Influenza vaccination coverage among high-risk groups has dropped in the European Region over the last seven years, and half the countries report a decrease in the number of vaccine doses available. These are the results of the first comprehensive overview of seasonal influenza vaccine coverage in the European Region of the World Health Organization (WHO) between 2008/09 and 2014/15, conducted by the European Centre for Disease Prevention and Control (ECDC) and the WHO Regional Office for Europe. Low uptake of seasonal influenza vaccination in Europe jeopardises the capacity to protect people during annual epidemics and the next pandemic, the two organisations warn.

“Vaccination is the most effective measure to prevent severe disease caused by influenza. However, according to our research, influenza vaccination uptake has been steadily declining in a number of countries in the European Region”, says Dr Zsuzsanna Jakab, WHO Regional Director for Europe. “This is of serious concern now for people at higher risk of severe consequences, especially older people, and in the future potentially for the entire population, as the production of pandemic vaccines is closely linked to seasonal vaccine use. I urge European countries to increase vaccination coverage to hit the goal of 75% uptake among older and other at-risk people.”

“All European Union Member States have signed up to the goal of reaching 75% uptake among older people and other vulnerable groups; however, these targets are not being reached”, says Dr Andrea Ammon, Director of ECDC. “ECDC is committed to further work with Member States in support of their efforts to control seasonal influenza”, she continues.

The overview appears in a peer-reviewed scientific article published in Vaccine in January 2018, based on data from the Vaccine European New Integrated Collaboration Effort (VENICE III) and WHO surveys. As the 2017/18 influenza season peaks in western Europe, a number of countries have seen a rapid increase in severe cases and, according to EuroMOMO, the organisation for European monitoring of excess mortality for public health action, some are reporting excess mortality among the elderly.

Older people at higher risk of death from influenza

WHO and partners estimate that over 44 000 people die annually of respiratory diseases associated with seasonal influenza in the WHO European Region, out of a total of up to 650 000 global deaths.

According to annual surveys funded by ECDC and WHO, although 34 000 (over 75%) of these deaths in Europe are among people aged 65 years or above, vaccine uptake remains low in this group. Half the countries in the WHO European Region are vaccinating fewer than one in three older people.

As for the other at-risk groups:

vaccination was generally recommended for people with chronic illnesses; however, coverage was below 40% in most countries;

almost all countries recommended influenza vaccination for health-care workers, but the majority reported influenza vaccine uptake as being as low as 40%;

in total, 90% of countries had vaccine recommendations for pregnant women in 2014/2015, compared with 40% before the 2009 A(H1N1) pandemic; however, coverage overall was low, with half the countries reporting uptake below 10%;

fewer than half the countries, most of them in eastern Europe, recommended influenza vaccination for young children; vaccination coverage ranged from less than 1% to 80%.

Vaccine shortages and declining demand behind low coverage

There are a number of context-specific factors influencing vaccination uptake. In the lower-resourced countries of the Region, where influenza may not be considered a high-priority disease, low coverage is a consequence of limited vaccine procurement.

Where vaccines are more widely available, uptake has been low or dropping for reasons ranging from complacency and lack of confidence in vaccines and health authorities, to lack of recommendations by health-care workers or access-related barriers, including out-of-pocket costs.

To address vaccination gaps effectively, it is necessary to understand the multiple barriers to vaccination, including: