History of the Norwegian Institute of Public Health
Article
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The Norwegian Institute of Public Health (NIPH) was founded in 1929. The idea of a public institute addressing population health issues was, however, born fifty years before and the notion of governmental responsibility for public preventive measures even earlier.
Historical overview
Initially, the institute was responsible for providing vaccines and sera to the population and performing chemical analyses of water and food. Some years later, the NIPH implemented immunisation programmes, but for several decades the scope of the institute was restricted to infectious disease control.
In the 1970s, the NIPH established toxicology and epidemiology departments, increasingly focusing on prevention of non-contagious diseases as well as the traditional infectious disease control. In the 1980s health services research was incorporated.
In 2002 and 2003, the public health institute merged with several other institutions and units to form a new, more comprehensive public health institute. The new institute was given responsibility for all health-related population registries, except the Cancer Registry of Norway. It would also coordinate all public collection of epidemiological data in the country, as well as conducting forensic toxicology and drug abuse research.
The Norwegian name changed from “Statens institutt for folkehelse” to “Nasjonalt folkehelseinstitutt”. The English name remained the same. The new role as national coordinator on several fields emphasised the importance of cooperating with universities, hospitals and other research institutes and a series of national collaborating groups were formed.
In 2005 and 2006, the institute expanded its scope even further, targeting social inequalities in health, establishing a division of mental health, and taking on responsibility for prevention of health injury and disease caused by behavioural factors such as tobacco smoking, abuse of alcohol and illicit drugs, physical inactivity, obesity and unprotected sex with unknown partners.
Throughout its nearly 80-year history, the NIPH has focused on health threats which in their time were considered most important for the population. In the beginning it was devastating epidemics and infectious diseases, but as the old epidemics were eliminated and infectious diseases better controlled, resources were redirected towards health injuries and diseases caused by environmental, social and mental factors.
In 1929, the NIPH had 18 employees, increasing to over 900 in 2007. The annual budget increased from NOK 107,000 to NOK 800 million in the same period. Even taking the price increase into account, the 1929 budget was extremely low. Most of the employees were volunteers. The considerable budget growth from 1929 to 2007 may be seen as a manifestation of the enormous changes in the national economy during this period. It may also reflect attitude changes and increasing awareness of effective preventive measures in relation to public health.
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1810 |
Mandatory vaccination against smallpox in Denmark-Norway |
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1856 |
A national leprosy registry was established in Bergen as the first known registry of this kind in the world |
| 1873 | Armauer Hansen discovered the bacillus causing leprosy |
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1874 |
Johan Bidenkap proposed a state laboratory for chemical analysis of water and food |
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1891 |
The Animal Vaccine Institute for production of smallpox vaccine was founded |
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1895 |
The Board of Health (Medisinalstyrelsen) started production of therapeutic sera |
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1916 |
The Board of Health formally established a laboratory for production of therapeutic sera, development of vaccines and chemical analysis of water and food |
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1919 |
Parliament decided to erect a new building for a national public health institute |
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1929 |
The government founded the Norwegian Institute of Public Health with 18 employees based on a donation of NOK 1 million from the Rockefeller Foundation. |
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1943 |
The National Mass Radiography Service was established for tuberculosis screening of the population. From 1952 services were offered to everyone in the whole country. |
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1947 |
Mandatory tuberculosis vaccination (BCG) before leaving primary school |
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1947 |
Serology testing of pregnant women for syphilis was made mandatory by law, and the Norwegian Institute of Public Health was given the responsibility of enforcement |
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1953 |
The Minister of Health and Social Affairs advocated immunisation of all children against diphtheria and proposed a new law on immunisation |
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1956 |
Immunisation against polio started and a national free of charge children’s vaccination programme was introduced. The Norwegian Institute of Public Health coordinated the programme |
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1960 |
The Department of Virology was established in a separate building for virus analyses |
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1962 |
The Central Tuberculosis Registry was set up at the National Mass Radiography Service |
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1967 |
The Medical Birth Registry of Norway was established as a result of the thalidomide scandal |
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1969 |
Vaccine against measles was introduced in the vaccination programme |
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1969 |
The Norwegian Institute of Forensic Toxicology was established |
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1971 |
The Department of Environmental Toxicology was established at the Norwegian Institute of Public Health |
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1974 |
The National Mass Radiography Service introduced cardiovascular health surveys in Norwegian counties |
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1974 |
An epidemic of meningococcal B disease broke out in Norway as the only country in Europe. The institute initiated research in order to develop a specific vaccine |
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1975 |
The Norwegian Notification System for Infectious Diseases was established at the Norwegian Institute of Public Health |
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1976 |
Smallpox vaccine was excluded from the vaccination programme |
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1982 |
The European WHO Collaborating Centre for Drug Statistics Methodology was founded at the Norwegian Medicinal Depot |
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1983 |
Vaccine against measles, mumps and rubella (MMR vaccine) was included in the vaccination programme |
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1986 |
The National Mass Radiology Service reorganised and changed its name to the National Health Screening Service (SHUS) |
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1988 |
The Norwegian Institute of Public Health finalised the development of a meningococcal B vaccine and initiated a broad vaccination study on high school students to test the effects. Over the next years, 256 000 individuals took part in the study. |
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1990 |
