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The Ultimate Guide to Studying in Sweden in 2024

Browse all phd programmes in sweden.

• Aug-Jun Academic Year
• 18 Listed Institutes
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• 32,000 Int. Students
• 453,000 Students
• 10,219,000 Population

Study in Sweden

Long-time ago a country of barbaric Vikings, nowadays Sweden, has polished its manners, and nothing proves it more than the fact that the Swedish higher education system ranks second in the world. Did we mention cutting-edge research and real-world challenges in multicultural academic communities? If you're looking to study at a university in Sweden , you will find a range of education programmes, innovative approaches, and international outlook.

To get a better picture about what’s like studying in Sweden , you need to know that the education here is more about self-development through student groups and independent studies, than about listening to the typical teacher lecture. Let’s try and see the details behind this big picture.

Why study in Sweden?

1. it's free for most european students.

That's right! If you come from the European Union (EU) or the European Economic Area (EEA), you don't have to pay any tuition fees to study at public universities in Sweden. And this is great news because you can use the money you save to cover living costs, which are above the European average.

2. Freedom, equality, and sustainability

These are the three core values of the Swedish society and citizens. These values are reflected in all aspects of life, including work, education, the natural environment, and so on.

Swedes will do as much they can to provide you with the support and resources you need to achieve your academic, professional, personal, or any other goal.

3. Sweden is the best example of eco-friendliness

If you're environmentally conscious, you'll love living here. Sweden has been investing in the wellbeing and preservation of nature for a long time now.

It represents an example of what any nation can do through involvement and commitment. For instance, by 2040, Sweden aims to achieve 100% renewable energy production.

4. Open and progressive mentality

Sweden is one of those wonderful places where you don't have to worry about being different or not fitting it. They embrace everybody regardless of their personal choices or background. Stockholm, for example, is often considered as one of the most open cities in the world.

5. English is widely spoken

Over 80% of Swedes speak English, which makes it super easy to interact with local people and find English-taught degrees in Sweden .

Still, we recommend learning at least the basics of Swedish, the most common words, for those rare cases when you meet someone who doesn't speak the English language.

Which universities and colleges to attend in Sweden?

Sweden is home to over 35 universities and university colleges, and they all offer degree programmes according to European standards.

Start your search for a dream Swedish university with one of these universities we recommend:

• University West
• Mälardalen University
• Linnaeus University
• Jönköping University
• University of Boras
• World Maritime University
• Uppsala University

What is it like to study in Sweden?

Studying in Sweden is likely to make you feel relaxed. Yes, students need to work hard, and expectations are high, but the higher education system is also very flexible and informal.

Popular student pastimes include team sports, cultural societies, and outdoor activities (performed very well dressed). There’s also a great nightlife, with clubs and bars dotting Sweden’s cities, and student unions organising evenings out.

What to study in Sweden?

Swedes are great with cars, great with IT, and great with the environment. So, it’s not hard to guess which are some of the most popular study areas in Sweden. These are:

• Computer Science degrees in Sweden  
• Engineering degrees in Sweden  
• Arts degrees in Sweden  
• Environmental Studies in Sweden  
• Cultural Studies in Sweden  

Where to study in Sweden?

Sweden is a great place to live and study. From buzzing larger cities like Stockholm, Gothenburg or Malmö, to cosy university towns like Uppsala and Lund, there’s a place for every taste in Sweden.

Whether you end up close to the Arctic Circle in Luleå or bumping shoulders with continental Europe in Malmö, you’ll find accessible towns with extensive public transport and bustling student scenes. So, check and pick one of the Swedish cities below, like:

• Study in Stockholm
• Study in Göteborg
• Study in Lund
• Study in Linköping
• Study in Uppsala

How to apply

• Identification document
• Record of completed upper secondary education (translated into English)
• University records (translated into English)
• Proof of language proficiency

Additionally, most universities also tend to ask for:

• Motivation letter
• Sample of academic writing
• Recommendation letters from professors and employers

Helpful ways to make sure you qualify for a Swedish university

Take preparation courses.

These kinds of courses enable degree-seeking students to get an extra educational boost just before they start their Master’s degree or other post-graduate degree programme.

Try a pre-M.B.A., pre-Law, or pre-Medicine programme, as well as any other foundation or preparation courses that will allow you to study in the degree programme of your choice.

Improve your English through an English-language prep course

If you’re attending a degree programme in Sweden, you will need to prove that your language skills are good enough to participate in the classes and understand the lectures; some schools will require Swedish, while others will require strong English skills. These courses will also prepare you for any of the English-language tests that universities require.

English-language tests

English is a must-have in Sweden, seeing how many Bachelor’s and Master’s programmes are taught in this language. Swedish universities accept as proof of your language skills: 

• High school studies taught in English/Swedish
• Previous university studies taught in English /Swedish
• English-language certificates: TOEFL, IELTS , PTE Academic , C1 Advanced or C2 Proficiency

Living in Sweden

Tuition fees in sweden.

In Sweden, students from the EU/EEA, Switzerland, or other Nordic countries do not have to pay tuition, but only an application fee of around 100 EUR.

Students from non-EU/EEA countries pay tuition fees of 7,500–25,500 EUR per year. Some Business degrees can cost over 30,000 EUR per year.

Naturally, fees vary depending programme and degree type , so be sure to check them when looking for study options in Sweden.

Accommodation, housing, food and other expenses

Living costs in Sweden are not exactly a bargain, but in this country, paying more really means getting more in return, in terms of quality of life. The monthly student budget here is around 700–1,200 EUR/month, out of which some of the most common expenses are:

• Monthly rent: 250–700 EUR
• Utilities: 90–130 EUR
• Monthly shopping cart (groceries): 210 EUR
• A meal at an affordable restaurant: 10 EUR
• A beer: 6 EUR
• Monthly transport pass: 80 EUR

About Sweden

Interesting facts about sweden.

From Abba to Avicii, Sweden is a great music exporter. But don’t let that fool you! Sweden isn’t only about pop culture.

In fact, the country prides itself with a great tradition of monarchy and one the highest gender equality rates in the world. Ready for some more facts that will make you smile while reading?  Here they are:

• The Nobel Prize is given each year in Sweden for extraordinary achievements in the fields of Physics, Chemistry, Medicine, Literature, and Economic Sciences. But did you know that students in Sweden can attend the Nobel Banquet and mingle alongside the Laureates?
• You might already know that companies like IKEA, H&M, Volvo, and Ericsson are Swedish. But did you know that Sweden is also a hub for software and game development? Spotify, Skype, Minecraft, Battlefield, and Candy Crush – amongst many others – are Swedish innovations.
• All employees (graduate students included) receive 5 weeks of paid leave per year.
• Learning Swedish will help you understand some Norwegian and Danish, as well, as all three languages evolved from the same dialect.
• Sweden doesn’t compromise when it comes to protecting the environment. You’ll discover an excellent recycling system and hear about all kinds of initiatives to reduce pollution.

But, on a lighter note, you should also know that, in Sweden:

• You can take sick leave during your holiday if you are ill.
• You’ll find elk fences along large roads to prevent elks from jamming traffic.
• Swedish children put on witch costumes and go trick-or-treating… on Easter.
• 20% of police stations are closed during the summer, because everyone is off on vacation.

Universities, colleges and schools in Sweden

• Dalarna University (4 PhDs)
• Chalmers University of Technology (26 PhDs)
• University of Gothenburg (78 PhDs)
• Blekinge Institute of Technology (9 PhDs)
• Karlstad University (22 PhDs)
• Linköping University (37 PhDs)
• Luleå University of Technology (65 PhDs)
• Lund University (76 PhDs)
• Swedish University of Agricultural Sciences (15 PhDs)
• Södertörn University (6 PhDs)
• Stockholm University (46 PhDs)
• Stockholm School of Economics (3 PhDs)
• Karolinska Institute (11 PhDs)
• KTH Royal Institute of Technology (33 PhDs)
• Konstfack University College of Arts, Crafts and Design (1 PhD)
• Umea University (44 PhDs)
• Uppsala University (76 PhDs)
• Mid Sweden University (1 PhD)

Interested in scholarships for Sweden? Check out our scholarship search page.

How to Apply to a Master's in Sweden

If you've decided to study a Master's degree at a university in Sweden, you will have to gather the right documents to prove that you fit the university requirements. Provide complete personal information, previous qualifications, financial information, and a personal statement.

What documents do I need to provide to apply in Sweden?

To apply to a university in Sweden you will likely be asked to provide some of the following documents:

• birth certificate;
• recent photos;
• your passport or national identity card;
• one or more reference letters from past employers or teachers;
• copies of past diplomas or certificates, including your graduated Bachelor's degree;
• academic transcripts;
• letter of intent;
• Curriculum Vitae;
• Some form of proof that you can support your stay in the country during your studies.

Depending on the subject or specialization of your chosen Master's, you might also be asked to provide scores for additional tests like the GRE, GMAT or LSAT. Check if your programme requires any of these, or others.

The list of documents depends on the specific requirements of universities in Sweden so you might be asked to include additional documents. It’s also likely you’ll have to provide official English translations of your documents, or translations in the local language.

Prove your English skills

Because you’ll study an international degree in English, you'll have to present a language certificate. Some popular options for international students are IELTS, TOEFL or C1 Advanced language certificates. You’ll have to meet a minimum language score set by the university, and your test scores shouldn’t be older than 1-2 years. If you don’t meet the minimum language requirements, you will have to improve your skills and scores by taking an English preparation course.

Application deadlines for Sweden

The deadlines for applying to a Master's in Sweden are usually during summer (June-July), or in winter (January-February). Keep in mind that some universities don’t have application deadlines, which means you can apply whenever you are ready.

To avoid delays or missed deadlines send your required documents with plenty of time in advance.

Interesting programmes for you

Find phds degrees in sweden, what subject to study in sweden.

• Agriculture & Forestry 12 Masters
• Applied Sciences & Professions 12 Masters
• Arts, Design & Architecture 28 Masters
• Business & Management 26 Masters
• Computer Science & IT 34 Masters
• Education & Training 25 Masters
• Engineering & Technology 94 Masters
• Environmental Studies & Earth Sciences 42 Masters
• Hospitality, Leisure & Sports 1 Masters
• Humanities 80 Masters
• Journalism & Media 7 Masters
• Law 7 Masters
• Medicine & Health 48 Masters
• Natural Sciences & Mathematics 115 Masters
• Social Sciences 106 Masters

PhD Degrees in Sweden

• Doctor of Philosophy (Ph.D.) 553 programmes

Recent international policies promote international university cooperation and student exchange between countries worldwide. High-quality study and PhD degrees are made more available to students in order to create a global educational network, achievable through student and staff mobility. Career and research oriented programmes support international student development.

University cooperation enables students study worldwide, for instance in Australia, Asia, Europe and the United States and provides ways of recognizing previous degrees. Different study options offer appropriate alternatives to students, depending on their preferred mode of study.

Many study programmes in Australia, Asia, Europe and North America are English-taught. The most popular international student destinations include the following countries: Australia, Belgium, China, Denmark, Finland, France, Germany, Italy, the Netherlands, Switzerland, Spain, Sweden, United Kingdom, the United States, and more. However, these are not the only countries offering English-taught education. The rest of the world is full of endless study choices, from highly ranked to smaller, more specialized, universities.

