Vaccinations falling in EU countries, with Denmark and Ireland leading the way

Stressing the importance of vaccines is Roberto Monaco, national secretary of the Federation of Medical Orders and president of the Medical Order of Siena. "After the Covid and the emergency in which everyone was good, now we have forgotten," he says. "We can say that history teaches but, sometimes, there are bad pupils. Yet, the doctor recalls, 'history teaches that vaccinations have saved lives for many years, think of smallpox or other diseases'.

The doctor also makes a point: 'We are a country ready to get involved when needed,' he says, 'and we saw this during the emergency, we were good during the Covid, when there were earthquakes and disasters. But when it comes to investing in prevention and everyday life, we are less good. That is not all. 'It is necessary to remember that vaccination helps those who cannot do it,' he adds. Vaccinating means making those close to us safe. For example, a worker or a frail family member. What is needed is attention to the socially fragile'. Hence the need for greater attention to social and cultural issues. 'Every time we talk about health,' he adds, 'we need to think about society, with a focus on schools and healthcare. Because a culturally strong society is also more attentive to health'. And in front of Eurostat data 'where Italy is not in a bad way', the doctor emphasises another positive fact: 'According to a survey we commissioned,' he concludes, '85% of people believe in science and doctors. This is positive and gives us hope'.

In Bulgaria, the decline in vaccination coverage in the years immediately following the pandemic has now been recovered. By 2021, the proportion of children immunised with compulsory vaccines had fallen below 90 per cent, with strong resistance fuelled by online misinformation and anti-vaccine political discourse also promoted by parties such as the pro-Russian nationalist Vazrazhdane and showman Slavi Trifonov's outfit, There is Such a People.

According to general practitioner Kostadin Sotirov, representing the Association of General Practitioners, the hesitant handling of the anti-Covid vaccination campaign by the authorities - summarised in the message 'everyone decides for themselves' - ended up negatively affecting routine paediatric vaccinations as well.

Already in 2020, there had been a four-month suspension of immunisations, first for influenza and then for Covid. A partial recovery had taken place, but the real drop came in 2021. In that year, hepatitis B coverage stood at 89.4%, polio, diphtheria, tetanus, pertussis and Haemophilus influenzae B at 89.5%, and measles-mumps-rubella (MMR) at 88.7%.

In the following years, thanks to the efforts of general practitioners and health authorities, coverage rose above pre-pandemic levels. In 2024, 96.7% of infants were vaccinated against tuberculosis and 97.6% against hepatitis B in the first days of life. In the first year of age, 94.2% of children received the hexavalent vaccine and 93.8% the pneumococcal vaccine. MMR coverage reached 94.2% for the first dose (13 months) and 90.5% for the second dose (12 years).

New measures have also been introduced: from 2025 varicella vaccination will become compulsory with two doses; HPV vaccination is free for girls and boys between 10 and 14 years of age, but remains below 10%, with much more ambitious targets for 2030 (70% for girls, 40% for boys). About 40% of newborns receive the anti-rotavirus vaccine, also covered by the state.

For influenza, on the other hand, public coverage only concerns the over-65s: vaccines are not free for children.

In Spain, the most obvious decline concerns seasonal vaccines against respiratory infections. According to Jaime Pérez, president of the Spanish Association of Vaccinology (AEV), flu coverage has dropped from around 70 per cent in 2021 to 58.5 per cent in 2024: a reduction of almost 12 percentage points. A trend attributed mainly to the lower perception of risk after the pandemic, despite the fact that influenza caused more than 33 thousand hospitalisations and almost 2 thousand deaths last season.

The decline particularly affects adults and people of working age, who face more logistical obstacles in accessing vaccination services. The most common reasons for non-use of vaccines include the feeling of 'not needing them', reduced risk perception, difficult access for working people, but also distrust, fear of adverse effects and misinformation.

To counteract the trend, the EYV re-launched its 'The best plan for this winter' campaign, which was released for the third consecutive year. According to the 'Gripómetro' survey, 59.9% of respondents had seen or heard messages related to the flu vaccination campaign, and about 15.2% recognised the specific message of the EYV initiative. Visibility was highest among people aged 60-64 and in the Basque Country and Galicia regions.

By contrast, the decline does not affect paediatric vaccinations, which remain at stable levels with no significant variations. Those registering the strongest contraction, after anti-Covid, remain the flu vaccines.

In Romania, the most critical data concerns the MMR vaccine: in 2024, only 62% of children received the second dose, far from the 95% needed to prevent epidemics. A fragility that has already had serious consequences. Between September 2023 and August 2024, the country faced its second measles epidemic in seven years, during which 30 children died, all unvaccinated. Overall, more than 40,000 children who should have received the first dose of the vaccine were not immunised and another 77,000 did not complete the cycle with the second dose. The coverage of the first dose, which had risen to 80% before the pandemic, has fallen to 78% over the past year.

According to Gindrovel Dumitra, coordinator of the Family Physicians' Vaccinology Group, this situation is no longer linked to supply difficulties as it was in 2016, when the country went through the previous epidemic. Vaccines have always been available in recent years, but parental resistance, fuelled by fear and misinformation, continues to be an obstacle. Dumitra recalls that mistrust of MMR has its roots in 1998, when the now-disproven link between vaccines and autism was circulated. Despite the complete absence of scientific evidence, that suspicion has continued to circulate and it only takes 'the slightest doubt', the doctor notes, to undermine public confidence.

Coverage for other mandatory vaccines also shows criticalities. In 2024, 79% of children received the first dose of the diphtheria, tetanus and pertussis vaccine, while 38,000 were not vaccinated even once. In contrast, the most recent vaccines are making steady progress. The HPV vaccination, which was made free of charge for boys and girls between the ages of 11 and 19, improved coverage significantly between 2019 and 2024. The same was true for the vaccines against rotavirus, Haemophilus influenzae type b and pneumococcus, with measurable effects: according to WHO and UNICEF, the new coverages have contributed to a reduction in HPV infections and related cancers, as well as in hospitalisations for rotavirus diarrhoea, pneumonia and invasive diseases in children.

However, Romania remains held back by a complex set of obstacles. Cultural resistance and fear of adverse effects add to the difficulties faced by more mobile or marginalised families, while misinformation, amplified by social networks, continues to have a significant impact on risk perception. These factors are compounded by systemic problems, such as bureaucracy, the lack of vaccination programmes in schools, and the logistical difficulties many families face in travelling. A picture that makes the recovery of coverage even more urgent, especially in view of future epidemiological seasons.

*This article is part of the European collaborative journalism project "Pulse"