The Norwegian Institute of Public Health reorganised. The abbreviation SIFF changed to ‘Folkehelsa’ and new departments of environmental medicine and community medicine were established |
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1992 |
Vaccine against Haemophilus influenzae type b was included in the vaccination programme |
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1995 |
Implementation of the Communicable Diseases Control Act |
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1995 |
The Norwegian Institute of Public Health moved into new vaccine production facilities. The Norwegian Institute of Forensic Toxicology moved to new laboratories in the same building |
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1996 |
The WHO Collaborating Centre for Drug Statistics Methodology became a global centre at the Norwegian Medicinal Depot, linked to the WHO headquarter |
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2002 |
The Norwegian Institute of Public Health (Folkehelsa), the National Mass Radiology Service (SHUS), the Birth Registry of Norway, the Mortality Registry, the Central Tuberculosis Registry, the abortion statistics, the Registry for Vaccination Control and the WHO Collaborating Centre for Drug Statistics Methodology with its associated national unit for medicines statistics merged to form a new public health institution. The Norwegian short name changed to “Folkehelseinstituttet”. |
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2003 |
The Norwegian Institute of Public Health merged with the Norwegian Institute of Forensic Toxicology. |
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2004 |
The Norwegian Prescription Database (NorPD) was established |
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2006 |
The Division of Mental Health was established |
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2006 |
Vaccine against pneumococci was included in the vaccination programme |
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2009 |
Influenza pandemic (swine flu pandemic A (H1N1) pdm09) |
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2009 |
Vaccine against HPV infection for girls introduced into the Norwegian Childhood Immunisation Programme |
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2011 |
Institute of Forensic Medicine became part of the Norwegian Institute of Public Health |
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2012 |
Norwegian Cardiovascular Disease Registry established with its own regulations valid from 2012 |
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2014 |
Norwegian Institute of Public Health took over the operation of the Norwegian Cause of Death Registry from Statistics Norway |
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2014 |
Vaccine against rotavirus was introduced into the Norwegian Childhood Immunisation Programme |
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2015 |
Poisons Information Centre was transferred from the Norwegian Directorate of Health to the Norwegian Institute of Public Health |
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2015 |
Norwegian Institute of Public Health together with WHO and Canadian authorities, contributed to the testing of the first effective vaccine against Ebola |
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2016 |
Norwegian Institute for Alcohol and Drug Research (SIRUS), the Norwegian Scientific Committee for Food Safety (VKM) and the Norwegian Knowledge Centre for the Health Services were incorporated into the Norwegian Institute of Public Health |
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2017 |
Norwegian Institute of Public Health established a Centre for Fertility and Health, a Norwegian Centre of Excellence granted by the Research Council of Norway |
The NIPH history in detail
1810 - Mandatory vaccination against smallpox in Denmark-Norway
In the 18th century, smallpox was the third most significant epidemic in Norway and the rest of Europe. The principle of variolation had been known for a long time, but Edward Jenner’s “vaccination”, using fluid from cowpox instead of smallpox vesicles, represented a much safer method. His publication in 1798, “An Inquiry into the Causes and Effects of Variolae Vaccinae”, convinced the medical society and the general population that the inoculation technique was safe and efficient.
The method was implemented in Great Britain and thereafter in many European countries. In Norway, which was under Danish rule at the time, vaccination was adopted sporadically from 1800 and made mandatory by law in 1810. At the same time Denmark-Norway established important institutions for health administration, health education and preparedness against epidemics, forming the basis for future public health initiatives eventually leading to the formation of a public health institute.
The history of smallpox vaccination is a success story. It would, however, take some 170 years before the World Health Assembly could declare smallpox eradicated on 8 May 1980.
1856 - A national leprosy registry was established in Bergen as the first disease registry in the world
Leprosy is one of the oldest and most terrifying plagues mankind has had to endure. Its victims were always stigmatized and expelled from society. During the 18th and 19th centuries most of Europe was leprosy free. In Norway, however, the disease was highly prevalent, especially in the western and northern regions.
The high incidence was probably the main reason for establishing the first national disease registry in the world in Norway. In 1856, the government decided that all cases of leprosy should be registered, and that all registrations were to be sent to the chief physician in Bergen. The idea was to identify and isolate all diseased persons thus preventing further spreading of the disease. Today the registry represents a historical cultural heritage, preserved in the building accommodating the Medical Birth Registry of Norway.
1874 - Bidenkap proposed a State laboratory for chemical analyses of water and food
In the 1870s, Norwegian microbiologists were responsible for several successes, the most important being Gerhard Henrik Armauer Hansen’s (1814-1912) discovery of the leprosy bacillus in 1883. This disease was later going to bear his name, Hansen’s disease, in many parts of the world. At the time it was generally accepted in the Norwegian society that infectious diseases and epidemics were the main threats to population health. Thus, it was only natural that M.D. Johan Bidenkap at the State Hospital in 1874 proposed that the government should establish a State laboratory for control of water and foods.
The Laboratory of the Medicinal Board
Clean water and safe food are perhaps the most important premises for a healthy population, and one would therefore presume that the idea of a state laboratory was met with praise. Somewhat surprisingly pharmacists strongly opposed the idea, probably because they feared that a state laboratory would take over their responsibility for performing chemical analyses and deprive them of their income. It would take another forty years before Parliament, after a heated debate, could establish the much wanted state laboratory. The key to solution was to change the name. In 1916 The Board of Health Laboratory was established at the premises of the State Hospital of Norway.
Animal Vaccine Institute
The Board of Health Laboratory became a pillar in the public health institute. Another pillar was the Animal Vaccine Institute founded in 1891, initiated and headed by the physician and veterinarian Ole Malm (1854-1917). The institute’s only task was to produce a smallpox vaccine. Smallpox was one of the two most feared infectious diseases at the time, the other being tuberculosis. Whereas there was no cure for tuberculosis, smallpox could be effectively prevented through vaccination and producing the necessary vaccine was of utmost importance.
The serum era
In the early 1880s, the German doctor Emil Behring and his assistant Kitasato developed the principle of therapeutic sera. The method was based on the discovery that animals would produce antibodies against most microbial agents when exposed to them, regardless of whether the microbe was able to induce a disease in the animal or not. Such antibodies can be collected from the animals’ blood and will kill microbes when injected in a diseased animal or human. Behring and Kitasato discovered that they could exploit this mechanism to produce therapeutic sera against many serious infectious diseases.
The discovery of this simple principle soon made a huge impact on medical practise. For the first time in history, humanity had an effective remedy against infectious diseases. Numerous countries around the world established serum institutes; horses and sheep turned into live serum factories; and physicians became heroes saving lives.
The serum era started in the 1890s and lasted for several decades, until therapeutic sera were eventually replaced by modern antibiotics. During the 1880s and 1890s, production of various types of sera became the main task for most public health institutes in Europe and the rest of the world. In Norway, the Board of Health started serum production in 1895.
1919 – Parliament passed a proposal to purchase a property in Geitmyrsveien for building a public health institute
Shortly after The Board of Health Laboratory was founded in 1916, it became obvious that the facilities were too small to accommodate all activities. In 1919, Parliament passed a proposal to purchase a property in Geitmyrsveien and erect a building with modern and sufficiently large laboratories.
Unfortunately, at that time Norway was, next to Albania, the poorest country in Europe. The government could not afford to build more than a stable and a small house for the animal caretakers. The premises were unused for several years, and the ambitious plans for a modern laboratory building could not be realised until the Rockefeller Foundation donated NOK 1 million to the Norwegian government in the late 1920s.
The donation had an important clause. The Norwegian government had to commit itself to finance the operation of a national institute of public health on a permanent basis. An inscription on the wall declaring the cooperation between the Norwegian government and the Rockefeller Foundation can still be seen on the wall of the old building, which is now officially declared worthy of preservation.
1929 – Norwegian Institute of Public Health was established
The decision to establish a national public health institute was made in 1916 when Parliament passed the proposal to found The Board of Health Laboratory, but the name Institute of Public Health was not used before the new building had been raised in 1929. The Board of Health Laboratory merged with the Animal Vaccine Institute, and three other small laboratories and units to form a new, larger institution. It was not merely the name that changed - the Norwegian Institute of Public Health was a completely new institution.
The name was probably inspired by the donor. The Rockefeller Foundation was offering aid to many developing and poor countries, the aid consisting of financial support to establish what they termed a national public health institute.
In 1929, 18 persons moved into the large (4,400 m2), very modern and impressive laboratory building that had been raised in Geitmyrsveien 75. The stables were soon filled with horses and sheep, and the animals turned into production units for various types of lifesaving therapeutic sera.
Initially, the institute had five departments: bacteriology, chemistry, syphilis serology, one for provision of vaccines and therapeutic sera, and one for animal vaccine production. The bacteriologists moved in during January 1929, the chemists in April, the production departments in June, and the last two in September, making October a perfect month for celebration.
Serum and vaccines to the population
In 1935, the institute produced therapeutic sera against diphtheria, bacterial meningitis, tetanus, streptococcal disease and typhoid fever and vaccines against gonorrhoea, typhoid and paratyphoid infections, staphylococcal and streptococcal infections, as well as smallpox. In addition, a human polio serum was imported from France.
Taking into account how demanding such medicine production is with today’s resources, this former production seems very impressive. Although the quality of the products cannot be compared to what is offered today, the population really got value for money.
Infectious disease control was the main task of the institute for several decades. Drinking water control was another important task, and during the war a department of blood typing and immunology was established as well.
1943 – The National Mass Radiography Service was established for tuberculosis screening of the population.
Although in decline, tuberculosis was still one of the most dominant infectious diseases in Norway when the Second World War broke out. In the early 1940s, there were approximately 10,000 new cases each year, totalling more than 200,000 infected persons in the country. 10,000 needed treatment. Since therapeutic means were limited to isolation in sanatoriums, preventive hygiene measures were of crucial importance.
In 1940 miniature chest X-rays were used for screening. Trained teams travelled from one municipality to another by bus or boat, offering their services. A national mass screening program was planned in the 1930s, and in 1943 the National Mass Radiography Service was established to guarantee such services to the entire population, a goal which was reached in 1952.
For several years, this institution screened the majority of the population at regular intervals. In 1962, the Central Tuberculosis Registry was established to further improve tracking of tuberculosis cases. From the late 1960s, however, the screening programme was gradually replaced by selective case-finding strategies, and eventually focus shifted to preventing cardiovascular disease. As an additional service, miniature X-rays for employees were offered at worksites with exposure to potentially harmful dusts. This service commenced in 1982.
1947 – Mandatory tuberculosis vaccination (BCG) before leaving primary school
Vaccination against tuberculosis (BCG) had been carried out in Norway since the late 1920s. In 1947 Parliament passed a law making it mandatory, and in 1949 the National Mass Radiography Service started a combined screening and vaccination programme – the screening consisting of chest x-rays and tuberculin test. The prevalence of tuberculosis had been markedly reduced even before the introduction of the programme, mainly due to better living conditions and improved hygiene and nourishment, but the campaign still made a significant contribution. In 1926 as much as 4,615 persons died from tuberculosis – in 1976 the number was 67. Even though the reduction was partially caused by the introduction of new medicines such as streptomycin and rifampicin – called “the magic bullet” – preventive measures were probably the most important success factors.