PhD (postgraduate) Degrees

If you want further education beyond the undergraduate level or if you want more personal development or a career in academia, you could obtain a PhD degree. PhD degrees are postgraduate programmes that usually follow a Master's, MPhil or MRes, but there might be additional requirements depending on the university. Students are required to do their own research in a chosen topic. With the help of a supervisor, you develop knowledge and analytical skills in a specific or multidisciplinary field and you carry out independent research. The duration of a PhD degree differs per country and institution. Sometimes your own research is accompanied by work for the department such as giving seminars or small group teaching.

PhD students are required to study on campus under close supervision, but there are universities that accept students enrolled into a part-time distance education PhD degree. Studying on campus can also be full-time as well as part-time, in which case the part-time variant is normally twice as long as the full-time study.

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Doctoral studies

Start your academic career with us and make a difference

World-class research, outstanding research staff and specialised research environments at Lund University create excellent conditions for doctoral students.

As a doctoral student at Lund University, you will not only be well prepared for a successful career as an independent researcher, but you will also have the possibility to publish your work independently during your studies and to gain significant teaching experience.

• Lund University offers doctoral education in all nine faculties
• There are no tuition fees for doctoral education at Lund University
• You apply directly to the relevant faculty/department when they advertise a doctoral position
• Self-funded doctoral students should contact the department of their research interest directly.

Admission requirements

To be admitted to a doctoral programme, you need to have completed courses of at least 240 credits (of which at least 60 credits must be for Master’s level studies) or acquired equivalent knowledge in some other way.

In most cases, students will hold a Bachelor’s degree and a Master’s degree, with a major in the same subject as the intended postgraduate study. The major must include a degree thesis presenting the results of independent research.

The quality of your thesis/theses is of particular importance and it is important that you demonstrate a capacity for independent thinking in this piece of work.

Students must have a very good command of English and you may be asked to include proof of proficiency in the form of a TOEFL or IELTS test, if requested by the individual department.

Admission rules for doctoral education at Lund University | 2022 (PDF 249 kB, new tab)

Applying for a doctoral (PhD) position

Doctoral education is organised at the faculty or department level. Application procedures and periods differ between faculties and departments. While some of them advertise their doctoral positions around the same time every year, mostly in spring, others advertise their positions on an ongoing basis.

You apply for a doctoral education position within a certain subject area. Admission to a doctoral education position is restricted and competition for advertised positions is usually tough.

Finding a suitable position

Any funded doctoral positions at Lund University are advertised on our vacancies page on this website (see link below). Select the category 'Doctoral students'.

Once you have found a position you are interested in, carefully read through the vacancy announcement to find out whether you meet the requirements.

Before you apply, we recommend that you also check the relevant faculty's or department's website for any additional information about the application process.

Should you have any questions about a specific position, please contact the contact person(s) listed in the vacancy announcement.

Find PhD vacancies

How to apply

To apply for a doctoral position, you must create an account in the recruitment system Varbi.

Follow the instructions regarding application documents and procedure in the vacancy announcement.

The application documents that you submit through Varbi, including any supporting documents, are sent directly to the faculty or department that advertised the position. 

If you are self-funded through external scholarships or funding, you do not need to create an account in Varbi. You should instead make direct contact with the relevant faculty or department. 

Applying for a position

Employment as a doctoral student

As a general rule, a person admitted to doctoral studies at Lund University is employed through a doctoral studentship.

If you have a doctoral studentship, you are considered to be both a student and an employee with a salary during your doctoral studies. As an employed doctoral student, you are covered by local and central agreements concerning your terms of employment.

In parallel to the doctoral education programme, as a doctoral student you may work with administrative and teaching duties (no more than 20% of a full-time position).

Lund University is responsible for education-related matters and the study environment regardless of how you finance your doctoral studies. All doctoral students also have access to the University’s Occupational Health Service.

Other forms of financing

It is possible to undertake your studies using another form of financing, such as an external scholarship or an agreement between Lund University and an external employer.

Financed by external employer

If you are admitted to doctoral studies and have a position with an employer other than Lund University, you are solely a student, and it is the employer who is responsible for employer-related matters.

External scholarships

As a doctoral student with a scholarship, you are solely a student. You are therefore not entitled to contractual employment benefits at Lund University.

In some cases, a doctoral student with a scholarship is entitled to apply for a doctoral studentship when three years remain of the third-cycle studies.

Doctoral studies – faculty information

On the faculties' webpages for prospective doctoral students you can get specific and detailed information application procedures, admission requirements for various subjects, study plans and more.

• Faculty of Engineering (LTH)
• Faculty of Fine and Performing Arts
• Faculties of Humanities and Theology
• Faculty of Law
• Faculty of Medicine
• Faculty of Science
• Faculty of Social Sciences
• School of Economics and Management (LUSEM)

Residence permits (if applicable)

If you require a residence permit, you can only complete your permit application after you receive a letter of acceptance from Lund University. Residence permit applications are dealt with by the Swedish Migration Agency.

Resi­dence permit for doctoral studies – migrationsverket.se

About doctoral studies

A doctoral programme consists of 240 ECTS credits and normally requires four years of full-time study. The programme concludes with a doctoral thesis of at least 120 credits.

A 'licentiate' degree is equivalent to half the coursework required for a full doctoral programme and a licentiate thesis of at least 60 credits. It is equivalent to the MPhil of the British education system.

The following links are to the Swedish Council for Higher Education website:

• Degree of Doctor
• Degree of Doctor in the fine, applied and performing arts 
• Degree of Licentiate 
• Degree of Licentiate in the fine, applied and performing arts

Related links

• Institutes and research centres
• Research excellence areas
• Find research at Lund University
• Services for LU researchers

Doctoral student vacancies

Check out our vacancies page regularly to find open doctoral positions.

Doctoral conferment ceremony

The ceremonial highlight of the academic year.

Postgraduate research schools

Additional development opportunities for doctoral students and postdocs.

• International website
• Find courses
• Find research
• Find organisation

Doctoral studies

Doctoral studies are an important part of the University’s mission and responsibility and, as a doctoral student, you will be making important contributions to research at the University of Gothenburg. Doctoral studies allow you to develop a deeper understanding of a scientific field of study and are provided free of charge in Sweden.

Doctoral studies comprise of 240 credits, equivalent to four years of full-time studies, and leads to a Degree of Doctor. It is also possible to finish your studies with a Degree of Licentiate (120 credits) after two years of full-time studies. Doctoral studies are divided into two parts: doctoral courses and an individual research project. The structure of your doctoral studies depends on the general syllabus for the subject you are admitted to and by your individual study plan that you establish together with your supervisor and your doctoral examiner.

How to apply to doctoral studies

Doctoral student at the University of Gothenburg

Study support for students with disabilities.

Doctoral students with documented permanent disabilities are eligible for different forms of study support. Examples of this are note-taking support, adapted course literature, adjusted assessments and software that can make reading and writing easier.

Doctoral studies at the faculties

• The Faculty of Science
• School of Business, Economics and Law
• Faculty of Humanities
• The Artistic Faculty
• The Sahlgrenska Academy
• Faculty of Social Science
• Faculty of Education

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If you would like to continue your studies beyond your master’s degree, it is possible to progress to doctoral studies. A doctoral programme corresponds to four years of full-time study (240 HE credits) and ends with a doctoral degree. After two years of study (120 HE credits), a licentiate degree can be awarded.

How to become a doctoral student

To be admitted to doctoral studies, you must first apply for and be granted, a vacant employed doctoral position at the university. All international doctoral positions will be posted in English. 

A majority of doctoral students in Sweden are employed by their universities. This means that you get a salary as well as paid vacation leave and the right to paid parental leave when you become a doctoral student.

There are no admission- or tuition fees if you are admitted as a doctoral student through Malmö University. Alternative financing (if you are not employed) for doctoral studies will only be accepted in special circumstances.

More information on admission to doctoral studies in Sweden can be found in the PhD Handbook .

Admission regulations

Information about entry requirements and how to write your application is provided in the advertisement for the vacant position.

The admission regulations are detailed in the document below.

Admission regulations for third-cycle studies

General entry requirements for all doctoral education

Higher Education Ordinance, Chapter 7, Section 39

A potential candidate meets the general entry requirements for third-cycle courses and study programmes if they:

• have been awarded a second-cycle qualification
• have satisfied the requirements for courses comprising at least 240 credits of which at least 60 credits were awarded in the second-cycle, or:
• have acquired substantially equivalent knowledge in some other way in Sweden or elsewhere.

The higher education institution may permit an exemption from the general entry requirements for an individual applicant, if there are special grounds.

Doctoral subjects

Malmö University offers doctoral studies in the following subjects.

• Doctoral subject: Applied Physics
• Doctoral subject: Biomedical Science
• Doctoral subject: Care science
• Doctoral subject: Computer science
• Doctoral subject: Criminology
• Doctoral subject: Global politics
• Doctoral subject: Health and society
• Doctoral subject: History and history didactics
• Doctoral subject: Interaction Design
• Doctoral subject: International Migration and Ethnic Relations
• Doctoral subject: Language and Literature in Education  
• Doctoral subject: Media and Communication Studies  
• Doctoral subject: Odontology/Dentistry
• Doctoral subject: Organisation Studies
• Doctoral subject: Pedagogy
• Doctoral subject: Science Education and Mathematics Education 
• Doctoral subject: Social Work
• Doctoral subject: Sport Science
• Doctoral subject: Urban Studies

In addition to the actual doctoral thesis, the doctoral study programme also includes one component course. The content of this course is governed by the general syllabus for the doctoral subject area. The specific courses that should be included in the study programme will be decided upon in consultation with the supervisors.

• Se current doctoral courses

Meet Palwasha Momand, Doctoral student

'The fellowship among doctoral students is fantastic in Malmö. The university does a lot for us. We get to know each other and can network.' Palwasha Momand, Doctoral student.

• Doctoral Schools

Doctoral schools bring together doctoral students with a common focus. That focus might be a postgraduate education subject or theme. The students conduct joint activities in the form of courses, workshops, and seminars. It is often the case that such schools are run in collaboration with other universities and financed with the help of external funding.

Visiting and exchange doctoral students

Malmö University welcomes exchange doctoral students who come to us in order to conduct part of their research in the framework of their doctoral education.

Different doctoral courses may have different application procedures. Read what applies to the course you are applying for.

Contact for visiting doctoral students

Johanna Boussard - International liaison officer

International Office

Information for doctoral students  admitted at Malmö University

You can find more information in your Faculty's study handbook, information about your individual study plan ISP, dissertations, doctoral support and upcoming workshops – on our Staff website.

The Staff website

As a doctoral student, researcher or guest researcher, you can rent housing through Malmö University.

Apartments for doctoral students, researchers, and guest researchers

Jenny Pobiega - Education and research liaison officer

University Executive Office

PhD Studies in Psychology

The PhD-program is a program for those who aspire to become a researcher. You are eligible to apply if you have a degree at an advanced level (master's or equivalent) and if you have completed at least 90 credits in psychology. The education consists of courses (corresponding to 60 credits) and an independent research project (corresponding to 180 credits). The PhD-program comprises 4 years of full-time study and ends (in the standard case) with a doctoral degree (for a unique exception, see degree of licentiate.

The PhD-program in psychology at Uppsala University was rated as of "high quality" in the University Chancellor's Office (UKÄ) latest evaluation of the country's graduate programs in psychology (2018).

General information on postgraduate education and guidelines

• General information regarding education at postgraduate level in Sweden (The Swedish Council for Higher Education)
• Uppsala University's general guidelines regarding education at postgraduate level The Faculty of Social Sciences' general guidelines regarding education at postgraduate level
• General syllabus for the PhD-program, Department of Psychology
• Research conducted at the Department of Psychology

PhD Studies

• Eligibility, application, and selection
• General syllabus
• Individual Study Plan
• PhD courses
• Mid-way review and final review
• Before the defence
• After the defence
• Degree of licentiate
• External employed doctoral student

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Doctoral education at Karolinska Institutet

Welcome to a University with focus on doctoral education! World-class research and specialised research environments create a breeding ground for doctoral (PhD) studies at Karolinska Institutet (KI).

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Available positions for doctoral education

Doctoral education positions at Karolinska Institutet are advertised continuoulsy and we welcome your application.

For current doctoral students at KI

Doctoral students and employees at Karolinska Institutet can find more information about the doctoral education and the resources needed in the every day working life within the university at the Staff portal.

Course catalogue and course vacancies

Karolinska Institutet offers a large number of doctoral courses for our current doctoral students every semester, look for the one that fits you and find vacancies in the course catalogue.

Blogging about research and career

Interested in life as a researcher? Follow doctoral students, postdocs, researchers and alumni blogging for KI Career Service on the Researcher blogs.

Study in Stockholm

The official guide on what Stockholm has to offer international students.

International staff

KI offers support service for international doctoral students. Here you can find all kinds of necessary information for your stay in Sweden and KI.

Doctoral education - available positions

Department of Education

Phd programme overview.

In Sweden, applicants apply competitively for paid positions as PhD students . The PhD students receive a salary for a maximum of 48 months/8 semesters/4 years (the starting salary is 28,000 SEK per month). Salaries are set according to the Stockholm University salary scale for PhD students.

The PhD programme consists of 240 Swedish higher education credits. The course work amounts to a third of the programme - 90 course credits – of which 52.5 credits consists of required courses and 37.5 are elective course credits. PhD students are expected to complete the required courses during the first two years of the programme. Their education, including course work and actual research, is conducted during weekdays and is mainly done on campus.

Our doctoral students have three supervisors cooperating and providing different skills in an effort to support the PhD student to become a proficient researcher in Education. A PhD student is expected to work independently to a high extent and receives supervision about 1-2 times per month.

Together with their supervisors, PhD students can choose elective courses in relation to their specific area of research. Students may choose elective courses among the courses offered by our department or by other departments/universities in both Sweden and abroad.

A PhD student is expected to engage in the research seminars at the department and cooperate with peers in creating a rich social environment with interesting and challenging discussions.

During the programme, PhD students are expected to present their research at, at least one international conference.

Please note that doctoral studies are only offered on campus. It is not possible to enrol through distance learning. Doctoral students are expected to actively participate in the departmental research environment through regularly participating in seminars.

Last updated: September 26, 2022

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PHD Handbook - a comprehensive guide for doctoral studies in Sweden

• 21 September 2021
• Doctoral students

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There is an overwhelming amount of knowledge to keep track of as a doctoral student in Sweden. Therefore, we've gathered all the most relevant information for current and future doctoral students in one place. Welcome to the PHD Handbook, a comprehensive guide to the admissions process, to what you need to know during your studies, and the laws that describe your rights. 

The SFS Doctoral Committee has worked on this handbook for several months, making sure that every last detail is included and double checked. Please share this guide to anyone who might have a use for it.

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Doctoral education

The Swedish University of Agricultural Sciences (SLU) is one of Sweden’s top research universities and offers an extensive range of research degrees.  Our doctoral students are part of a supportive research community and an exciting and challenging research culture.

Admission to doctoral studies

Learn more about the admissions process and requirements for doctoral education.

Doctoral studies at SLU

Doctoral studies at SLU train students to become skilled independent researchers.

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The PhD program in Business Administration (240 ECTS) has a history of over 50 years. Our overall purpose is to give the doctoral student a deepened and broadened theoretical and methodological knowledge, alongside the experience of having completed a substantial piece of original scientific work.

The conferral of the PhD in Business Administration signifies that the candidate has attained expert competence in a major field of study.

The PhD program in Business Administration is divided into four different specializations:

• Accounting and Managerial Finance
• Entrepreneurship, Innovation and Technology
• Management & Organization
• Marketing, Strategy & International Business

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PhD in Sweden: ...

PhD in Sweden: A Complete Guide to Study PhD in Sweden for International Students

A PhD in Sweden is the highest level of educational qualification in Sweden. A PhD degree can be completed in 4 years of full-time study whereas you will graduate with a licentiate degree after 2 years of full-time study which is equivalent to MPhil of the British education system. Around 70% of the research in Sweden is privately financed and the remaining 30% is public funded. Research programs in Sweden are quite competitive and to be admitted as doctoral students you must fulfill the entry requirements, have good English language proficiency and also demonstrate strong interest and ability to cope with the program.

Sweden provides a specialized environment for doctoral education. One of the main highlights of a PhD in Sweden is that it is free of cost for all students including non-EU/ EEA students. Along with the doctoral program, you will work as administrative or teaching staff at the university which is equivalent to not more than 20% of the full-time position. If you are planning to study PhD in Sweden, read this guide to get information regarding top universities, PhD programs in Sweden, PhD requirements in Sweden, top universities, cost of studying, funding opportunities and more.

Why Study PhD in Sweden?

Before diving deep into the details of PhD in Sweden for Indian students, let us take a look at reasons why studying PhD in Sweden is preferable:

• Home to reputed institutions: Sweden is home to some historical institutions that enjoy world-class reputation as leaders of research especially in the field of Medicine, Health, Life Sciences among others.
• No tuition fees: Yes, you read it right. Sweden does not charge any tuition fee for PhD from students of any nationality. It is one of the top reasons why international students prefer studying PhD in Sweden.
• Progressive country: Sweden is quite a progressive country with high tech research facilities, promotes growth mindset and provides a very supportive environment for creative thinkers.

Suggested: Get acquainted with the education system of Sweden!

Popular Specializations for PhD in Sweden

Sweden is known for its world class research and about 3% of the country’s GDP is dedicated to research and innovation. All the 17 public universities in Sweden and 14 private universities in Sweden contribute significantly to research. Almost 30% of the research is carried out at top universities in Sweden for PhD. Sweden is home to some top pharmaceutical giants Astrazeneca, GlaxoSmithKline, Pfizer, Bayer and more. Some key areas of research in Sweden are:

• Pharmaceuticals
• Biotechnology
• Sustainable energy
• Environmental technology
• Life sciences

Top PhD Colleges and Universities in Sweden

Sweden is home to 8 universities that ranked in QS rankings 2022 which also has a very high research output. Though rankings of institutions are not relevant for research, it will definitely help you in understanding the area of specializations of the university. Take a look at the table below to learn about top universities in Sweden for PhD:

How to Apply for a PhD in Sweden?

The process to apply for PhD in Sweden is somewhat different than applying for bachelor’s or master’s in Sweden . Take a look at the steps in the application process to study PhD in Sweden:

• You will have to apply directly to the universities in Sweden for PhD as there is no centralized application portal for PhD admission in Sweden.
• Start by looking for projects advertised by top universities in Sweden for PhD if you are interested in STEM subjects or go ahead with your project ideas for PhD in Education in Sweden or research in the areas of Arts, Humanities and Social Science.
• Depending on your area of interest, check whether you fulfill the PhD requirements in Sweden.
• Universities in Sweden for PhD set their own entry requirements and also specify the procedure for applying.
• Complete your application for PhD admission in Sweden and prepare all supporting documents.
• Track the progress of your application and wait for the admission decision.
• You may be invited to an interview regarding your research proposal.

Eligibility Criteria for PhD in Sweden

The Sweden PhD requirements are set by individual universities. The general eligibility criteria to study PhD in Sweden are:

• Educational qualifications
• Proof of English language proficiency

Research experience

• Residence permit
• Health insurance

Let us discuss the eligibility criteria to be met for admission to PhD programs in Sweden:

Educational Qualifications

To apply for PhD in Sweden, you will need a second-cycle qualification i.e. a master’s degree in a related field is recommended especially if you wish to apply for funding. You must have completed courses of at least 240 credits of which at least 60 credits must be for a master's degree.

Proof of English Language Proficiency

Swedish universities offer PhD in English so if English is not your first language, you must submit IELTS or TOEFL scores as proof of language proficiency. There is no need to be proficient in Swedish language to study in Sweden. The minimum English language proficiency scores recommended for admission are:

• IELTS score: Overall 6.5, no band less than 5.5
• TOEFL-iBT: Overall 90, with minimum 20 in written test

Having some previous research or work experience in a field related to your research proposal can immensely help you in the application and selection process.

Residence Permit

International students need to apply for a residence permit to study in Sweden for programs longer than 90 days. To apply for residence permits, you will need to provide copies of your passports, proof of finances, educational qualifications, etc. You can apply for a residence permit after receiving a letter of acceptance from the university where you have been admitted.

Health Insurance

After coming to Sweden, all students will require health insurance. Your university may cover the health insurance as a part of funding for international students.

Suggested: Complete guide on student visa of Sweden!

Cost of Studying PhD in Sweden

Having learned about the Sweden PhD requirements, let us take a look at the cost of studying PhD in Sweden. The cost of studying for a PhD in Sweden includes tuition fees and cost of living.

• One major relief for students applying for PhD in Sweden is that there is absolutely no tuition fees for all students irrespective of their nationality.
• Universities in Sweden for PhD don’t even charge application fees.
• So clearly you are only left with the living expenses which is around 8,568 SEK per month on an average. This can differ depending on your preferences and location in Sweden.
• Usually, the rent of accommodation ranges between 2,500-6,500 SEK per month which is a major expense and you will find costlier accommodation in cities like Stockholm and Gothenburg compared to other places.

Suggested: Estimated cost of living in Sweden for international students!  

Funding Opportunities for Studying PhD in Sweden

Funding options include applying for various scholarships and bursaries awarded by universities in Sweden for PhD. As a general practice, doctoral students in Sweden are regarded as employees at most universities. Here is how this works:

• You will be applying for doctoral positions available and universities offer them departmental administration service or teaching.
• With an employment contract, you will be entitled to a salary which is commonly known as a study grant.
• You can expect to get 1500 SEK as a study grant while studying PhD in Sweden for international students.
• The Swedish government funds third-cycle education programs through direct government funding, government agencies, research councils, public research foundations and municipalities.

