Impact of European vaccination policies on seasonal influenza vaccination coverage rates: An update seven years later

Figures & data

Figure 1. Vaccination coverage rates for; A) elderly, B) healthcare professionals, C) those with a medical risk condition for seasons 2013–14 (black bars), 2014–15 (grey bars) and 2015–16 (white bars). The dashed horizontal line indicates the 75% target vaccination coverage rate for all groups.

Table 1. Vaccination coverage rates and implemented policy elements aimed at increasing influenza vaccination coverage rates in 23 European countries in 2014/15.

	Bulgaria	Croatia	Czech Rep	Estonia	France	Germany	Greece	Hungary	Ireland (Eire)	Italy	Kosovo	Latvia	Lithuania	Netherlands	Poland	Portugal	Romania	Serbia	Slovakia	Spain	Switzerland	UK-England	UK-Scotland
Vaccine coverage rate
Elderly	ND	20.1	24.9	1.1	50.8	35.3	ND	19.0	54.5	49.9	48.8	2.4	13.9	64.6	13.7	67.9	11.0	10.7	14.1	56.1	38.0	71.0	74.5
Healthcare professionals	ND	31.3	7.0	ND	46.0	39.2	26.3	30.7	22.5	ND	1.0	ND	27.0	ND	9.0	59.1	29.0	10.3	ND	27.5	21.0	50.6	36.0
Living with a medical risk condition	ND	34.4	20.0	ND	39.1	ND	ND	20.0	ND	21.4	ND	ND	ND	27.4	ND	59.6	ND	ND	ND	ND	30.0	45.1	48.0
Influenza vaccination program policy element
Influenza vaccination recommendation for elderly
Influenza vaccination recommendation for HCPs	yes	yes	yes	yes	yes	yes	yes	yes	yes	yes	yes	yes	yes	yes	yes	yes	yes	yes	yes	yes	yes	yes	yes
Influenza vaccination recommendation for those living with a medical risk condition
Vaccination free for recommended patients (vaccine or administration)	no	yes	yes	no	yes	yes	yes	yes	yes	yes	yes	yes	yes	yes	no	yes	yes	yes	yes	yes	yes	yes	yes
National action plan to improve VCR	no	no	yes	no	NA	no	no	no	NA	NA	no	yes	no	no	yes	NA	no	no	no	NA	yes	yes	NA
Objective for 75% VCR in targeted groups	NA	NA	yes	NA	yes	yes	yes	no	yes	yes	no	yes	NA	no	no	yes	NA	NA	NA	NA	no	yes	NA
Yearly national VCR objective	no	no	no	no	NA	no	yes	no	NA	NA	no	no	no	no	no	NA	no	yes	no	NA	yes	yes	NA
Annual monitoring & communication of VCR, by target by HA	NA	NA	no	NA	NA	no	yes	yes	NA	NA	no	yes	NA	yes	no	NA	NA	NA	NA	NA	yes	yes	NA
Summit before or during annual campaign	no	no	no	no	NA	NA	yes	no	NA	NA	yes	yes	yes	no	yes	NA	yes	yes	yes	no	no	no	NA
HCP have clear objectives to achieve in high-risk groups (GP and/or other specialist)	no	no	yes	no	NA	no	no	yes	NA	NA	no	yes	no	no	no	NA	no	no	no	NA	no	yes	NA
HCP financial incentive	no	no	yes	no	yes	no	no	no	yes	no	no	NA	no	yes	no	NA	no	no	no	no	no	yes	yes
Awareness campaign by HA and/or NVIG	yes	no	no	no	yes	yes	yes	yes	yes	yes	yes	yes	yes	yes	yes	no	yes	no	yes	yes	yes	yes	NA
Awareness campaign: TV / radio	no	yes	no	yes	no	no	yes	yes	yes	yes	yes	yes	no	yes	yes	yes	yes	yes	yes	yes	no	yes	yes
Awareness campaign: press advertisements for public	yes	yes	yes	yes	yes	yes	no	yes	yes	yes	yes	yes	yes	yes	yes	no	no	no	yes	yes	no	yes	yes
Awareness campaign: flyers / leaflets/ folders in medical waiting rooms	yes	yes	yes	yes	yes	yes	yes	yes	yes	yes	yes	yes	yes	yes	yes	no	no	yes	no	yes	yes	yes	yes
Awareness campaign: website for public	yes	yes	no	yes	yes	yes	no	yes	no	yes	yes	yes	no	yes	yes	yes	yes	no	yes	yes	yes	yes	yes
Awareness campaign: advertisements or mailings to HCP	yes	no	no	yes	yes	yes	yes	no	yes	yes	yes	yes	no	yes	yes	no	yes	no	no	yes	yes	yes	yes
Additional data sources

yes: fully or partially implemented; no: not implemented: NA: no answer.

¹ 65+ years and people with chronic respiratory or cardiovascular illness or diabetes on permanent medication

² Slovak health insurance companies have paid vaccine and administration costs for everyone, not only for recommended target populations, for several years

³ Polish National Program for Influenza Prevention (NPIP) is a social initiative that does not receive financial support from the Ministry of Health or Sanitary Inspection

⁴ summits are organized by NPIP twice a year, with representatives from Polish Health Ministry, Sanitary Inspection, and Parliament. The most important activities are meetings: Flu Forum (at the beginning of the season, organized in September) and Flu Meeting (at the end of the season).

⁵ partially.

⁶ by the Hellenic Center for Disease Control and Prevention.

Data sources: ECDC²²; Croatia -grip.hr – supported by NPH; France – Institut de veille sanitaire (InVS). Couverture vaccinale. http://invs.santepubliquefrance.fr//Dossiers-thematiques/Maladies-infectieuses/Maladies-a-prevention-vaccinale/Couverture-vaccinale/Donnees/Grippe , https://www.lequotidiendupharmacien.fr/actualite/article/2017/03/01/59-des-pharmaciens-vaccines-contre-la-grippe_264771?xtor = EPR-2-%5BNL_quotidienne%5D-20170301, Haut Conseil de la santé publique. Objectifs de santé publique: Évaluation des objectifs de la loi du 9 août 2004: Propositions (High Public Health Council. Public health objectives: Assessment of the objectives of the law of 9 August 2004: Proposals). 2010; Germany – Robert Koch Institut (RKI). RKI/ Epedimiologisches Bulletin 2017/1, http://www.rki.de/DE/Content/Infekt/EpidBull/Archiv/2016/47/Art_01.html; Hungary – OTH-ÁNTSZ (public health department of MoH), Ireland – http://www.hpsc.ie/a-z/respiratory/influenza/seasonalinfluenza/influenzaandhealthcareworkers/hcwinfluenzavaccineuptakereports/File ,15542,en.pdf, Health Protection Surveillance Centre. Influenza vaccine uptake and adults 65 years and older http://www.hpsc.ie/a-z/respiratory/influenza/seasonalinfluenza/influenzaandadults65yearsandolder/Seasonal%20influenza%20uptake_Sep%202016_Feb%202017___12%2004%202017_10v_.pdf ; Italy – Ministero della Salute. Piano Nazionale Prevenzione Vaccinale PNPV 2012‐2014 (Ministry of Health. National Vaccination Plan). 2012, Epicentro – Ministry of Health ( http://www.epicentro.iss.it/problemi/influenza/CoperturaVaccinale2015-2016.asp , http://www.epicentro.iss.it/passi/dati/VaccinazioneAntinfluenzale.asp; Kosovo – National public health institute; Latvia – Center for disease prevention and control of Latvia, https://www.spkc.gov.lv/lv/informativi-izdevum; Netherlands – Heins M, Hooiveld M, ten Veen P, Korevaar J. Vaccine Coverage Dutch National Influenza Prevention Program 2015 – Brief monitor. Utrecht, NIVEL: 2016; Poland – Czarkowski MP, Kondej B, Staszewska-Jakubik E, Cieląbek E (2016) Vaccinations in Poland in 2015. National Institute of Public Health – National Institute of Hygiene – Department of Epidemiology, Warszawa; Portugal – Direção‐Geral da Saúde (DGS). Vacinação contra a gripe com a vacina trivalente para a época 2015/2016 (Directorate General for Health (DGS). Influenza vaccination with trivalent vaccine for the season 2015/2016). 2015; Serbia – National public health institute; Slovakia – Report of Influenza season 2015/16 in the Slovak Republik, web of Public Health Authority of SR: http://www.uvzsr.sk/docs/info/epida/Vyhodnotenie_chripkovej_sezony_2015_2016.pdf; Spain – Ministerio de Sanidad, Servicios Sociales e Igualdad. Coverturas de Vacunacion. Datos estadísticos. https://www.msssi.gob.es/profesionales/saludPublica/prevPromocion/vacunaciones/docs/CoberturasVacunacion/Tabla10.pdf; Switzerland – Office fédéral de la santé publique (OFSP). Recommandations pour la vaccination contre la grippe (Federal Office of Public Health. Recommendations for vaccination against influenza). 2011; Nationale Strategie zur Prävention der saisonalen Grippe (GRIPS), Bull OFSP 2016; Nr. 37:559-566; UK – Screening and Immunisations Team, Health and Social Care Information Centre. NHS Immunisation Statistics England, 2014‐15. 2015, https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/544552/Seasonal_flu_GP_patient_groups_annual_report_2015_2016.pdf , https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/508557/HCWs_Seasonal_Flu_Vaccine_February_Final_Report_170316.pdf , https://www.gov.uk/government/statistics/annual-flu-reports , https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/600880/annual_flu__letter_2017to2018.pdf , https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/600880/annual_flu__letter_2017to2018.pdf .

Table 2. Implementation of policy elements aimed at increasing influenza vaccination coverage rates and correlation with vaccination coverage rates in healthcare professionals and the elderly in countries with vaccination coverage rate data for the season 2015–16 available.

		HCPs		Elderly
	Program implementation	Countries with 2015–16 VCR (n)	Average VCR % (95% CI)	Countries with 2015–16 VCR (n)	Average VCR % (95% CI)
Recommendation for annual seasonal influenza vaccination	Yes	17	27.9 (19.8, 35.9)	21	35.3 (24.4, 46.3)
	No	0	—	0	—
Vaccination free for recommended patients (vaccine or administration)?	Yes	16	29.0 (20.8, 37.2)	19	38.3 (27.0, 49.5)
	No	1	NN	2	7.4 (NN)
National action plan to improve VCR	Yes	4	21.9 (0, 53.9)	5	30.0 (0; 62.8)
	No	8	24 (13.9, 34.7)	10	23.8 (9.7, 37.9)
Objective for 75% VCR in targeted groups	Yes	7	35.8 (19.0, 52.6)	8	44.6 (25.5, 63.7)
	No	4	15.4 (0, 36.2)	5	36.8 (10.7, 62.9)
Yearly national VCR objective	Yes	4	27.1 (0, 54.2)	3	39.9 (NN)
	No	8	21.8 (10.1, 33.4)	12	22.4 (10.4; 34.3)
Annual monitoring & communication of VCR, by target by HA	Yes	4	32.2 (11.6, 52.7)	5	39.0 (2.7, 75.3)
	No	4	14.1 (0; 41.3)	4	30.7 (6.9, 54.5)
Summit before or during annual campaign	Yes	6	17.1 (4.7, 29.5)	7	16.3 (2.6, 30.1)
	No	6	28.0 (13.0, 42.9)	8	36.8 (16.0, 57.6)
HCP have clear objectives to achieve in high-risk groups (GP and/or other specialist)	Yes	3	29.4 (0; 83.7)	3	38.3 (0; 109)
	No	9	21.6 (12.1, 31.1)	12	22.8 (10.3, 35.2)
HCP financial incentive	Yes	5	32.4 (10.3, 54.6)	7	50.6 (29.2, 72.0)
	No	11	22.9 (15.2, 30.6)	12	26.5 (14.8; 38.1)
Awareness campaign by HA and/or NVIG	Yes	12	27.5 (18.6, 36.3)	15	36.2 (23.9, 48.5)
	No	4	26.9 (0; 65.1)	5	24.9 (0; 56.8)
Awareness campaign: TV / radio	Yes	12	27.8 (17.3, 38.3)	16	36.2 (21.9, 50.5)
	No	5	28.0 (9, 47.1)	5	32.6 (15.3, 49.9)
Awareness campaign: press advertisements for public	Yes	12	27.3 (17.5, 37.1)	16	37.5 (24.6, 50.4)
	No	5	29.1 (6.5, 51.8)	5	28.3 (0; 59.2)
Awareness campaign: flyers / leaflets/ folders in medical waiting rooms	Yes	15	25,7 (17.7, 33.6)	18	36.1 (24.3, 47.8)
	No	2	44.1 (NN)	3	30.9 (NN)
Awareness campaign: website for public	Yes	12	31.7 (21.2, 42.2)	17	37.5 (24.7, 50.4)
	No	5	18.6 (7, 30.2)	4	26.0 (0, 57.7)
Awareness campaign: advertisements or mailings to HCP	Yes	11	28.1 (18.1, 38.0)	14	40.8 (26.5, 55.1)
	No	6	27.6 (8.0, 47.1)	7	24.3 (6.0, 42.6)

* NN: not calculated due to small sample size.