1947 – Serological testing of pregnant women for syphilis was made mandatory by law, and the Norwegian Institute of Public Health was given the responsibility of enforcement
Traditionally, one of the most important tasks of the Norwegian Institute of Public Health had been to perform bacteriological and serological tests for the health services. In 1946, the NIPH engaged in prevention of congenital syphilis by establishing a serological test programme for pregnant women. This test was made mandatory by law for all pregnant women in 1947, and the institute performed the laboratory analyses.
1953 – The Minister of Health and Social Affairs advocated immunisation of all children against diphtheria and proposed a new law on immunisation
During the 1940s, the population suffered from repeated large outbreaks of bacterial meningitis, measles, poliomyelitis and diphtheria, as well as dysentery and typhoid fever. During the diphtheria epidemic great successes had been obtained by vaccinating school children when and where an outbreak was imminent in a local community.
It was, however, obvious that to prevent new, large outbreaks it would be necessary to expand the immunisation programme radically. Based on a report from the World Health Organization (WHO), the Minister of Health and Social Affairs in 1953 proposed to Parliament that all children should be vaccinated against diphtheria before their first birthday.
During the 1950s, immunisation programmes were successively introduced in most of the larger cities and even in many small municipalities. Eventually, the principle was accepted as a national programme, using the triple vaccine against diphtheria, tetanus and pertussis (whooping cough).
1956 – Immunisation against polio started and a national free of charge children’s vaccination programme was introduced. The Norwegian Institute of Public Health coordinated the programme
The introduction of a vaccine against poliomyelitis in the United States in 1954 was a major medical breakthrough. The vaccine was soon successfully adopted in numerous countries all over the world.
In Norway, immunisation started in 1956. School children were the first to be immunised, but the vaccination was offered to as many as possible from infants up to adults around forty years of age. The Norwegian Institute of Public Health coordinated the national programme.
1960 –The Department of Virology was established in a separate building for virus analyses
During the 1950s, the workload of the NIPH had grown markedly, mostly due to the steadily increasing number of laboratory analyses and the vaccination programmes. When new knowledge on viruses was to be transformed into useful services for hospitals and general practitioners, expanding the facilities was necessary. The new virus laboratory building opened in 1960.
1962 – The Central Tuberculosis Registry was set up at the National Mass Radiography Service
In 1962, the Central Tuberculosis Registry was established to further improve tracking of tuberculosis cases. The registry is still active, although the number of cases has been considerably reduced. The registry was part of the National Mass Radiography Service from 1947 to 2002, and has since then been part of the Norwegian Institute of Public Health.
1967 – The Medical Birth Registry of Norway was established as a result of the thalidomide catastrophe
Established in 1967, the Medical Birth Registry of Norway was organised in the wake of the thalidomide catastrophe that caused more than 10,000 cases of limb reduction deformities throughout the world. The aim of the registry was to detect as soon as possible any increase in birth deformities.
The registry was for many years a separate unit affiliated with the University of Bergen, but merged with in the Norwegian Institute of Public Health in 2002. The registry contains relevant medical data from birth certificates for all births in Norway from 1967 and onwards.
Heads of the Medical Birth Registry
- 1967-69: headed by SSB-Norway
- 1969-82 Tor Bjerkedal (1926 - ), PhD, professor
- 1982-2007 Lorentz Irgens (1942 - ), PhD, professor
- 2007- Stein Emil Vollset (1955 - ), PhD, professor
* In the two month interim between Irgens and Vollset, Kari Klungsøyr was appointed head of the registry.
1969 - Vaccine against measles introduced in the vaccination programme
Measles was and still is a serious childhood disease. It is estimated that this virus killed some 20 children annually and damaged ten times as many in the 1950s and 1960s in Norway. A vaccine was highly appreciated when introduced. The vaccine was included in the national vaccination programme in 1969 and soon proved to be highly effective. Today measles is not endemic in Norway anymore.
1969 – The Norwegian Institute of Forensic Toxicology was established
As the first country in the world, Norway introduced a legal limit for blood alcohol concentration of motor vehicle drivers in 1936. Until 1966, the University of Oslo performed toxicological analyses requested by the police for use in criminal cases, including drunk driving cases. This was, however, not a task well suited for a university. The activities were until 1969 taken care of by state laboratories outside the university when the government decided to establish a new institution dedicated to the purpose. The aim was to cover the need for laboratory analyses from living and dead suspects investigated for drunk driving, and toxicological analyses in forensic autopsy cases.
The institute gradually expanded its activities. Frequent detection of non-alcoholic drugs in samples from impaired drivers was first recognised in Norway. The analyses and interpretation of such cases have since the beginning of the1990s been a main activity at the institute. The expansion also covered the field of drug abuse by analyses/interpretation of samples from prison inmates, workplace employees and follow-up cases within social medicine. Similar services as well as clinical toxicological services for hospitals and out-patients were also added. The analytical repertoire gradually expanded to cover several hundred exogenous substances and their metabolites with state of the art technology in an increasing number of biological matrices.
Results obtained from the broad spectrum of samples received were registered in a database for research and monitoring the national drug abuse situation. Several projects related to drugs in roadside traffic and the biomedical effects of alcohol and drugs were established.
Heads of the Norwegian Institute of Forensic Toxicology
- 1969 – 1974 Fred Dybing (1919 – 1974). Mag. Scient. physiology and pharmacology.
- 1975 – 1978 Johan Sakshaug (1929 – 1996). DVM (dr.med.vet.)
