ECDC supports Member States to increase COVID-19 vaccination acceptance and uptake in the EU/EEA

News story

On October 15, ECDC published the report “Facilitating COVID-19 vaccination acceptance and uptake in the EU/EEA” which aims to further support Member States in identifying barriers to the uptake of COVID-19 vaccination, and designing and implementing interventions aimed at increasing vaccination coverage.

While 74% of people aged 18 and over in the EU/EEA are currently fully vaccinated, coverage is far from equal across countries, ranging from 23% to 91% of people fully vaccinated. This highlights several gaps that must be addressed in order to increase COVID-19 vaccine uptake, as low vaccination rates in some countries or across population subgroups can result in the continued overloading of health care systems and preventable mortality rates.

This report presents examples of interventions that have been implemented in the EU/EEA in order to increase vaccine acceptance and can be adapted for use in other settings where similar drivers of low uptake are observed.

“A sustainable and successful COVID-19 vaccination programme can only be built on an understanding of, and a proper response to individuals’ and communities’ beliefs, concerns and expectations regarding the vaccine and the disease. These drivers need to lead to strategies adapted at sub-national or local level – there is no one-size-fits-all approach”, says Andrea Ammon, ECDC Director.

The report is based on the ‘5Cs’ model – Confidence, Constraints, Complacency, Calculation, and Collective responsibility – and can be used by Member States as a tool to understand the reasons behind low vaccination uptake, and for designing strategies aimed at facilitating COVID-19 vaccination acceptance. The 5Cs model relies on five factors that can affect an individual’s vaccination behaviour:

  • Confidence – Do people have trust in vaccines, health systems, policymakers?
  • Constraints – Is it easy to get vaccinated, physically and financially; do people have access to easily understood information about the vaccine in a language that they know?
  • Complacency – How do people perceive the potential risks of getting COVID-19?
  • Calculation – How do people search for and use information to inform their risk-benefit analysis about vaccination?
  • Collective responsibility – Are people motivated by the need to protect others? 

Even in countries that have achieved good overall vaccination coverage, there are sub-populations where coverage remains lower than desired. The specific challenges faced by each group’s access to information and vaccinations need to be properly understood and addressed.

Drivers of low COVID-19 vaccination acceptance and uptake can also change over time, which means that reviews may need to be conducted regularly in order to ensure the continued relevance of the interventions being applied.

The report has been published by ECDC in English and will be translated in all EU/EEA languages.

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Facilitating COVID-19 vaccination acceptance and uptake in the EU/EEA

Guidance - 15 Oct 2021

This technical report presents considerations for European Union/European Economic Area (EU/EEA) countries when diagnosing barriers to acceptance and uptake of COVID-19 vaccination, and designing and implementing interventions to increase uptake.