Childhood vaccination coverage in Europe: impact of different public health policies

ABSTRACT

Introduction: Vaccination is a crucial tool for the primary prevention of infectious diseases. Thanks to widespread vaccination, in the last century smallpox has been eradicated, and the Americas and Europe have become polio-free.

Areas covered: The aim of our study was to assess vaccination coverage in childhood up to booster preschool age in order to update the analysis on European trends of immunization coverage in the last nine years (2009–2017) and to assess the impact of different national policies on vaccine uptake.

Expert opinion: Despite the good results, several EU countries are going through unprecedented outbreaks of vaccine-preventable diseases due to insufficient coverage. The increase of vaccine hesitancy has made it difficult to reach and maintain high rates of vaccination coverage. Enforcing mandatory vaccinations is one of the strategies adopted by some countries, like Italy and France, to increase coverage. However, each country should find the most suitable way to keep up with vaccination coverages according to own cultural and organizational background.

KEYWORDS:

• Vaccination coverage
• public health policy
• Poliomyelitis
• Tetanus-Diphtheria-Pertussis
• Hepatits B
• Haemophilus influenzae type b
• measles
• Pneumococcal disease
• Rotavirus

Article Highlights

• Childhood vaccination coverage in Europe has been increasing for decades, and several countries have managed to achieve the 95% coverage goal. However, in recent years, this trend has decreased in many countries or regions.

• According to the European Center for Disease Prevention and Control (ECDC), numerous European countries are going through unprecedented outbreaks of vaccine-preventable diseases.

• Vaccination policies vary widely, with different processes and outcomes in each country.

• In Italy, due to the decrease in vaccination coverage registered in recent years and in agreement with the National Plan of Vaccination, the Parliament approved law n.119/2017, whereby 10 vaccinations were made mandatory and monetary fines were imposed on the families of unvaccinated children.

• France is one of the countries with highest prevalence of vaccine hesitancy in the world. The French government added eight mandatory vaccinations (Haemophilus influenzae type b, Pertussis, Hepatitis B, Measles, Mumps, Rubella, Meningococcus C, Streptococcus pneumoniae) to the three already required (Diphtheria, Tetanus, Polio).

• In Germany, kindergartens notify public health authorities if parents fail to provide the required evidence of immunization for their children. Public health doctors can call non-compliant parents for consultations or levy fines of up to 2,500 euros.

• In the last years (but with a reverse trend in the more recent ones in some countries), vaccination coverage in Europe has experienced a setback and, in some cases, even a decrease. Factors such as the ability of no-vax movements to use the social media to spread their false information and the consequent vaccine hesitancy have contributed to this phenomenon.

• An important goal of the EU Commission could be the possibility of establishing an EU Vaccine Information Sharing System with a view to developing guidelines on a vaccination schedule common to the EU countries, and a website with reliable and updated information on the benefits and safety of vaccination.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.