- 1980 – Jørg Mørland (1941 – ). MD, PhD, specialist clinical pharmacology
In the interim between Fred Dybing and Johan Sakshaug and between Johan Sakshaug and Jørg Mørland, Sakshaug was temporarily appointed to head the institute for some months and for a couple of years afterwards.
1971 – The Department of Environmental Toxicology was established at the Norwegian Institute of Public Health
Chemical analyses of drinking water and foods had been performed by the institute even before it was established in 1929, but major emphasis was not given to toxicology until 1971 when Department of Environmental Toxicology was established. Toxicological research, health risk assessment and health advice related to environmental health issues became important tasks for the institute.
Initially, toxicological activities at the institute emphasised food toxicology, including assessing health effects of pesticides and other foreign compounds in the diet. In the late 1970s and early 1980s, the department expanded its activities to consumer chemicals and outdoor as well as indoor air contaminants. After reorganisation of the institute in 1990, water hygiene, chemical analyses and environmental immunology merged with toxicology and formed the Department of Environmental Medicine. In the late 1990s, noise related health effects were also addressed and in the early 2000s, food consumption research was initiated.
Research has always been the main activity of the department, aiming at generating new knowledge as well as developing risk assessment competence. Risk assessment is important for the advisory functions of local health authorities, regulatory agencies, international expert bodies, media and the public.
1974 - The National Mass Radiography Service introduced cardiovascular health surveys in Norwegian counties
In the early 1970s, mortality rates from cardiovascular diseases were high and increasing. Based on evidence from epidemiological and intervention studies, the National Mass Radiography Service initiated cardiovascular health surveys in Norwegian counties. At first, surveys were conducted in Finnmark, the county with the highest cardiovascular mortality rates (1974-75), and two counties with low rates, Sogn og Fjordane (1975-76) and Oppland (1976-78). The surveys invited all inhabitants at the ages of 35-49 and collected samples from other adult age groups. The surveys were repeated in 1977-83 and in 1985-88.
As a follow-up, the Age 40 Programme was established and run in all counties except Oslo in 1985-99. Oslo had its own programme. The aims of the programme were health monitoring, epidemiological research, health education and prevention through “population strategy” and “high-risk strategy”. From 1997, the survey programme also included a broader spectre of chronic diseases. The scientific basis for the cardiovascular health surveys was the Oslo Study and an intervention study in Bugøynes.
During 2000-2003, surveys mainly inviting persons aged 15, 30, 40, 45, 60 and 75 years were conducted in Oslo, Hedmark, Oppland, Troms and Finnmark, primarily aiming at health monitoring and epidemiological research.
1974 – An epidemic of meningococcal B disease broke out in Norway as the only country in Europe. The institute initiated research in order to develop a specific vaccine
From 1974 Norway experienced an epidemic of severe meningococcal group B disease. The epidemic started in Northern Norway and spread quickly to the rest of the country with about 300 cases each year, peaking in 1983 with 368 cases (8 cases per 100 000). The highest burden of disease was seen in children below five years of age and teenagers. The case fatality rate was high, about 10 per cent during the whole epidemic.
The size and importance of the health problem justified general preventive measures such as mass vaccination. However, since there was no vaccine against this microbial strain, and the Norwegian market was too small to stimulate the leading pharmaceutical enterprises to develop a vaccine, the institute initiated a long-lasting research and development programme. The aim was to produce and deliver a suitable and effective vaccine for the population.
1975 – The Norwegian Notification System for Infectious Diseases was established at the Norwegian Institute of Public Health
In 1975, the Norwegian Notification System for Infectious Diseases (MSIS) was established. This registry made it possible to continuously monitor the prevalence of infectious diseases in Norway, and to identify outbreaks at an early stage. The system soon became and still is, an indispensable part of the national surveillance system.
1976 Smallpox vaccine was excluded from the vaccination programme
In the 1970s, smallpox had been a non-existing disease in Europe for several years. However, to ensure world-wide eradication of the disease, it was of utmost importance to maintain national vaccination programmes in developed countries as long as the disease could still be spread by travellers. In 1976, health authorities eventually found it safe to abolish mandatory vaccination against smallpox in Norway, and in 1980 the World Health Assembly finally declared the disease fully eradicated.
1982 – The European WHO Collaborating Centre for Drug Statistics Methodology was founded at the Norwegian Medicinal Depot
During the 1970s, pharmacists and other researchers at the Norwegian Medical Depot had, in collaboration with researchers in Sweden and Northern Ireland, developed a method for drug classification, making it possible to compare drug utilisation patterns in different countries. The ATC/DDD (Anatomical Therapeutic Chemical/ Defined Daily Dose) system soon became generally approved, and in 1982 the World Health Organization (WHO) decided to establish the European WHO Collaborating Centre as an independent body affiliated to the Norwegian Medicinal Depot.
During the first years, the centre was linked to the WHO Regional Office for Europe in Copenhagen, but as the system was adopted internationally in 1996, the centre was directly linked to the WHO Headquarters in Geneva. Since 2002, the centre has been based at The Norwegian Institute of Public Health.
1983 - Vaccine against measles, mumps and rubella (MMR vaccine) was included in the vaccination programme
To complete the vaccination programme, vaccination against measles, mumps and rubella was included in 1983. The two latter were not as serious as the first one, but mumps could result in male infertility and rubella could cause serious foetal damage when affecting non-immune pregnant women. It was both reasonable and cost-effective to include them in the programme and the vaccines have been highly effective. Congenital rubella is eliminated from Norway and most other European countries.