PhD in Sweden for international students is a lucrative option. Sweden happens to be a research and development intensive country in the world and an ideal location for young and innovative minds. There are various areas of specializations for pursuing research in Sweden which ensures opportunities for all. Post completion of Phd, you can apply for work permit in Sweden ! 

Frequently Asked Questions about PhD in Sweden

Is PhD in Sweden free?

Yes, PhD in Sweden is free for all students irrespective of their nationality. You will not be charged any tuition or application fee for PhD. The only expense you will be paying is the cost of living.

Is it hard to get a PhD in Sweden for Indian students?

PhD in Sweden is recognized worldwide. Therefore, expect stiff competition when it comes to selection of candidates. The application process is quite simple and open to all candidates. Try to maintain a research-oriented background from the beginning that will help you in being a suitable match for the position, if you wish to pursue PhD in Sweden.

Is a PhD in Sweden a job for students?

Yes, it can be said that a PhD in Sweden is a job for students. You are applying for a doctoral position rather than just a doctoral program and some part of your program will include administrative or teaching work.

Are international students allowed to stay in Sweden after PhD?

Once you have a residence permit for doctoral studies for four out of the last seven years and are employed in Sweden, you can apply for a permanent residence permit to stay in Sweden after PhD.

What are the top areas of research in Sweden?

The top areas of research in Sweden include healthcare, biotechnology, pharmaceuticals, sustainable energy, environmental technology, etc.

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Entry requirements for doctoral studies

In order to be accepted for doctoral (PhD) studies, the applicant is required to meet the general entry requirements and any special requirements outlined in the position announcement. The applicant must also possess any other abilities required in order to benefit from the education.

General entry requirements

The general entry requirements are met by those who

• have been awarded a second-cycle qualification, or
• have satisfied the requirements for courses comprising at least 240 credits of which at least 60 credits were awarded in the second-cycle or
• otherwise acquired largely equivalent knowledge.

KTH may exempt an individual applicant from the general entry requirements if there is an extraordinary reason to do so.

Specific entry requirements

 The specific requirements may relate to:

• knowledge from higher education or equivalent studies
• special professional or vocational experience
• necessary language skills or other conditions determined by the programme, subject or project

Language requirements

English language proficiency equivalent to (the Swedish upper secondary school) English course B/6 is required. The requirement can be satisfied through a result equal to, or higher than, those stated in the following internationally recognised English tests:

• TOEFL Paper-based: Score of 4.5 (scale 1-6) in written test, total score of 575. TOEFL ITP is not accepted.
• TOEFL iBT internet-based: Score of 20 (scale 0-30) in written test, total score of 90
• IELTS Academic/IELTS UKVI: A minimum overall mark of 6.5, with no section lower than 5.5
• Cambridge ESOL: Cambridge English: Advanced (CAE) Certificate in Advanced English or Cambridge English: Proficiency (CPE) (Certificate of Proficiency in English)
• Michigan English Language Assessment Battery (MELAB): Minimum score of 90
• University of Michigan, ECPE (Examination for the certificate of Proficiency in English)
• Pearson PTE Academic: Score of 62 (writing 61)

The language requirement can also be fulfilled through previous university and upper secondary school studies. More information on recognised English tests, previous studies, and required documents is provided by University Admissions in Sweden  under information for Master's level.

 Requirements regarding skills in the Swedish language may also be imposed.

Assessment of entry requirements

Entry requirements and prospective students' suitability are assessed at each school by the school's director of third-cycle education.

Foreign Higher Education studies

In most cases, studies that meet the general entry requirements for doctoral (PhD/third-cycle) education in the country where the degree is issued will also meet the general entry requirements for doctoral studies at KTH. If you are unsure about the status of your education, you may contact the Swedish Council for Higher Education  for an evaluation.

Assessment of equivalence

The assessment of equivalence determines whether an applicant's knowledge – acquired in another system – is equivalent to the higher education studies that are normally required for the doctoral subject in question.

Exemption from the general entry requirements

An exemption from the general entry requirements may be granted to an applicant who has not completed courses corresponding to 240 credits but who has already completed advanced (master's/second-cycle) courses corresponding to a minimum of 60 credits, as well as an independent degree project linked to the intended subject of study.

Assessment of suitability

Applicants are judged suitable for doctoral education if they possess the necessary maturity, judgement and capacity for independent critical analysis.

Candidate(s) will be selected from among the applicants who fulfil the requirements for doctoral education. The results of studies at an advanced (master's) level or in the form of independent work are of particular interest in this context, as is the candidate's ability to benefit from the studies (suitability).

The selection process is handled by each school and the final decision is made by the head of school, in consultation with the intended supervisor(s).

The admission process is conducted at the school-level.

Doctoral studies may lead to two qualifications, a licentiate and/or a doctoral degree. Those accepted to studies leading to a doctoral degree may take a licentiate degree as an intermediate stage in their studies. Students accepted to studies leading to a licentiate degree who subsequently wish to pursue studies leading to a doctoral degree must submit a new application and are not guaranteed admission.

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How to apply

Applying to study in sweden is pretty easy. find a programme. apply. then wait for the results. 🤞🏽 what’re you waiting for let’s get cracking., on your marks….

What you’ve got to do first is find a programme. Sounds simple, right? But with over 1,000 programmes at 39 universities to choose from? 😩 Easier said than done. But don’t worry, we’ve done a bit of the legwork for you. We’ve put together a list of all the bachelor’s and master’s programmes on offer . So all you need to do is figure out what you want. What your passion is. And then find a programme to match.

Got a question about a programme? Get in touch with the university directly.

Don’t be shy – they’re always happy to help .

Need help applying? You can always hire an educational consultant to guide you through the application process.

Applying to study abroad is a huge decision. And, well, the application process can be super stressful too. If you need some extra help along the way, you’re welcome to work with an educational consultant .

“I decided to study in Sweden because it is a country that stands for social inclusion and guarantees modern rights to all its people”

So you’ve found a programme. Or programmes. What’s next? Okay, you’re getting to the super important stuff like requirements, documents, and deadlines. And this might be the longest step of the process. Our advice? Start early. And take the time to get everything in order. You’ll thank us later.

+ - What entry requirements do I need to meet?

General entry requirements.

So these are things like having completed your high-school studies. Or having a bachelor’s degree. Also? Having a sufficient level of English. And you can find the general entry requirements for bachelor’s programmes ↗️ and master’s programmes ↗️ on Universityadmissions.se.

Programme-specific entry requirements

You may need to meet some specific entry reqruirements too. You’ll find them listed on the programme’s webpage. Navigate there through our programme database or from Universityadmissions.se . ↗️

+ - When can I apply? 📅

Pretty much all of our English-taught programmes start in the autumn semester. So, chances are you’ll apply by mid-January. ⏰ Only a few English-taught programmes start in the spring. And there’s a different deadline for these programmes – you’ll apply by mid-August instead. But head over to Universityadmissions.se ↗️ to find out more. There are a few other dates and deadlines you’ll need to keep in mind.

“Obviously, you don’t have to be a native English speaker. But in order to follow your classes, English language skills are important”

Phew, you’re almost there. Just one thing left. Actually submit your application. And here’s what you’ll do:

+ - Apply online – but don’t be late ⏰

So you’ll head on over to Universityadmissions.se ↗️ – Sweden’s central application portal. Applying for a master’s? You can apply for up to four programmes in the same application. And if you’re applying for a bachelor’s? You can apply for up to eight programmes.

Keep track of the deadline – don’t miss it!

When you apply will depend on when you’ll start studying. And since most English-taught programmes start in the autumn, you’ll probably apply by mid-January. But there are a few programmes that start in the spring. Applying for one of them? Well, then you’ll apply for mid-August instead.

+ - Send in your documents

What documents do i need to include.

• Documentation proving that you meet the general entry requirements for bachelor’s ↗️ or master’s ↗️ programmes
• Proof of English proficiency ↗️
• Documentation showing that you meet programme-specific entry requirements

And for full details about your supporting documents, head on over to Universityadmissions.se . ↗️

+ - Pay the application fee 💸

You’ll pay one application fee of SEK 900 to Universityadmissions.se . ↗️ Sure, it sounds like a lot. But it doesn’t matter how many programmes you apply for – you’ll pay SEK 900 even if you apply for one, four, or eight programmes.

+ - Find your scholarship

Looking for a scholarship? Then look no further. You’ll find a whole load of available scholarships  here. Some offered by our universities. Others are from private companies.

+ - Sit back, relax, and wait for the results 🤞🏽

You won’t hear your results for a while. But go on and celebrate that you’ve sent in your application. Give yourself a well-deserved pat on the back. Congratulations! 🥳 You’ve taken the time to invest in your dreams. And that’s worth celebrating.

But what’ll happen next with my application?

So the university you’ve applied to will have a look at your application. At your documents, grades, courses. And they’ll make a decision whether or not you’ll be admitted.

+ - Receive your admissions results

You might need to wait a while to get a decision. But when the time comes around, head back over to Universityadmissions.se ↗️ to see if you’re coming to study in Sweden! 🎊

• 5 common mistakes when applying to study in sweden ↗️

• ✍️ 📨 Want to write a perfect motivation letter? Here's how ↗️

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Lund University is the only university in Sweden to offer a Phd-programme in the multidisciplinary field of Human Rights. The programme covers four years of full time studies (240 credits). The programme is convened by Human Rights Studies at the Department of History.

The research field integrates historical, philosophical, legal, and political perspectives on the study of human rights, their circumstances, challenges and role in our current times. Current areas of study are state and non-state agency, historiography and conceptualizations of human rights, minority protection, human rights in school curricula and teaching practice, women’s rights, rights and activism, children’s rights, political resistance, and rights discourses in civil society.

Read about our Doctoral students and their projects at our doctoral students .

Eligibility

In order to satisfy the general eligibility requirements for admission to Doctoral studies the applicant must have completed an academic degree on advanced level (one or two year master), or completed courses amounting to 240 Swedish university credits (of which at least 60 credits on advanced level), or equivalent. In order to satisfy the special eligibility requirements for Doctoral studies in Human Rights, two of the applicant’s prior years of study (120 credits) must have clear relevance for the field of human rights studies and for the planned dissertation project. The applicant must also have completed a thesis on master level (at least 15 credits) clearly oriented within the field of human rights.   Read more in our general syllabus .  

Questions about Doctoral studies in Human Rights are answered by Dan-Erik Andersson .  

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Dan-Erik Andersson LUX:A227 E-mail: dan-erik.andersson mrs.lu se

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Sep 24 2022

• 4 things you should know before doing PhD in Sweden

PhD Sharing

Before joining PhD program in Sweden, it is very important to know key factors to make sure that you know the roadmap as you will live at least four years in a new country. Here are five things you should know about PhD study in Sweden.

1- What are the requirements for a PhD entry  in Sweden?

In Sweden, PhD is considered as a staff position at university/institute/company. Professors or groups of research at University/Company often collaborate to submit applications to get grants from governments or funding agencies like VINNOVA, KKS, SSF, String. After receiving the grant, professors will broadcast job ads  to recruit PhD candidates. This is a strict process to find high quality candidates. It often take three rounds as follows:

a) Interview to filter the best candidates who may match well with the requirements of the project.

 b) Selected candidates will be assigned an assignment to examine the background and other things.

 c) The selected candidate will join the salary negotiation. 

To get a PhD position in Sweden, you should prepare things as follows:

Have at least one conference paper in a high rank conference or journal. Your published result should match well with research topics but sometimes it is not a prerequisite. It is only to prove that you can do research and how passionate you are about research.

There is no specific English requirement for PhD entry in Sweden. But you must be good at all skills reading, writing, and communicating.

2- How long does it take?

 To complete a PhD program in Sweden, it often takes 4-5 years in general. If your position holds for 4 years. You often focus 100% on research. Otherwise, you will spend 20% for teaching and 40% for research.

There are two phase in PhD:

1- Lecente PhD (mid-term): 

After doing PhD in 2-3 years, you need to complete some courses and defend the mid-term. One opponent will join the defense and give you comments about contributions and future work. This is a wonderful opportunity to practice writing skills, defend skills, and so on. All PhD candidates should pass this mid-term to get a higher salary. Some PhD candidates will quit after completing this phase because they find a good job in an industrial company. It is worth remembering that a PhD in Sweden is considered as a job. If you don’t like this job, you can find a new one that you really love. 

2- PhD defend:

After you satisfy the requirements of your supervisors, project, and courses, you will write the thesis, and then send it to the committee before the defense day in two months. 

Note that If something is not good, members of the committee will inform your professor to delay your defense day to fix your thesis. 

A committee of five members from different countries will be established on the basis of your supervisor's suggestions. During the defense day, one opponent will ask you many questions but he/she does not join the adjustment. After debating with the opponent, you  will debate with other members of the committee. They will vote if you pass or not.

The committee comes to share the success and the happy moment with you on defense day. Thus, do not overstress. Just focus on the presentation and prepare for the party.  

3- PhD benefits:

Because a PhD is considered a job in Sweden, thus you will get paid and you have to pay for the income tax as well. You also get full social benefits from Sweden. You don’t have to pay for hospital and school fees. 

The salary is high and you can save a lot if you are single. If you have a family, you still can save but not much. It depends on your spending style. 

You may travel to other countries in order to join conferences and connect with other researchers. You not only visit many countries but also make friends with many researchers all over the world. 

If you have children, your children can get full social benefits such as almost free school fee, free dental care, and the child allowance, you will have 16 months for parental leave with 80% salary. 

4- After PhD:

You have a high opportunity to get the permanent resident permit and become Sweden citizenship after 5 years living in Sweden provided that you find a job with two year contracts and pass basic Swedish course (SFI).

In summary, Sweden is the perfect country to study for a PhD, you get a high salary, and benefits for you and your family. The worst thing in Sweden is the weather, it is very cold and dark in the winter. PhD may suffer more stress this time. However, in the summer, the weather is wonderful and  it is perfect to have outside activities. Let's enjoy it.

Tags: PhD benefits in Sweden,PhD salary in Sweden,4 things you should know before doing PhD in Sweden

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A, Example of an individual who was vaccinated with a first dose on May 20, 2021, and followed up 0 to 28 days from first dose, and vaccinated with a second dose on June 25, 2021, and followed up 0 to 28 days after a second dose. B, Example of an individual who was not vaccinated and was followed up until the end of follow-up on October 5, 2021.

Squares represent incidence rate ratios (IRRs) with 95% CIs; square size, country weight; and diamonds, pooled estimates with 95% CIs. A single vaccine name indicates first dose of that vaccine (eg, BNT162b2) and the risk of the outcome after the first dose. Vaccine names in combination indicate a vaccine schedule of first dose of the first vaccine and a second dose of the second vaccine (eg, BNT162b2, BNT162b2) and the risk of the outcome after the second dose. Model 2 adjusted for age group and sex, previous SARS-CoV-2 infection, health care worker status, nursing home resident, and comorbidity variables.

eMethods. Descriptions of Data Sources, Washout Period, Outcome Events, and Ethical Regulations

eTable 1. Definition of Myocarditis and Pericarditis Outcome and Washout

eTable 2. Definition of Covariates per Country

eTable 3. Number of Persons Vaccinated by Country

eTable 4. Pericarditis Within 28 Days Following a Dose of SARS-CoV-2 Vaccine, According to Sex and Age

eTable 5. Myocarditis, Pericarditis, and Myocarditis and Pericarditis Combined Within 28 Days Following a Dose of SARS-CoV-2 Vaccine, According to Sex and Age, and Model for Adjustment

eTable 6. Myocarditis and Pericarditis Combined Within 28 Days Following a Dose of SARS-CoV-2 Vaccine, Boys 12-15 years

eTable 7. Myocarditis Within 28 Days of a Positive SARS-CoV-2 Test, According to Sex and Age

eTable 8. Myocarditis Within 7 Days Following a Dose of SARS-CoV-2 Vaccine, According to Sex and Age

eTable 9. Days From Vaccination to Date of Admission for Vaccinated Myocarditis Cases

eTable 10. Distribution of Comorbidities for Total Population at Start of Follow-up and for Myocarditis Cases, by Vaccination Status; Nordic Countries Denmark, Finland, Norway, and Sweden Combined

eTable 11. Mortality and Discharge Outcomes Among Myocarditis Cases

eFigure 1. Myocarditis in Females Within 28 Days Following SARS-CoV-2 Vaccination

eFigure 2. Meta-analysis Results of Myocarditis Following COVID-19 Vaccination in 4 Nordic Countries

• Myocarditis Following a Third BNT162b2 Vaccination Dose in Military Recruits in Israel JAMA Research Letter April 26, 2022 This study assessed whether a third vaccine dose was associated with the risk of myocarditis among military personnel in Israel. Limor Friedensohn, MD; Dan Levin, MD; Maggie Fadlon-Derai, MHA; Liron Gershovitz, MD; Noam Fink, MD; Elon Glassberg, MD; Barak Gordon, MD
• JAMA Network Articles of the Year 2022 JAMA Medical News & Perspectives December 27, 2022 This Medical News article is our annual roundup of the top-viewed articles from all JAMA Network journals. Melissa Suran, PhD, MSJ
• Communicating the Benefits of Vaccination in Light of Potential Risks JAMA Cardiology Editor's Note June 1, 2022 Ann Marie Navar, MD, PhD; Robert O. Bonow, MD

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Karlstad Ø , Hovi P , Husby A, et al. SARS-CoV-2 Vaccination and Myocarditis in a Nordic Cohort Study of 23 Million Residents. JAMA Cardiol. 2022;7(6):600–612. doi:10.1001/jamacardio.2022.0583

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SARS-CoV-2 Vaccination and Myocarditis in a Nordic Cohort Study of 23 Million Residents

• 1 Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
• 2 Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
• 3 Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
• 4 Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
• 5 Division of Licensing, Swedish Medical Products Agency, Uppsala, Sweden
• 6 Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
• 7 Norwegian Research Centre for Women’s Health, Oslo University Hospital, Oslo, Norway
• 8 Division of Use and Information, Swedish Medical Products Agency, Uppsala, Sweden
• 9 Information Services, Finnish Institute for Health and Welfare, Helsinki, Finland
• 10 Department of Drug Design and Pharmacology, Pharmacovigilance Research Center, University of Copenhagen, Copenhagen, Denmark
• 11 Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
• Editor's Note Communicating the Benefits of Vaccination in Light of Potential Risks Ann Marie Navar, MD, PhD; Robert O. Bonow, MD JAMA Cardiology
• Research Letter Myocarditis Following a Third BNT162b2 Vaccination Dose in Military Recruits in Israel Limor Friedensohn, MD; Dan Levin, MD; Maggie Fadlon-Derai, MHA; Liron Gershovitz, MD; Noam Fink, MD; Elon Glassberg, MD; Barak Gordon, MD JAMA
• Medical News & Perspectives JAMA Network Articles of the Year 2022 Melissa Suran, PhD, MSJ JAMA

Question   Is SARS-CoV-2 messenger RNA (mRNA) vaccination associated with risk of myocarditis?

Findings   In a cohort study of 23.1 million residents across 4 Nordic countries, risk of myocarditis after the first and second doses of SARS-CoV-2 mRNA vaccines was highest in young males aged 16 to 24 years after the second dose. For young males receiving 2 doses of the same vaccine, data were compatible with between 4 and 7 excess events in 28 days per 100 000 vaccinees after second-dose BNT162b2, and between 9 and 28 per 100 000 vaccinees after second-dose mRNA-1273.

Meaning   The risk of myocarditis in this large cohort study was highest in young males after the second SARS-CoV-2 vaccine dose, and this risk should be balanced against the benefits of protecting against severe COVID-19 disease.

Importance   Reports of myocarditis after SARS-CoV-2 messenger RNA (mRNA) vaccination have emerged.

Objective   To evaluate the risks of myocarditis and pericarditis following SARS-CoV-2 vaccination by vaccine product, vaccination dose number, sex, and age.

Design, Setting, and Participants   Four cohort studies were conducted according to a common protocol, and the results were combined using meta-analysis. Participants were 23 122 522 residents aged 12 years or older. They were followed up from December 27, 2020, until incident myocarditis or pericarditis, censoring, or study end (October 5, 2021). Data on SARS-CoV-2 vaccinations, hospital diagnoses of myocarditis or pericarditis, and covariates for the participants were obtained from linked nationwide health registers in Denmark, Finland, Norway, and Sweden.

Exposures   The 28-day risk periods after administration date of the first and second doses of a SARS-CoV-2 vaccine, including BNT162b2, mRNA-1273, and AZD1222 or combinations thereof. A homologous schedule was defined as receiving the same vaccine type for doses 1 and 2.

Main Outcomes and Measures   Incident outcome events were defined as the date of first inpatient hospital admission based on primary or secondary discharge diagnosis for myocarditis or pericarditis from December 27, 2020, onward. Secondary outcome was myocarditis or pericarditis combined from either inpatient or outpatient hospital care. Poisson regression yielded adjusted incidence rate ratios (IRRs) and excess rates with 95% CIs, comparing rates of myocarditis or pericarditis in the 28-day period following vaccination with rates among unvaccinated individuals.

Results   Among 23 122 522 Nordic residents (81% vaccinated by study end; 50.2% female), 1077 incident myocarditis events and 1149 incident pericarditis events were identified. Within the 28-day period, for males and females 12 years or older combined who received a homologous schedule, the second dose was associated with higher risk of myocarditis, with adjusted IRRs of 1.75 (95% CI, 1.43-2.14) for BNT162b2 and 6.57 (95% CI, 4.64-9.28) for mRNA-1273. Among males 16 to 24 years of age, adjusted IRRs were 5.31 (95% CI, 3.68-7.68) for a second dose of BNT162b2 and 13.83 (95% CI, 8.08-23.68) for a second dose of mRNA-1273, and numbers of excess events were 5.55 (95% CI, 3.70-7.39) events per 100 000 vaccinees after the second dose of BNT162b2 and 18.39 (9.05-27.72) events per 100 000 vaccinees after the second dose of mRNA-1273. Estimates for pericarditis were similar.

Conclusions and Relevance   Results of this large cohort study indicated that both first and second doses of mRNA vaccines were associated with increased risk of myocarditis and pericarditis. For individuals receiving 2 doses of the same vaccine, risk of myocarditis was highest among young males (aged 16-24 years) after the second dose. These findings are compatible with between 4 and 7 excess events in 28 days per 100 000 vaccinees after BNT162b2, and between 9 and 28 excess events per 100 000 vaccinees after mRNA-1273. This risk should be balanced against the benefits of protecting against severe COVID-19 disease.

The European Medicines Agency and European Commission have, by October 2021, approved 4 vaccines against SARS-CoV-2: BNT162b2 (Pfizer-BioNTech), mRNA-1273 (Moderna), AZD1222 (AstraZeneca), and Ad26.COV2.S (Janssen). The Nordic countries have primarily used the 2 messenger RNA (mRNA) vaccines BNT162b2 and mRNA-1273. These vaccines have been shown to be efficient and safe, although cases of myocarditis or pericarditis during the first weeks after vaccination have been reported. 1

Case reports, surveillance data, and other reports from the US, Israel, and Canada indicate an increased risk of myocarditis after vaccination with SARS-CoV-2 mRNA vaccines, higher after the second dose, especially in younger men. 2 - 9 Data from Canada and France indicate more cases of myocarditis after mRNA-1273 than after BNT162b2, but this remains to be elucidated. 10 , 11

In nationwide cohort studies in Denmark, Finland, Norway, and Sweden, we evaluated the risks of myocarditis and pericarditis following SARS-CoV-2 vaccination in a combined population of 23.1 million individuals. High-quality nationwide registers enabled us to evaluate the risk by vaccine product, vaccination dose number, sex, and age.

We conducted population-based cohort studies in 4 Nordic countries (Denmark, Finland, Norway, and Sweden) using linked data from nationwide health registers on SARS-CoV-2 vaccination, myocarditis and pericarditis diagnoses, and other covariates (eMethods in the Supplement ). All Nordic residents are assigned a unique personal identifier at birth or immigration, enabling deterministic linkage between registers. These countries have universal and tax-financed health care systems, and reporting to national registers is mandatory, providing near-complete follow-up of all residents over time. 12 , 13 Each cohort study was analyzed separately according to a common protocol, and the results were combined by meta-analyses. On the basis of current law in each of the countries, this register-based research was conducted according to the laws, regulations, and authority permits, and informed consent from individuals was not applicable (eMethods in the Supplement ). 14 The requirement for obtaining informed consent was waived because all data are publicly available. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology ( STROBE ) reporting guideline.

We included all persons who turned 12 years or older in 2021, were residents on January 1, 2017, and were alive and still residing within the country on December 27, 2020. We excluded 20 211 persons with any myocarditis or pericarditis in inpatient or outpatient hospital care from January 1, 2017, to December 26, 2020 (eMethods in the Supplement ).

The Nordic countries implemented national vaccination campaigns against SARS-CoV-2 from December 27, 2020, providing free vaccinations to all residents. Phased distribution plans were implemented, prioritizing vaccination of individuals at highest risk of COVID-19 complications (ie, nursing home residents, health care workers, and older adults). Denmark, Finland, and Norway almost exclusively used mRNA vaccines after full or partial discontinuation of AZD1222 in March 2021 because of serious but rare events of thrombosis with thrombocytopenia. 15 , 16 Sweden used AZD1222 for a majority of the population older than 64 years and mRNA vaccines in other age groups. The vaccine Ad26.COV2.S had very limited use. The Nordic countries vaccinated approximately 6 times more individuals with BNT162b2 than with mRNA-1273 because of higher availability of the former vaccine. We studied risk of myocarditis and pericarditis in 28-day risk periods after the administration date of the first and second dose with BNT162b2, mRNA-1273, and AZD1222 ( Figure 1 ). A homologous schedule was defined as receiving the same vaccine type for doses 1 and 2.

We defined incident outcome events as the date of first hospital admission for myocarditis or pericarditis from December 27, 2020, onward. The primary outcome was a main or secondary diagnosis of myocarditis at discharge from inpatient hospital care. Secondary outcomes were a main or secondary diagnosis of pericarditis (inpatient hospital care) and a main or secondary diagnosis of either condition (myocarditis or pericarditis) combined from either inpatient or outpatient hospital care (eTable 1 in the Supplement ).

We used the following covariates for adjustment and stratification: sex, age, calendar period, health care worker status, nursing home resident, and 5 comorbidities (pulmonary disease, kidney disease, autoimmune disease, cardiovascular disease or diabetes, and cancer) defined by diagnoses before the start of follow-up (eTable 2 in the Supplement ). We also adjusted for verified SARS-CoV-2 infection before December 27, 2020, whereas infection after this date was a censoring event. We defined having SARS-CoV-2 as the sample date of a positive reverse transcriptase–polymerase chain reaction or lateral flow test.

We took advantage of the longitudinal information in our national cohorts to calculate exact unvaccinated and vaccinated person-time at risk for each individual ( Figure 1 ). We started follow-up on December 27, 2020. Each individual was followed up until first outcome event of interest or a censoring event, defined as first occurrence of a positive test result for SARS-CoV-2 infection, receiving Ad26.COV2.S vaccine, receiving a third dose of any SARS-CoV-2 vaccine, emigration, death, or country-specific study end (latest October 5, 2021). Individuals contributed person-time as unvaccinated until the first vaccination. After each first or second dose, individuals contributed person-time in a main risk period of interest defined as day 0 up to and including day 28 ( Figure 1 ). The resulting follow-up periods and numbers of myocarditis and pericarditis cases were aggregated for all individuals according to vaccination status (ie, unvaccinated, risk period after first dose, and risk period after second dose).

We used Poisson regression for the number of events to estimate incidence rate ratios (IRRs) with 95% CIs, comparing rates in the risk periods after vaccination with rates in unvaccinated periods. We took potential confounding factors into account by adjustment in 3 models. Model 1 included adjustment for sex and age group (12-15, 16-19, 20-24, 25-29, 30-39, 40-64, and ≥65 years). Model 2 included adjustment as in model 1 and for health care worker status, nursing home resident, and the aforementioned comorbidities. Model 3 included adjustment as in model 2 and for calendar periods (December through March, April through June, and July to the study end). We used model 2 in the main analyses, whereas models 1 and 3 were used for sensitivity analyses. We included subgroup results according to sex and age (12-15, 16-24, 25-39, and ≥40 years). Analyses were conducted in Denmark and Sweden with SAS, version 9.4 (SAS Institute Inc), in Finland with R, version 3.6.3 (R Foundation for Statistical Computing), and in Norway with Stata, version 16.0 (StataCorp LLC).

Meta-analyses of the IRR estimates were based on random-effects models implemented using the mixmeta package 17 of R. 18 We tested the homogeneity of country-specific estimates using the Cochran Q test, 19 calculated the pooled incidence rates using the sum of events and person-years in the countries, and calculated the pooled excess rates using the pooled incidence rates and IRR estimates. For the CIs, we used the delta method, assuming independence of the incidence rates and IRR estimates.

In a complementary analysis, we studied incident myocarditis within 28 days following SARS-CoV-2 infection from August 1, 2020, to end of study. We also studied risk of myocarditis or pericarditis in a shorter 7-day risk period. Furthermore, among myocarditis cases, we estimated the proportion of patients discharged on day 4 or later and the proportion of cases in which the patient died within 28 days of the admission date, using the Kaplan-Meier estimator. Among myocarditis cases after vaccination, we calculated the median time from vaccination to outcome (hospital admission date).

Across 4 Nordic countries, 23 122 522 residents (49.8% male and 50.2% female) were followed up from December 27, 2020, to October 5, 2021, at the latest. By study end, 17 129 982 residents (74%) had received 2 doses and 1 681 930 residents (7%) had received 1 dose of SARS-CoV-2 vaccines. By study end, 487 751 of 1 238 004 persons (39%) aged 12 to 15 years, 2 009 995 of 2 675 558 persons (75%) aged 16 to 24 years of age, 3 736 517 of 5 046 164 persons (74%) aged 25 to 39 years, and 12 579 805 of 14 162 796 persons (89%) aged 40 years or older had received at least 1 dose of a SARS-CoV-2 vaccine ( Table 1 ; eTable 3 in the Supplement ).

During the 28-day risk periods following vaccination and during unvaccinated periods (13 million person-years in total), we observed 1077 incident myocarditis cases and 1149 incident pericarditis cases. Incidence rates of myocarditis during the unvaccinated period were 9.7 per 100 000 person-years for males and 4.3 per 100 000 person-years for females ( Table 2 ). Among individuals aged 16 to 24 years, incidence rates were 18.8 per 100 000 person-years for males and 4.4 per 100 000 person-years for females. Incidence rates of pericarditis increased with age (eTable 4 in the Supplement ).

During the 28-day risk period, we observed 105 myocarditis cases following administration of the first dose of BNT162b2 and 115 myocarditis cases following the second dose. We also observed 15 myocarditis cases following administration of the first dose of mRNA-1273 and 60 myocarditis cases following the second dose.

Adjusted IRRs comparing the 28-day risk periods following first and second doses compared with unvaccinated periods were 1.38 (95% CI, 1.12-1.69) for the first dose of BNT162b2 and 1.75 (95% CI, 1.43-2.14) for the second dose, and 1.16 (95% CI, 0.69-1.93) for the first dose of mRNA-1273 and 6.57 (95% CI, 4.64-9.28) for the second dose. Among males, after the first and second doses, adjusted IRRs were 1.40 (95% CI, 1.09-1.80) for the first dose of BNT162b2 and 2.04 (95% CI, 1.61-2.58) for the second dose, and 1.45 (95% CI, 0.84-2.52) for the first dose of mRNA-1273 and 8.55 (95% CI, 6.40-11.41) for the second dose. Among females, following the first and second doses, adjusted IRRs were 1.46 (95% CI, 1.01-2.11) for the first dose of BNT162b2 and 1.25 (95% CI, 0.77-2.05) for the second dose, and 1.45 (95% CI, 0.35-5.97) for the first dose of mRNA-1273 and 2.73 (95% CI, 1.27-5.87) for the second dose.

Among males 16 to 24 years of age, the adjusted IRRs for myocarditis were 5.31 (95% CI, 3.68-7.68) for a second dose of BNT162b2 and 13.83 (95% CI, 8.08-23.68) for a second dose of mRNA-1273. For females, the comparative adjusted IRRs were lower ( Table 2 , Figure 2 , Figure 3 ; eFigure 1 in the Supplement ).

We also estimated the excess numbers of myocarditis events per 100 000 vaccinees in the 28-day risk periods. Among all males, these numbers were 0.27 (95% CI, 0.09-0.46) events after the first dose of BNT162b2 and 0.67 (95% CI, 0.46-0.88) events after the second dose, and 0.33 (95% CI, −0.11 to 0.78) events after the first dose of mRNA-1273 and 4.97 (95% CI, 3.62-6.32) events after the second dose. Among all females, the excess numbers of events per 100 000 vaccinees in the 28-day risk periods were 0.15 (95% CI, 0.02-0.28) events after the first dose of BNT162b2 and 0.09 (95% CI, −0.09 to 0.26) events after the second dose, and 0.05 (95% CI, −0.13 to 0.23) events after the first dose of mRNA-1273 and 0.48 (95% CI, 0.07-0.89) events after the second dose ( Table 2 ).

