Survey report on national seasonal influenza vaccination recommendations and coverage rates in EU/EEA countries, 2024/25

EU/EEA countries continue to recommend influenza vaccination for the primary target groups (older adults, individuals with chronic medical conditions, pregnant women and healthcare workers). Since the last season/s, the most important development is the expansion in the number of countries recommending seasonal vaccination to children/adolescents, with all 30 countries for the 2024/25 season having a recommendation, either an age-based or a risk-based approach. This signals important public health efforts to strengthen the prevention of seasonal influenza by making the vaccine more widely available to the groups that could benefit most from the programme. 

Nonetheless, when looking at the performance of such programmes through the reported national vaccination coverage data, it is evident that policies still fall short of meeting sufficient levels of uptake across key target groups, including older adults. In addition, issues of data availability persist, and there is a strong need to invest in digitalised infrastructure to strengthen the monitoring of national seasonal vaccination programmes. 

Seasonal influenza vaccination remains a key public health intervention, making it essential to implement targeted strategies to increase vaccine uptake and address barriers to vaccination. Efforts to expand recommendations must be bolstered by efforts to improve implementation.

Highlights on policies, recommendations and vaccination coverage rates in key target groups 

Vaccination in children and adolescents – All 30 EU/EEA countries had either age-based recommendations or recommendation for specific risk groups for children and/or adolescents, this is a notable increase compared to 18 countries in 2023/24 [1], and compared with 14 countries reporting influenza recommendations in the 2020/21 season [2]. In particular, for the 2024/25 season, 19 countries had an age-based recommendation, 11 a risk-based only approach. Among the 19 countries with age-based recommendation, four countries have a wider age-range recommendation for risk groups as compared to the general age-based recommendation. 

Of the 30 countries with recommendations, 13 reported VCRs for the 2024/25 season, the VCRs ranged between 1- 48.1%, with Spain (48.1%), Finland (32.9%), and Iceland (22.2%), reporting the highest VCRs. The median coverage for the 2024/25 season was 6.9% compared to 7.2% in 2023/24, but the comparison with data collected in previous questionnaires should be interpreted with caution, as different countries reported data across years and there was heterogeneity in the age groups reported, which at times did not reflect the age cut-off of the recommendation. 

Vaccination in older adults – All EU/EEA countries maintained recommendations for older adults for the 2024/25 season. There was some variation in the lower age limit, ranging from 50 to 65 years. 

The median vaccination coverage for older adults in the 2024/25 season was (47%) and ranged between 5-76%. Only Denmark (76%), Ireland (74.7%), Portugal (70.5%) and Sweden (68%) approached the 75% EU council recommendation target. Overall, the VCRs for older adults showed a slight increase compared with the median VCRs of (45.7%) in the previous season 2023/24 and a decline compared with 55.2% in 2022/23, 49% in 2021/22 and 59% in 2020/21. Levels of uptake continue therefore to remain sub-optimal in most EU countries, without overall further progress since the past annual influenza seasons. 

Vaccination in adults with chronic medical conditions not targeted by the age-based recommendations – All 30 EU/EEA countries had specific recommendations for adults with chronic medical conditions in the 2024/25 season, and including pulmonary, cardiovascular, renal, hepatic, metabolic, haematological, and neurological diseases, as well as immunosuppression. Many countries explicitly included HIV, morbid obesity, compromised respiratory function, and longterm aspirin therapy. Overall, chronic conditions targeted by the recommendation remained similar compared with 2023/24 and similar funding schemes was recorded in several countries as compared to the previous season. No comparison on VCR could be made with the past season as only two countries were able to report on this indicator.

Pregnant women – All EU/EEA countries had national recommendations for influenza vaccination during pregnancy in the 2024/25 season, most with full or partial funding. Eight countries reported VCRs, with a median of 22% (up from 16% in 2023/24). The VCR ranged between (1%–60.9%), and Spain (60.9%), Ireland (34.7%), and Denmark (23%) had the highest VCRs, while many countries remained below 10%. 

Healthcare workers – twenty-nine EU/EEA countries had recommendation for healthcare workers, with no change from the previous season. Denmark did not recommend the vaccination for this group. A total of 23 countries recommended vaccination for all healthcare workers and in six countries the recommendations were limited to staff in close contact with patients or potentially contaminated materials. Nine countries reported VCRs, which ranged between 16.6% to 62.8%; the median was 32% (an increase from 22% in 2023/24, and 25% in 2022/23). Latvia (62.8%, social care workers), Ireland (45.4%), and Spain (39.5%) had the highest VCRs