1988 – The Norwegian Institute of Public Health finalised the development of a vaccine against meningococcal B disease
After almost ten years of research and development, an outer vesicle-membrane vaccine against the Norwegian strain of the group B meningococcal disease was ready for clinical trials. The trials were concluded in 1991, and the vaccine was considered acceptable for the national vaccination programme. However, by the time the vaccine was ready for general use, the epidemic had subsided. A large scale immunisation programme was never adopted, but the vaccine is still produced as a preparedness measure in case of an epidemic relapse.
During the first year, trials in adults and military conscripts showed that the vaccine was only moderately reactogenic (many of the participants got sore arms) and led to good immune response against the prevalent epidemic strain of meningococci. In 1988, a large phase III clinical trial, aiming to show if the vaccine really protected against disease, was launched. 180,000 secondary school students, 14-16 years of age, participated in this placebo controlled school randomised trial. After two and a half years the results showed that two doses of the vaccine resulted in 57 per cent protection against meningococcal disease. The data also indicated that the protection was best in the first year after vaccination. Further clinical trials confirmed that a booster dose given after 6-12 months probably would increase the long term protection to approximately 80 per cent.
When the trial was concluded in 1991, the results were considered acceptable for including the vaccine in the Norwegian vaccination programme. However, the former production facilities had been declared unsuitable and plans for new facilities were under way. During the planning and building period, the meningococcal epidemic waned. When the institute eventually was able take up meningococcal vaccine production, the incidence of meningococcal disease was too low to warrant a general vaccination programme.
The expertise, however, proved valuable. In co-operation with Chiron Vaccines (now Novartis) the institute developed a meningococcus group B vaccine “tailor made” to fight a meningococcal epidemic in New Zealand. The vaccination campaign using this vaccine in New Zealand has been a huge success. Since 2006, the Norwegian vaccine has also been used to fight an ongoing epidemic in Northern France, caused by a meningococcal strain almost identical to the one in Norway 20 years earlier.
1990 – The Norwegian Institute of Public Health reorganised
During the 1970s and 1980s, a major change took place in the microbial services in Norway. In the earlier years, the Norwegian Public Health Institute was responsible for performing microbiological analyses on behalf of hospitals and general practitioners. During the 1970s and 1980s more microbiologists were educated and the number of commercially available microbiological tests increased. With a health policy favouring decentralisation, new microbiological laboratories were set up in most county hospitals.
Consequently, the number of microbial analyses at the National Institute of Public Health was reduced considerably and capacity was freed for other purposes. The institute gradually widened its scope, increasingly focusing on research and new preventive activities, mainly related to environmental health and public health measures. In1990, the time was right for reorganizing the institute, making it better adapted to the new tasks. The short name changed from ‘SIFF’ to ‘Folkehelsa’ and new departments of environmental medicine and community medicine were established.
1992 Vaccine against Haemophilus influenzae type b was included in the vaccination programme
Having eradicated most of the ordinary infectious childhood diseases by the aid of vaccines, invasive Heamophilus influenzae disease remained one of the most serious infectious diseases affecting small children in Norway in the late 1980s. The institute recommended that the ministry include a vaccine against this microbe in the vaccination programme. The ministry introduced the vaccine in the programme in 1992, and within a few years the number of cases and deaths caused by this disease plummeted.
1995 Implementation of the Communicable Diseases Control Act
The great microbiological successes obtained after the Second World War had created general therapeutic optimism in most of the western world. There were even experts stating that the war against infectious diseases had been won once for all. In the 1980s this optimistic trend abruptly came to a halt. The new and frightening HIV epidemic clearly demonstrated that the war against microbes would never be won once for all, but had to be fought over and over again. The realization of this fact laid the basis for a new law – the Communicable Diseases Control Act. The law, which was heavily debated, was passed by Parliament in 1994 and implemented in 1995. According to the law, the National Institute of Public Health has major responsibilities and tasks in the national infectious disease control.
1995 – The Norwegian Institute of Public Health moved into new vaccine production facilities. The Norwegian Institute of Forensic Toxicology moved to new laboratories in the same building
In the 1980s, it became obvious that the demands on vaccine production posed by modern quality assurance systems could not be met by the production facilities in the old buildings of the institute. At the same time, it was equally obvious that the Norwegian Institute of Forensic Toxicology needed new laboratories. After a heated political debate, Parliament passed a budget proposal making it possible to erect a new building for these purposes on the premises of the Norwegian Institute of Public Health in Lovisenberggaten 6. The building was formally opened by His Majesty King Harald in May 1995.
The building offered new and functional rooms for all vaccine related activities at the institute. The production facilities made it possible to fulfil all Good Manufacturing Practise (GMP) requirements. Re-establishing vaccine production in a new place always demands careful planning and more time than expected, but after a few years, meningococcal B vaccine was produced for new clinical trials, to show that the vaccine was equivalent to the one the institute produced earlier.
However, after a thorough debate about the future role of the Norwegian Institute of Public Health in national preparedness for vaccine production, it was decided that the facilities should be used for contract production of different biotechnological products under development, rather than for routine vaccine production. The high quality of the facilities and the high competence of the staff was maintained as part of the Norwegian preparedness in the vaccine field.
1996 – The WHO Collaborating Centre for Drug Statistics Methodology became a global Centre at the Norwegian Medicinal Depot, linked to the WHO headquarter
The World Health Organization (WHO) recognized the need to develop the Anatomical Therapeutic Chemical (ATC) classification system and the defined daily dose (DDD) as international standards for drug utilization studies and decided to adopt the system internationally. The centre was linked directly to the WHO headquarters in Geneva to allow close integration of international drug utilization studies and WHO initiatives to achieve universal access to drugs in demand and rational use of drugs particularly in developing countries. The WHO and the Norwegian government signed an agreement regarding the activities of the WHO Collaborating Centre.
