VACCINATION POLICY IN EUROPE – strengthening accountability and collaboration across sectors to improve uptake rates

Vytenis Povilas Andriukaitis, presentation in the webinar “Mobilising patient groups to change vaccine policy”, 02 December, 2020

During its long history since Edward Jenner invented a method to protect against smallpox in 1796 vaccination in Europe saved millions of lives and strongly contributed to both public health as well as the fact that most of Europeans have trust in evidence-based medicine. Vaccination against Smallpox, Diphtheria, Tetanus, Polio, TB are undoubtfully success stories. The success was always based on two interrelated approaches – accountability and collaboration.

Accountability of all actors involved – from governments, parliaments, institutions, providers of health services, ordinary citizens. And collaboration across sectors, knowing that we are speaking about multifactorial, multi sectorial and multilevel governance of vaccination policies.

Keeping in mind such very complex phenomena we need to state, that immunisation campaigns (though in most cases considered as successful) are not immune from inefficiencies. There are always opportunities to enhance accountability and collaboration of all actors involved.

One hand, we see consistent vaccination policies in Europe developed by national governments and parliaments, elaborating their own national vaccination strategies, national vaccination calendars, vaccination schemes and their targets. Member states are looking for scientific advice, studying experiences of pairs. WHO, EU institutions and ECDC facilitates, supports and provides some technical assistance to the development looking at epidemiological situation in the concrete country.

European countries are renown backers of immunisation processes globally. Private sector is key in development of new immunisation technologies.

One the other hand, worrisome trends of declining vaccination coverage in some countries, failure to achieve measles free status in the EU, vaccine supply shortages, vaccine scepticism and vaccine hesitancy, the fact that it takes more than 10 years do develop a new vaccine and 20-30 years to assure accessibility of a new vaccine globally ( see chart) shows inefficiencies of contemporary immunisation processes.

Big health crisis underlined critical importance of accountability and collaboration. The COVID19 pandemic has caused immense human suffering and pushed healthcare systems to their limits. The experience of the current pandemic shows that coordination and cooperation between all sectors are crucial. And accountability of all actors and collaboration of sectors is the biggest societal value.

Wild competition for resources was the first response of international markets to the pandemic. This competitive approach appeared to be counterproductive. The emergency magnified importance of international cooperation of combining purchasing power of states with innovativeness of private businesses.

European Union Member States discovered value added of joint procurement. An approach to COVID-19 vaccine as European or even global public good is gaining a strong public support and this in addition to record braking development of a new vaccine, hopefully, will open a new page in drive for the universal health coverage.   No doubt, Europeans will find   new ways how to act more effectively on national and at the EU level.

Vaccination is one of the most effective and frontline public health actions preventing millions of deaths worldwide. WHO has rated it second only to clean water. We all know, that today, like never before, we have better vaccine science, more safety regulations and processes, thorough and transparent clinical trials systems, but despite that we have a doubting public, which leads to a decrease in vaccination.

All countries also have been facing constraints in the supply, delivery and cost burden of vaccines. All of those challenges require a new approaches developing revised vaccination strategies and introducing new vaccination policies.

EC already proposed more coordinated vaccine strategy at EU level, enforcing coordinated response at EU level, strengthening joint procurement mechanisms purchasing medical countermeasures, developing response planning, and reporting in time of outbreaks and so on and fighting vaccine hesitancy.

And WHO European Regional Director Dr. Hans Kluge proposed a new flagship initiative “The Immunization 2030 Agenda”. This flagship initiative will mobilize political leaders, at regional, sub regional and country levels, to ensure continued high-visibility commitment to and promotion of full vaccination, ensuring upwards convergence of coverage achievements with the best performers within and between countries. With the Immunization 2030 agenda, the WHO European Regional Office will do its part, in synergy with global initiatives, to stimulate and coordinate the accessible supply of vaccines.

Immunization against COVID-19 is a huge logistical challenge. The EU and Member states should prioritise. At the beginning the action should be focused on the vaccination of older adults. Older adults and those with chronical diseases – NCD’s – are immunocompromised and susceptible to vaccine preventable diseases (VPD) and most serious complications.

Apart of importance to assure intergenerational solidarity there are a lot of other barriers to vaccination in older adults: low level of understanding of value of adult vaccination, limited knowledge of existing immunization policies, limited awareness of the potentially serious consequences of the disease There are also the logistical issues related to vaccine delivery remotely located settlements, limitations of accessibility of immunisation services for those with poor health,  insufficient supply of age-specific vaccines.

And here we can look at some two fundamental issues – patient centred approach and community-based care and cure services. And without inter sectorial cooperation and collaboration we can’t achieve better results on the ground. Civil society (patient, professional and aging organisations) are powerful agents of change because they represent millions of citizens, and health care professionals. These organizations are recognized as valuable sources for patient-centred support and relied to provide evidence informed health content, in plain language and through user-friendly platforms that are easy navigate. Actions of patient groups in cross sectorial collaboration is of importance.

Unfortunately, many patient and aging organizations are limited in their knowledge about the critical importance of vaccination policies.  Targeted awareness and education strategies about stronger immunization policies are important to upgrade health literacy of older adults and those with underlying chronic conditions, to assure proper utilisation of benefits provided for this group by immunisation. Civil society should have a role in improving uptake rates, especially in case of COVID19 vaccination.

There is a new sense of urgency created by the incoming reality with new vaccine against COVID19. It includes preparation for the major operational regulatory and financial planning implications of the deployment of a new vaccine, while ensuring also high influenza vaccine coverage and tackling the coverage gaps for other vaccine-preventable diseases.

This requires a detailed roadmap that takes into account not only the priorities, needs, capacities and immunization system experience specific to each country but also necessary transparency and solidarity to ensure fair access to and distribution of vaccines in the European region.

In this context strengthening accountability and collaboration across sectors, countries, and European region to improve vaccination uptake rates is of paramount importance.

Keeping it in mind we need a reinforced framework of coordination and strengthening of existing structures and mechanisms at EU level for better protection, prevention, preparedness, and response against human health hazards. Therefore, drawing lessons from current crisis many stakeholders, including European Commission, are calling to build a stronger European Health Union.

A strong European Health Union will protect our health, but also our healthy living standards. And without accountability and multilevel, multi sectorial collaboration across sectors, without solidarity between all actors of our society we can’t succeed to develop effective vaccination policies and vaccination strategies in front of new pandemics and new cross border threats, for whom older adults are more susceptible.

Let us all be accountable for the protection of most vulnerable part of our society.


Vytenis Povilas Andriukaitis, Presentation on 02.12.2020