Coverage and Access Conditions of 4CMenB Vaccination Across Different Regions of Germany: A Retrospective Ecological Study

OBJECTIVES: Invasive meningococcal disease (IMD), caused by Neisseria meningitidis, can lead to severe health implications. The four-component meningococcal serogroup B (MenB) vaccine (4CMenB) was approved by the European Medicines Agency in 2013 for individuals aged ≥2 months. MenB vaccination was introduced into the German national immunization calendar in January 2024 and is recommended for children aged <5 years at a 2+1 dosing schedule. The effect of voluntary reimbursement by health insurers on German 4CMenB coverage, before the national recommendation, is unknown. This study estimated 2022 regional 4CMenB coverage in Germany and the correlation between coverage and voluntary reimbursement rates.

METHODS: 4CMenB doses and the proportion of infants (aged <2 years) eligible for voluntary reimbursement were obtained per region for 2022. 4CMenB coverage was estimated as the proportion of fully vaccinated infants in the region. To account for variation in the number of received doses, vaccination was estimated as total doses distributed (numerator) divided by doses required for a complete schedule (2 for newborns, 3 for 1-year-olds; denominator). Correlation between coverage and reimbursement rates was calculated using Spearman’s coefficient.

RESULTS: Among the infant population, national 4CMenB coverage was 10.9%. 4CMenB coverage was higher in eastern Germany regions, such as Saxony (37.1%) and Mecklenburg-Western Pomerania (23.6%). Lowest coverage rates were observed in Baden-Wuerttemberg (7.5%) and Bavaria (6.9%). Reimbursement rates were also highest in eastern Germany. A positive, statistically significant correlation (r=0.61, 95% CI: 0.14–0.86, p=0.009) was observed between 4CMenB coverage and reimbursement rates at a regional level.

CONCLUSIONS: Regional reimbursement may lead to inequity in access to vaccination, as this study shows it was a driver of MenB vaccination. 4CMenB coverage rates suggest there may be high acceptance among patients, parents and healthcare professionals if reimbursement is provided. These policies should be regulated to adjust for regional differences in vaccination coverage, prior to national vaccination recommendations.