Among males 16 to 24 years of age, the excess number of myocarditis events per 100 000 vaccinees in the 28-day risk periods after the first dose of BNT162b2 was 1.55 (95% CI, 0.70-2.39) events and after the second dose was 5.55 (95% CI, 3.70-7.39) events, and it was 1.75 (95% CI, −0.20 to 3.71) events after the first dose of mRNA-1273 and 18.39 (95% CI, 9.05-27.72) events after the second dose ( Table 2 ).

For a heterologous schedule (1 dose with BNT162b2 and the other dose with mRNA-1273), 38 myocarditis cases (34 males) occurred following the second dose, with an excess number of events in males of 10.34 (95% CI, 6.86-13.83) events. In males aged 16 to 24 years, 17 myocarditis cases occurred, with an excess number of events of 27.49 (95% CI, 14.41-40.56) events ( Table 2 ).

Pericarditis in males followed a pattern similar to myocarditis by vaccine product and age but with lower IRRs. Pericarditis was rare in females aged 12 to 39 years. Among males aged 16 to 24 years of age, the excess number of pericarditis events within the 28-day risk period was 7.39 per 100 000 vaccinees (95% CI, 1.46-13.32) events for the second dose of mRNA-1273 (eTables 4 and 5 in the Supplement ).

The IRRs of myocarditis or pericarditis combined among males aged 16 to 24 years were slightly higher than those of myocarditis ( Table 3 ). In males aged 25 to 39 years, the IRRs were generally lower. Among females aged 16 to 24 years, the IRRs were similar to those for males but with fewer events. Among males aged 12 to 15 years, the crude IRR was based on very few events among the vaccinated population (eTable 6 in the Supplement ).

During the 28-day risk period after a positive SARS-CoV-2 test, there were 73 myocarditis cases. Excess events of myocarditis were 3.26 (95% CI, 1.90-4.61) events per 100 000 individuals with a positive test result among all males, and 1.37 (95% CI, −0.14 to 2.87) events per 100 000 individuals with a positive test result among males aged 16 to 24 years (eTable 7 in the Supplement ).

The IRRs and excess rates were slightly attenuated when model 1 was complemented by other covariates (model 2) and further attenuated when calendar period was added (model 3) (eFigure 2 and eTable 5 in the Supplement ). Among males aged 16 to 24 years, adjustment for calendar period (model 3) yielded unstable point estimates with wide CIs for the second dose of mRNA-1273. Heterogeneity of the analyses across countries was not statistically significant (eFigure 2 in the Supplement ); thus, we present the results as pooled 4-country estimates of IRRs and excess rates.

Of the 213 myocarditis cases in the 28-day risk window after a second dose of SARS-CoV-2 mRNA vaccination, 135 events occurred within the first week, yielding higher IRRs in the 7-day risk period ( Table 2 ; eTable 8 in the Supplement ). Among males aged 16 to 24 years, the adjusted IRRs were 12.50 (8.24-18.96) for a second dose of BNT162b2 and 38.29 (21.95-66.80) for a second dose of mRNA-1273.

For males aged 12 to 39 years, country-specific median time to hospital admission for myocarditis cases was 3 to 7 days (eTable 9 in the Supplement ). Comorbid conditions did not differ markedly between vaccinated and unvaccinated myocarditis cases (eTable 10 in the Supplement ). Median hospital length of stay was 4 to 5 days for both vaccinated and unvaccinated cases (eTable 11 in the Supplement ). For all age groups, the 28-day mortality of the unvaccinated cases with myocarditis was 0.8% (95% CI, 0.3%-2.0%) and ranged from 0.2% (95% CI, 0.0%-0.4%) after the second dose of BNT162b2 to 4.5% (95% CI, 0.0%-13.2%) after the second dose of mRNA-1273; there were no deaths among cases for patients younger than 40 years (eTable 11 in the Supplement ).

This cohort study of 23.1 million residents across 4 Nordic countries showed higher rates of myocarditis and pericarditis within 28 days after being vaccinated with SARS-CoV-2 mRNA vaccines compared with being unvaccinated. The risks of myocarditis and pericarditis were highest within the first 7 days of being vaccinated, were increased for all combinations of mRNA vaccines, and were more pronounced after the second dose. A second dose of mRNA-1273 had the highest risk of myocarditis and pericarditis, with young males aged 16 to 24 years having the highest risk.

Myocarditis after mRNA vaccination was rare in this study cohort and even among young males. The risk of myocarditis following the mRNA vaccines has been evaluated by the US Food and Drug Administration, which concluded that the benefits of vaccination outweigh the risks and fully authorized the use of mRNA-1273 in persons 18 years or older and BNT162b2 in persons 16 years or older. In addition, BNT162b2 is authorized for emergency use in children 5 years or older. 20 , 21 The European Medicines Agency concluded that the benefits of vaccination outweigh the risks and approved mRNA-1273 for use in persons 12 years or older and BNT162b2 for those 5 years or older. 22 , 23 In addition, a comment published by the American College of Cardiology 24 evaluated vaccine-associated myocarditis risk and concluded that the benefits of vaccination outweigh the risks. As of January 2022, there have been nearly 5.8 million deaths associated with COVID-19 worldwide since the start of the pandemic. 25 All currently available SARS-CoV-2 mRNA vaccines are highly effective against severe COVID-19 and provide some protection against transmission and infection. 26 - 28 There is some evidence that the mRNA-1273 vaccine, possibly owing to its higher concentration of mRNA, is associated with increased immunogenicity and effectiveness. 29 , 30 This more profound immune response could be one reason for the higher risk of myocarditis, but this hypothesis needs to be investigated further.

Our findings are consistent with higher risk after the second dose and higher risk in young males. 2 , 3 , 10 , 11 , 31 - 36 Excess events within 28 days in males aged 16 to 24 years of 5.55 events per 100 000 vaccinees after the second dose with BNT162b2 and 18.39 events per 100 000 vaccinees after the second dose with mRNA-1273 are among the highest reported. 3 , 4 , 32 , 33 Our finding of a higher risk of myocarditis after mRNA-1273 than after BNT162b2 in this group is in line with data from the US, Canada, France, and England. 5 , 10 , 11 , 33 , 35 In comparison with previous studies, we had the advantage of data analyzed according to a common protocol from 4 different countries, and that showed similar directions of associations, despite considerable differences in prior SARS-CoV-2 infection levels and lockdown policies.

The main strengths of our study include the population-based cohort design in 4 Nordic countries, large sample size, near-complete follow-up, and independent ascertainment of vaccinations and diagnoses from nationwide registers with mandatory reporting. The findings in the meta-analyses were supported by consistent findings across all 4 countries, despite some country-specific differences in data sources, SARS-CoV-2 transmission, testing activities, and vaccination schedules.

There are also some limitations of the study. We defined events as an inpatient hospital admission with a corresponding main or secondary discharge diagnosis of myocarditis or pericarditis. Diagnostic codes have been shown to have 85% positive predictive value among patients younger than 60 years. 37 Thus, without access to data on clinical measures, such as troponin levels, diagnostic imaging results, and endomyocardial biopsy, we studied myocarditis as diagnosed in clinical practice and could therefore not assess how many of these patients fulfilled all criteria for receiving a myocarditis diagnosis. 38 However, the median hospital length of stay was 4 to 5 days for both unvaccinated and vaccinated patients, enabling sufficient time for adequate diagnostic procedures and indicative of no difference in disease severity between vaccinated and unvaccinated cases. Deaths were rare, with no deaths of persons younger than 40 years. Our findings in children aged 12 to 15 years were limited to relatively few exposed individuals because vaccination in this age group only recently started in most countries.

Surveillance bias, whereby increased focus and media attention on myocarditis as an adverse event after vaccination 39 resulted in more subclinical cases being diagnosed, cannot be ruled out. Hence, all studies including data on vaccination and myocarditis after April 25, 2021, are likely prone to this potential surveillance bias. However, in our study, surveillance bias is unlikely to fully explain the differences between the first and second dose, between the 2 mRNA vaccines, and between age groups. Denmark and Norway had lower background incidence rates of myocarditis than Finland and Sweden.

We studied rates of myocarditis after a positive test result for SARS-CoV-2 infection. However, SARS-CoV-2 infection is associated with acute and postacute events other than myocarditis, including hospitalizations, intensive care unit admissions, and death. 40 The present study showed increased risk of myocarditis after a positive test result for SARS-CoV-2 infection, and the risk was highest in the older age groups, whereas the risk of myocarditis after vaccination was highest in the younger age groups. However, the estimated risk of any outcome after SARS-CoV-2 infection will be dependent on the testing strategy. If only severe COVID-19 cases are tested, the association with other events will be strengthened owing to selection bias. Therefore, to reduce selection bias in our analyses of myocarditis after SARS-CoV-2 infection, we included only the period from August 2020 onward, when testing was widely available in the Nordic countries.

The 2 mRNA vaccines were used in the Nordic countries according to availability during 2021, and supply was limited during the first months of 2021. Furthermore, vaccination was first provided for older adults. The availability has thus varied across age, calendar months, and countries. The background incidence rate of myocarditis fluctuates with infectious disease burden, being typically higher during the fall and winter. 41 Moreover, differences in lockdown measures affecting the spread of SARS-CoV-2 and other viruses could also affect the background incidence rate in both unvaccinated and vaccinated persons. Most of the younger age groups were vaccinated from July to September 2021, and very few during the spring. However, our supplementary model 3 with adjustment for calendar period resulted in wider CIs but did not substantially change the point estimates.

The observed risks of myocarditis and pericarditis are applicable to the current SARS-CoV-2 pandemic situation in the Nordic countries. In other settings, the background incidence of myocarditis and pericarditis and risks following vaccination may differ. Furthermore, we cannot draw conclusions from the study results to predict myocarditis and pericarditis after a third dose or for children younger than 12 years. We captured all hospitalizations for myocarditis and pericarditis in the Nordic countries during the study period; however, without access to data on clinical measures and diagnostic imaging results, future adjudication must assess how many of these patients fulfill all criteria for a myocarditis diagnosis. Although studies on the long-term prognosis of vaccine-associated cases of myocarditis are lacking and are urgently needed, some evidence suggests that the 28-day risk of death, hospital readmission rates, and development of heart failure appear low, especially in the younger age groups. 34

In this cohort study of 23.1 million Nordic residents aged 12 years or older, the risk of myocarditis was higher within 28 days of vaccination with both BNT162b2 and mRNA-1273 compared with being unvaccinated, and higher after the second dose of vaccine than the first dose. The risk was more pronounced after the second dose of mRNA-1273 than after the second dose of BNT162b2, and the risk was highest among males aged 16 to 24 years. Our data are compatible with 4 to 7 excess events within 28 days per 100 000 vaccinees after a second dose of BNT162b2, and 9 to 28 excess events within 28 days per 100 000 vaccinees after a second dose of mRNA-1273. The risk of myocarditis associated with vaccination against SARS-CoV-2 must be balanced against the benefits of these vaccines.

Accepted for Publication: February 23, 2022.

Published Online: April 20, 2022. doi:10.1001/jamacardio.2022.0583

Open Access: This is an open access article distributed under the terms of the CC-BY License . © 2022 Karlstad Ø et al. JAMA Cardiology .

Corresponding Author : Rickard Ljung, MD, PhD, MPH, Division of Use and Information, Swedish Medical Products Agency, PO Box 26, SE-751 03 Uppsala, Sweden ( [email protected] ).

Author Contributions : Drs Karlstad and Ljung had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Karlstad, Hovi, and Husby contributed equally to this study and are considered co–first authors; Drs Hviid and Ljung contributed equally and are considered co–senior authors.

Concept and design: Karlstad, Hovi, Husby, Selmer, Nohynek, Sundström, Grünewald, Gulseth, Hviid, Ljung.

Acquisition, analysis, or interpretation of data: Karlstad, Hovi, Husby, Härkänen, Selmer, Pihlström, Hansen, Gunnes, Sundström, Wohlfahrt, Nieminen, Grünewald, Gulseth, Hviid, Ljung.

Drafting of the manuscript: Karlstad, Husby, Härkänen, Nohynek, Ljung.

Critical revision of the manuscript for important intellectual content: Karlstad, Hovi, Husby, Härkänen, Selmer, Pihlström, Hansen, Nohynek, Gunnes, Sundström, Wohlfahrt, Nieminen, Grünewald, Gulseth, Hviid.

Statistical analysis: Karlstad, Härkänen, Selmer, Pihlström, Hansen, Gunnes, Sundström, Grünewald, Ljung.

Obtained funding: Gulseth, Hviid.

Administrative, technical, or material support: Karlstad, Nohynek, Gulseth.

Supervision: Hovi, Husby, Nohynek, Wohlfahrt, Hviid, Ljung.

Conflict of Interest Disclosures: Dr Karlstad reported participating in research projects funded by Novo Nordisk and LEO Pharma, all regulator-mandated phase 4 studies with funds paid to his institution and outside the submitted work. Dr Hovi reported being affiliated with the Finnish Institute for Health and Welfare and was thus obligated by legislation to investigate the potential postmarketing harmful effects of vaccines during the conduct of the study. Dr Husby reported receiving funding from the Lundbeck Foundation. Dr Nohynek reported receiving nonfinancial support from WHO SAGE (Strategic Advisory Group of Experts) and the Global Advisory Committee on Vaccine Safety during the conduct of the study; and being employed by the Finnish Institute for Health and Welfare (THL), which receives research funding from Sanofi Pasteur, GlaxoSmithKline, and Pfizer for research studies not related to the current study nor to COVID-19. Dr Sundström reported participating in research funded by governmental agencies, universities, Astellas Pharma, Janssen Biotech, AstraZeneca, Pfizer, Roche, (then) Abbott Laboratories, (then) Schering-Plough, UCB Nordic, and Sobi, with all funds paid to Karolinska Institutet, outside the submitted work. Dr Nieminen reported receiving grants from Sanofi Pasteur outside the submitted work; and being employed by THL. Dr Grünewald reported being involved in the European Medicines Agency regulatory assessment of Comirnaty; being previously employed at a drug development consultancy firm with cross-product responsibilities; and being involved on a project for pertussis vaccines funded by Sanofi Pasteur, Merck Sharp & Dohme Corp, and GlaxoSmithKline at the Swedish Agency of Infectious Disease Control. Dr Gulseth reported participating in research projects and clinical trials funded by Novo Nordisk, GlaxoSmithKline, AstraZeneca, and Boehringer-Ingelheim paid to Oslo University Hospital; and receiving personal fees from Sanofi-Aventis. Dr Hviid reported receiving grants from The Lundbeck Foundation during the conduct of the study. Dr Ljung reported receiving grants from Sanofi Aventis paid to his institution outside the submitted work; and receiving personal fees from Pfizer outside the submitted work. No other disclosures were reported.

Additional Information: Among us, Dr Hviid had full access to all the Danish data, Dr Hovi had full access to all the Finnish data, Dr Karlstad had full access to all the Norwegian data, Dr Ljung had full access to all the Swedish data, and Dr Härkänen had full access to all the meta-analyses data in the study, and each investigator takes responsibility for the integrity of the data and the accuracy of the respective analyses. In addition, Drs Husby, Hansen, and Wohlfahrt, of the Statens Serum Institut, analyzed the Danish data and are responsible for those analyses; Drs Karlstad, Selmer, and Gunnes, of the Norwegian Institute of Public Health, conducted and are responsible for the analyses of the Norwegian data; Drs Hovi and Härkänen, of the Finnish Institute for Health and Welfare, conducted and are responsible for the analyses of the Finnish data; and Drs Pihlström, Sundström, Grünewald, and Ljung, of the Swedish Medical Products Agency, conducted and are responsible for the analyses of the Swedish data.

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Directorate for Education and Skills

The Education and Skills Directorate is one of twelve substantive departments of the OECD and provides policy analysis and advice on education to help individuals and nations to identify and develop the knowledge and skills that drive better jobs and better lives, generate prosperity and promote social inclusion.

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The OECD Directorate for Education and Skills seeks to help individuals and nations to identify and develop the knowledge, skills and values that drive better jobs and better lives, generate prosperity and promote social inclusion. It assists OECD countries and partner economies in designing and managing their education and skills systems, and in implementing reforms, so that citizens can develop the knowledge, skills, attitudes, and values they need throughout their lives.

Andreas Schleicher

Director Directorate for Education and Skills

Yuri Belfali

Head Early Childhood and Schools Division

Paulo Santiago

Head Policy Advice and Implementation Division

Tia Loukkola

Head Innovation and Measuring Progress Division

How we work

The work of the Directorate for Education and Skills is overseen by four bodies, each with its own mandate, membership, and programme of work and budget, to help deliver work under the overall governance of the OECD Council:

• The Education Policy Committee, which also provides strategic oversight of our work
• The Centre for Educational Research and Innovation Governing Board (CERI) 
• The Programme for International Student Assessment Governing Board (PISA)
• The Programme for Teaching and Learning International Survey Governing Board (TALIS)
• The Board of Participating Countries for the Programme for the International Assessment of Adult Competencies (PIAAC) is overseen by both the Education Policy Committee and the Employment, Labour and Social Affairs Committee.

What we are working on

The best way for education systems to improve is to learn what works from each other. We deploy large scale surveys and reviews, designing common methodological and analytical frameworks for utmost comparability of empirical evidence from different education systems. We collect data about nearly all aspects of countries’ education systems from key policies, teacher practises, adult proficiency, and early childhood learning and well-being to how 15-year-olds perform in mathematics and what their attitudes are about global issues like climate change.

• The International Early Learning and Child Well-Being Study
• OECD Survey on Social and Emotional Skills
• Survey of Adult Skills
• The OECD Teaching and Learning International Survey
•    Education at a Glance
•   The Education Policy Outlook
•   PISA Global Crisis Module
•   Global Teaching Insights
• Explore by country
• Explore by topic
• Review policies    
•   PISA for schools

Assisting countries with policy development and implementation

We help countries answer important questions facing education policy makers and practitioners alike: how to identify and develop the right skills and turn them into better jobs and better lives; how best to allocate resources in education to support social and economic development; and how to offer everyone the chance to make the most of their abilities at every age and stage of life OECD and partner countries look to our expertise to review their education and skills systems, and assist them in developing and implementing policies to improve them. We conduct reviews ranging from those on individual national education policy to comparative educational policy and thematic peer-analysis. We review and support the development of higher education systems with analysis on resource use and labour market relevance. All of these provide in-depth analyses and advice that draw on OECD data resources, national policy documents and research, and field-based interviewing by OECD review teams. Comparative thematics, covering areas such as ECEC in a digital world, diversity, equity and inclusion in education, teacher policy and transitions in upper secondary education, are based on a common conceptual framework and methodology developed with advice from a group of national experts.

Through tailored implementation support the directorate offers countries assistance in implementing policy, from curriculum reform to helping schools become effective learning organisations. It also brings countries and stakeholders together in a variety of fora to exchange ideas, an important step in the policymaking process.  

Pivoting to tomorrow

What knowledge, skills, attitudes and values will students need in a swiftly evolving world? We develop long-term “leading-edge” thinking that looks beyond the current state of education to what it can become. These multiple-scenario analyses nourish our ground-breaking Education 2030 work on curriculum. They inform international debate and inspire policy processes to shape the future of education. The one certainty about the future of education is that it will be a digital one though we cannot know to what degree. In staying ahead of the EdTech curve, the directorate advises countries on the fast-changing potential of digital tools like robotics, blockchain and artificial intelligence, and how they can be integrated and used to equitably boost teaching, learning and administrative performance. The digitalisation of education is just one of the many strategic foresight areas the OECD’s Centre for Educational Research and Innovation (CERI) focuses on. Its exploration of best practices flagged by international comparisons helps countries move towards the frontiers of education.

Programmes of work

• Education and Skills Policy Programme The OECD’s programme on education and skills policy support policymakers in their efforts to achieve high-quality lifelong learning, which in turn contributes to personal development, sustainable economic growth, and social cohesion. Learn more
• CERI The Centre for Educational Research and Innovation (CERI) provides and promotes international comparative research, innovation and key indicators, explores forward-looking and innovative approaches to education and learning, and facilitates bridges between educational research, innovation and policy development. Learn more
• INES The OECD Indicators of Education Systems (INES) programme seeks to gauge the performance of national education systems through internationally comparable data. Learn more
• PISA PISA is the OECD's Programme for International Student Assessment. PISA measures 15-year-olds’ ability to use their reading, mathematics and science knowledge and skills to meet real-life challenges. Learn more
• PIAAC The Survey of Adult Skills, a product of the PIAAC, measures adults’ proficiency in literacy, numeracy and the ability to solve problems in technology-rich environments. Learn more
• TALIS TALIS - the Teaching and Learning International Survey - is the world's largest international survey about teachers and school leaders. Learn more
• Survey on Social and Emotional Skills (SSES) The OECD Survey on Social and Emotional Skills is an international survey that identifies and assesses the conditions and practices that foster or hinder the development of social and emotional skills for 10- and 15-year-old students. Learn more
• Early Childhood Education and Care The Early Childhood Education and Care (ECEC) programme conducts analysis and develops new data to support countries in reviewing and improving their early childhood services and systems. Learn more
• Higher Education Policy The Higher Education Policy Programme carries out analysis on a wide range of higher education systems and policies Learn more

Directorate outputs

Policy and working papers

More facts, key findings and policy recommendations

Create customised data profiles and compare countries

Related policy issues

• Education access, participation, and progression
• Education economic and social outcomes
• Education equity
• Education evaluation and quality assurance
• Education financing
• Education leadership
• Education organisation and governance
• Future of education and skills
• Learning environment
• Teachers and educators
• Student performance (PISA)

Get in touch

Contact us: edu.contact@oecd.org