The WHO International Working Group for Drug Statistics Methodology was established as a result of the WHO decision to make the ATC/DDD system global. The International Working Group comprises 12 expert members selected by WHO headquarter to represent the six WHO global regions. The WHO Collaborating Centre receives expert advice from the International Working Group.
1996 - The National Mass Radiology Service reorganised and changed its name to the National Health Screening Service (SHUS)
Due to intensive preventive measures over a prolonged period of time, tuberculosis as a major public health threat was eventually overcome during the 1950s and 1960s. At the same time, an epidemic of cardiovascular disease evolved, probably caused by changes in lifestyle and The National Mass Radiology Service decided to change focus.
In the 1970s and 1980s, tuberculosis screening was increasingly replaced by extensive surveys of risk factors for cardiovascular disease, and in 1985 the so-called Age 40 Programme started. All citizens aged 40 were invited to participate in a health survey. They were given advice about what sort of lifestyle changes they should undertake. The effects of the programme were remarkable. Survey participants had a much lower risk of getting cardiovascular disease later in life compared to those who had not participated. The programme was made nationwide in 1993, and in 1996 the institution reorganized and changed its name.
2002 – The Norwegian Institute of Public Health reorganised and merged with other institutions and bodies
Due to a comprehensive reorganisation of the central health administration in Norway, the Norwegian Institute of Public Health reorganized in the autumn of 2001. The institute merged with the National Mass Radiology Service (SHUS), the Birth Registry of Norway, the Mortality Registry, the Central Tuberculosis Registry, the abortion statistics, the Registry for Vaccination Control and the WHO Collaborating Centre for Drug Statistics Methodology with its associated national unit for medicines statistics. At the same time, the Department of Health Services Research, which until then had been a part of the former public health institute, was transferred from the institute and merged with the newly established Directorate of Health and Social affairs.
The new public health institute was formally established in January 2002. The Norwegian short name changed from ‘Folkehelsa’ to ‘Folkehelseinstituttet’. The English name remained the same. The institute was given responsibility for surveillance of infectious and non-infectious diseases, health statistics, coordination of health surveys and epidemiological studies, and environmental health. In order to take care of these tasks efficiently, a Division of infectious disease control, a Division of epidemiology and a Division of environmental medicine were established.
2003 – The Norwegian Institute of Public Health merged with the Norwegian Institute of Forensic Toxicology
As a prolongation of the major reorganisation of the central health administration in 2001/2002, the Norwegian Institute of Public Health and the Norwegian Institute of Forensic Toxicology merged. The decision took effect from January 2003. The latter institute became a division within the public health institute, responsible for forensic toxicology and drug abuse research.
The division maintained all tasks that the Norwegian Institute of Forensic Toxicology had been responsible for, in addition to developing more research activity related to biological health effects of drug abuse and preventive measures aimed at reducing the number of traffic accidents.
2004 - The Norwegian Prescription Database (NorPD) was established
The Norwegian prescription database (NorPD) was established in January 2004 at the Norwegian Institute of Public Health. NorPD includes prescribing information at individual patient level from all Norwegian pharmacies. The database offers detailed information about drug use in the population, and represents an important research basis for pharmacoepidemiology. A research unit in pharmacoepidemiology was established in connection with the new prescription database.
2006 – The Division of Mental Health was established
When the new institute was established in 2002, mental health was identified as a new important field for the institute to engage in. A department was established within the Division of Epidemiology, but it soon became evident that growth in resources and personnel made it necessary to expand. A new Division of Mental Health was established in January 2006.
2006 - Vaccine against pneumococci included in the vaccination programme
The history of the Norwegian Institute of Public Health is closely linked to the history of vaccines. Many new vaccines are not relevant for the national vaccination programme, but a new vaccine against invasive pneumococcal disease was developed especially for children below two years of age. The introduction of this single vaccine would double the total costs of the vaccination programme. The high cost of the vaccine was a hindrance for a couple of years, but the vaccine was eventually introduced as a permanent part of the vaccination programme in 2006. Preliminary results show that the vaccine has efficiently reduced incidence of invasive disease in vaccinated children, and even in other age groups, probably due to herd effect.
2009 - Influenza Pandemic (Swine Flu Pandemic A (H1N1) pdm09)
A new influenza pandemic had long been considered to be a potentially high threat to public health. A separate contingency plan had been prepared and an agreement was in place with vaccine providers about the purchase of vaccine in the event of a pandemic. In April 2009, there were reports of a new influenza virus that caused severe illness and many deaths in Mexico. The virus eventually spread to all parts of the world. In June 2009, the World Health Organization declared that there was an influenza pandemic - the infection was no longer limited geographically.
The virus was believed to come from pigs and the pandemic was therefore given the term "swine flu pandemic". The virus was very similar to an influenza virus that had circulated until the 1950s. Some of the elderly population had some immunity to the virus, and were therefore not hit as hard as expected. For the vast majority, the pandemic virus gave a regular influenza bout. However, it had increased ability to give lung complications and other serious illness in adolescents. Complications affected especially people with chronic diseases (cardiovascular disease, but also neurological diseases, diabetes, pregnant women, etc.), but there were also deaths among healthy young people.
In October 2009, a vaccine against the virus became available in Norway. The vaccine was first offered to people at special risk of serious illness, and then to the entire population. About half of the population took the vaccine. The pandemic triggered a huge response in the Norwegian health service. Hundreds of thousands of patients were examined and treated, around 1300 received hospital treatment, of which nearly 200 were in intensive care units.
