a form of "awakening” and being treated for HCV gave participants hope for the future. Conclusion. HCV treatment improves the mental and physical health in addition to play an important social function. Successful HCV treatment was associated with a greater sense of hope for the future, reconnection with significant others, and reduced feeling of stigma. Overall, improved health and social relationships contributed to improved quality of life.
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Palliative care promotes quality of life for seriously ill and dying patients and their loved ones. An ageing population with more complex chronic and life-limiting conditions will increase the demand for competence in the field. Interprofessional cooperation will be a critical factor in achieving this. Such cooperation within the field of nursing is critical because of registered nurses' (RNs) role and function in patient- and family-centred care. A project focusing on learning interdisciplinary teamwork using simulation as a learning approach was established. Two groups of students participated in the project: one group consisted of 17 nursing associates who were participating in a 2-year part-time study programme in cancer care and palliative care at a vocational college. The second group was made up of 28 RNs, a social worker and learning disability nurses, all postgraduate students taking part in a part-time interdisciplinary programme in palliative care at master's degree level.Simulation activity is usually conducted with participants physically present, but because of the COVID-19 pandemic situation, this was not possible. A pilot project was conducted where simulation activity was tried out as online learning. RNs and nursing associates (NA) participated, and their cooperation was focused on palliative/end-of-life care. They were all trained clinicians in two different study programmes.In this chapter, we present how simulation activity with participants physically present was transformed into an online learning situation. A brief presentation of students' and teachers' reflections on the pedagogical advantages and disadvantages of such a transition is also included. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
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The aim of this article was to use an interpretivist approach to analyse the state–citizen nexus in general and the conflict between civil and social rights imposing restrictions on people's freedom of movement during the COVID-19 pandemic in the Nordic countries: Sweden (restrictions were voluntary and relied on nudging and individual implementation), Norway (restrictions of movement were for everyone and was enforced by authorities), and Finland (restrictions of movement were for the capital region and was enforced by authorities). Sweden focused more on upholding the civil rights vis-à-vis social rights whereas in Norway and Finland social rights have trumped civil rights in the face of the pandemic. Thus, the analysis suggests that the Nordic countries cannot be understood as monoliths in all respects. The article thereby contributes to a greater understanding of how the Nordic governments prioritise civil and social rights differently when they are forced to choose.
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The aim of this research is to describe the use of telemedicine applied to patients characterised by a particular state of illness, which often drives them toward a frail and chronic status, in a systematic manner. This work employed the Tranfield approach to carry out a systematic literature review (SLR), in order to provide an efficient and high-quality method for identifying and evaluating extensive studies. The methodology was pursued step by step, analysing keywords, topics, journal quality to arrive at a set of relevant open access papers that was analysed in detail. The same papers were compared to each other and then, they were categorised according to significant metrics, also evaluating technologies and methods employed. Through our systematic review we found that most of the patients involved in telemedicine programs agreed with this service model and the clinical results appeared encouraging. Findings suggested that telemedicine services were appreciated by patients, they increased the access to care and could be a better way to face emergencies and pandemics, lowering overall costs and promoting social inclusion.Copyright © 2022 Inderscience Enterprises Ltd.
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The current study investigated 97 Norwegian elite-level coaches' appraisal of working as a coach during the COVID-19 pandemic, and the predictive outcomes of these cognitive processes. The participants were part of a Norwegian coach education program carried out by the Norwegian Olympic Sport Center (NOSC). The results in the current study show that the coaches appraised their work during the pandemic as controllable-by-self, as a challenge, as controllable-by-others, and stressful. The regression analysis showed that challenge and controllable-by-self were unique and positive significant predictors of the coaches' subjective performance, and that controllable-by-self was the strongest predictor of the two. Appraising the situation as uncontrollable-by-anyone was also a significant positive predictor of coaches' subjective performance in the step 2 of the regression analysis, and not coaches' exhaustion level as hypothesized. Threat appraisals were found to significant predict coaches' exhaustion level at the first step of the regression analysis, whereas controllable-by-self was the strongest negative significant predictor for coaches' exhaustion. The results indicate that controllable-by-self appraisals play a particular role in preventing burnout and inducing performance in elite coaches when they face stressors such as the COVID-19 pandemic.
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Many societies experienced pushback against governmental COVID-19 measures. When the Norwegian government made it a punishable offence to spend the night at privately owned cabins in the first phase of the pandemic, this resulted in discussions and pushback. Basing our research on in-depth interviews at three different time points during the pandemic, we ask how Norwegian participants discursively explain why the cabin ban was the first measure that evoked pushback in Norway. We conducted a Foucauldian discourse analysis (FDA), exploring three overarching explanations provided by the interview participants. In the first explanation, the pushback was presented as a result of the cultural importance of the cabin. Here, participants partly legitimised the pushback when constructing it as a predictable reaction in this cultural context. In the second explanation, participants constructed the pushback as an expression of 'cabin people' in particular and Norwegians in general being 'too privileged' to acknowledge the measure's necessity. Here, the pushback was constructed as an illegitimate reaction. In the third explanation, participants explained the pushback as a result of people seeing the measure as meaningless. This interpretation constructs pushback as a legitimate response to an illogical measure. These different constructions illustrate the complexity of compliance with COVID measures, where people negotiated individual freedom against solidarity, and compliance against critical thinking. The article contributes to the understanding of people's negotiations of resistance and pushback against restrictive measures. We argue that social psychological theory and research need to acknowledge the temporal, contextual and ideological specificities in understanding compliance and non-compliance. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
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BACKGROUND: Public trust is often advantageous for health authorities during crises such as the COVID-19 pandemic. Norwegian health authorities used the public´s high trust to control the pandemic, resulting in relatively few casualties. METHODS: We wanted to describe and compare the Norwegian public trust in GPs, public healthcare, information and treatment in hospitals before and during the early phases of the COVID-19 pandemic. Further, we wanted to investigate the relationship between somatic or mental illness, and trust in GPs and public health information, and to develop a theoretical understanding of the relationship between trust in healthcare institutions, generalised trust and the societal situation caused by the COVID-19 pandemic. We performed two surveys, the first in December 2019; the second in May 2020, thus providing two snapshots of the Norwegian public's trust in healthcare and healthcare actors before and during the COVID-19 pandemic. RESULTS: There was statistically significant increased trust in public healthcare, in treatment at hospital and in information at hospital after the outbreak of the COVID-19 pandemic. There was a non-significant rise in trust in GPs. We found that trust in public health information was not related to mental health nor having a chronic, somatic disease. CONCLUSION: The findings confirm that the Norwegian public's trust in healthcare and healthcare actors is high. The trust levels are also relatively stable, and even show an increase during the early phases of the pandemic. We suggest that there is a dynamic relationship between trust in public health information, healthcare institutions, generalised trust and a societal crisis situation such as the COVID-19 pandemic. However, the GP-patient trust seems less affected by a crisis situation, than the public´s trust in healthcare institutions. This difference may be explained by the relative stability caused by mandates of trust obtained from the patient.
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COVID-19 , Pandemics , Humans , Trust , COVID-19/epidemiology , Health Facilities , Delivery of Health CareABSTRACT
BACKGROUND: Health care workers (HCW) have a higher exposure to SARS-CoV-2 virus than other professionals and to protect both HCW and patients, HCW have been prioritized for vaccination against SARS-CoV-2 in many countries. Estimating the COVID-19 vaccine effectiveness among HCW is important to provide recommendations to protect risk groups. METHODS: We estimated vaccine effectiveness against SARS-CoV-2 infections using Cox proportional hazard models among HCW with comparisons in the general population, from 1 August 2021 to 28 January 2022. Vaccine status is specified as a time-varying covariate and all models incorporated explicit time and were adjusted for age, sex, comorbidities, county of residence, country of birth, and living conditions. Data from the adult Norwegian population (aged 18-67 years) and HCW workplace data (as registered 1 January 2021) were collated from the National Preparedness Register for COVID-19 (Beredt C19). RESULTS: Vaccine effectiveness was higher for Delta than for the Omicron variant in HCW (71 % compared to 19 %) as well as in non-HCW (69 % compared to -32 %). For the Omicron variant a 3rd dose provides significantly better protection against infection than 2 doses in both HCW (33 %) and non-HCW (10 %). Further, HCW seem to have better vaccine effectiveness than non-HCW for the Omicron, but not for the Delta variant. CONCLUSIONS: Vaccine effectiveness were comparable between HCW and non-HCW for the delta variant, but significantly higher in HCW than non-HCW for the omicron variant. Both HCW and non-HCW got increased protection from a third dose.
Subject(s)
COVID-19 , SARS-CoV-2 , Humans , Adult , COVID-19 Vaccines , Vaccine Efficacy , Norway , Health PersonnelABSTRACT
During the Covid-19 pandemic, funerals have been conducted consistently in Norway, but, of course, the ceremonies were subject to rules and regulations, while digitization was on the increase. Against the background of already ongoing discussions, both in contexts related to the Church of Norway and in practical -theological discourses, this article analyses scenes and excerpts from interviews conducted in 2021 and asks: What does the sociologist Hartmut Rosa's concept of resonance convey in the pandemic situation? - This concept aims at a mode of relating that empowers fulfilling, resonant relationships between subjects and between subject and world;the aim here is to bring it into play as a sensitizing concept, in a situation of supposedly increased distance and unaffectedness between people. The article discusses where the concept conveys the need for stable frameworks, and where it conveys the need for ongoing work with an ecclesiastical-theological self-understanding in the field of church funerals.
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Background: Data from several North European countries have indicated that the Pakistani immigrant populations have higher mortality, higher hospitalization rates and higher infection rates from COVID-19 than the majority populations. Therefore the aim of the study was to examine challenges faced by the Pakistani migrant community in Oslo during the pandemic. Methods: We included data from national reports, national statistics and scientific articles and discussed them with data gained by 16 semi-structured interviews, and thereby elaborated challenges inhabitants of Norway with a Pakistani background experienced during the first year of the COVID-19 pandemic. Results: The literature study confirmed that mortality, hospitalization, and infection rates from COVID-19 for the sub-groups of the populations with Pakistani background were consistently higher in Denmark, England and Norway, all countries that published data by ethnicity or origin, even when correcting for all known risk factors. Our interview data from Norway showed that information from the authorities was insufficient and not adapted to the needs of the minority population, especially in the early phases of the pandemic. Furthermore, information was not available in the common minority languages of the country. Another finding indicates that health literacy, particularly regarding COVID-19, seemed to be low in the Pakistani minority, and COVID-19 was not considered as a threat in Norway before death rates began rising in Pakistan. Conclusion: Adapting information at an early stage to the countries' minority groups may help reduce the increase in COVID-19 rates.
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Summit participants also noted that regulators must come to a consensus regarding requirements for clinical trial data, become more familiar with technology platforms through review of data across various pathogens over time, and provide guidance on the feasibility of alternative pathways to emergency use approval, especially in the context of the 100 Days Mission (10). Speakers shared reports of progress being made on several fronts: the World Health Organization (WHO) and partners are setting up mRNA vaccine technology transfer hubs in South America (12) and South Africa (13);Moderna (https://www.modernatx.com) plans to set up an mRNA manufacturing facility in Kenya (14);SK bioscience (https://www.skbioscience.com) plans to produce routine vaccines in preparation for Disease X that can quickly transfer to large-scale manufacturing if a new pandemic occurs;and WHO has designated South Korea as a biomanufacturing training hub (15). More tools and innovations that enable rapid R&D and manufacturing responses will, in turn, be needed, including standardized animal models and assays, accelerated trial designs, improved rapid diagnostics, laboratory and clinical trial networks that enable data sharing, and distributed manufacturing across regions. March 8, 2022 [cited 2022 Jun 7]. https://www.reuters.com/business/healthcare-pharmaceuticals/moderna-build-mrna-vaccine-manufacturing-facility-kenya-2022-03-07/ World Health Organization.
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This study examines vaccine allocation policy during the COVID-19 pandemic by applying a hierarchical, a negotiation, and a cultural perspective. It addresses how vaccine allocation principles under conditions of scarcity are translated into practice in the case of Norway. A main finding is that the policy was informed by instrumentalism as well as by path dependencies, but over time the issue became more salient by activating stakeholder interests, which resulted in an adaptation of established norms. The three perspectives reveal how different approaches to a "fair vaccine allocation” policy can lead to different explanations of the same phenomenon. © The Author(s) 2023.