In 2010, it was discovered that some children and adolescents who had the pandemic vaccine developed narcolepsy within a few months. It led to long discussions about whether it had been appropriate to vaccinate in such a way, even though the vaccine had saved many lives. The mechanism for disease development is still unclear.
2009 - Vaccine against HPV infection for girls introduced into the Childhood Immunisation Programme
Some HPV virus strains cause cancer of the mucosal membranes, primarily cervical cancer. Since school year 2009/2010, all girls in the 7th grade (12-13 years) have been offered vaccines against the virus. This triggered major debate about whether it was right to vaccinate such young girls against a sexually transmitted disease and, secondly, whether the effect of the vaccine was sufficiently documented. A surveillance programme was established to follow the vaccine effect at the individual and society level over a longer period. Similar follow-up programmes from other countries that began to vaccinate earlier showed a clear decline in precursors of cancer among the vaccinated population groups.
2011 – Institute of Forensic Medicine became part of Norwegian Institute of Public Health
In summer 2011, the Institute of Forensic Medicine was moved from the University of Oslo to the Norwegian Institute of Public Health and became part of the Division of Forensic Sciences. The field of work in the new division includes forensic biology, forensic pathology, clinical forensic medicine and forensic toxicology. The transfer took place only a month before the tragic events of July 22nd, 2011.
2012 – Norwegian Cardiovascular Disease Registry established
Preparations for creating a separate cardiovascular register had been ongoing for a long time when the Norwegian Cardiovascular Disease Registry was established in January 2012. The registry is based at the Norwegian Institute of Public Health in Bergen. It is a registry of diseases in the heart and blood vessels. The information in the registry is used in health surveillance, preventive work, quality improvement of the health service and in research. The goal is to contribute to improving quality of health care for people with cardiovascular diseases. The registry will also provide a basis for the management and planning of health services aimed at people with cardiovascular disease.
2014 - Norwegian Institute of Public Health took over the operation of the Cause of Death Registry
The Cause of Death Registry was previously part of Statistics Norway, but was transferred to the Norwegian Institute of Public Health in 2014. The purpose of the registry is to monitor the causes of death over time, such as the trends in mortality for heart attacks, cancer, accidents and suicide. For example, we can see that cardiovascular disease is now becoming a less frequent cause of death, while cancer is still as important. Using data from the Cause of Death Registry, we can monitor the health of the population, quality assure services and research into causes of disease.
2014 - Vaccine against rotavirus introduced in Childhood Immunisation Programme
Rotavirus infection is the most common cause of small children being admitted to hospital with vomiting and diarrhoea. The Norwegian Institute of Public Health estimated that approximately 900 admissions each year was a sufficiently large disease burden to consider offering the vaccine to all infants. The vaccine was first given to all children born after September 1st, 2014. The vaccine is given orally, with the first dose at six weeks of age.
2015 - Norwegian Institute of Public Health, together with WHO and Canadian authorities, contributed to the testing of the first effective vaccine against Ebola
In 2014, the WHO asked Norway to help initiate effective studies of an ebola vaccine in Guinea. The study started in late March 2015. Follow-up studies indicate that the vaccine provides complete protection against ebola. The attention and effort surrounding the ebola outbreak in West Africa has helped to create a vaccine that is effective against the disease.
2015 – Poison Information Centre transferred from Norwegian Directorate of Health to Norwegian Institute of Public Health
The Poison Information Centre is the national advisory and competence body for acute poisoning and poisoning in Norway. Their 24-hour helpline receives about 40,000 enquiries each year. The centre was officially transferred from the Norwegian Directorate of Health and became part of the Norwegian Institute of Public Health in January 2015.
2015 - Norwegian Institute of Public Health was reorganised
The Norwegian Institute of Public Health conducted a comprehensive strategy and reorganisation process in 2014 and 2015. In autumn 2015, it was decided that the five scientific divisions should be restructured in four divisions. The Division for Epidemiology and the Division of Mental Health were gathered in the area of Mental and Physical Health, while the Division of Infectious Diseases and the Division of Environmental Medicine were gathered in the Division of Infection Control and Environmental Health. IT and e-health, health registries, population studies and biobank are gathered in the Division of Health Data and Digitalisation. The Division of Forensic Sciences continues as its own division.
2016 - SIRUS, the Norwegian Knowledge Centre for the Health Services and VKM incorporated in Norwegian Institute of Public Health
A reorganisation in the state health administration led to the Norwegian Institute for Alcohol and Drug Research (SIRUS), the Norwegian Knowledge Centre for the Health Services and the Secretariat of the Scientific Committee on Food Safety (VKM), became part of the Norwegian Institute of Public Health in January 2016. SIRUS became part of the Division of Mental and Physical Health. The Knowledge Centre became part of the Division of the Health Services, which was established in January 2017, focusing on knowledge production for, and to the health and care services.
Director Generals of the Norwegian Institute of Public Health
- 1929-1956* Einar Aaser (1886-1976) MD, PhD
- 1957-1983 Christian Lerche (1917-2008) MD, PhD, specialist in bacteriology, serology and public health
- 1984-2001 Bodolf Hareide (1937- ) MD
- 2002-2012 Geir Stene-Larsen (1955- ) MD, PhD, professor, specialist in internal medicine
- 2012- Camilla Stoltenberg (1958- ) MD, PhD, professor
*In the interim between Aaser and Lerche, Joakim Foss was temporarily appointed to head the institute for some months.
