Implementation of the Council Recommendation on seasonal influenza vaccination

In December 2009 the EU Council adopted a Council Recommendation on seasonal influenza vaccination. The Recommendation asks that concerted action be taken at the level of the European Union to mitigate the impact of seasonal influenza by encouraging vaccination among risk groups and healthcare workers. The Recommendation encourages Member States to adopt and implement national, regional or local action plans or policies, as appropriate, in order to improve seasonal influenza vaccination coverage among older age groups, other risk groups such as people with chronic conditions and healthcare workers.

The specific purpose of the Recommendation is to increase vaccination coverage of older age groups, preferably to reach a target of 75% coverage by the 2014-15 winter season. It is proposed in the Recommendation that the target should, if possible, be extended to the risk group of people with chronic conditions. Member States are also encouraged to improve vaccination coverage among healthcare workers.

As directed in the Recommendation and at the request of the European Commission, ECDC has provided technical assistance to Member States on monitoring the current situation with seasonal influenza and influenza immunisation, drawing on data, analyses and actions undertaken in recent years. This included the annual surveys conducted by the VENICE (Vaccine European New Integrated Collaboration Effort)project, scientific guidance on risk populations, training, communication tool kits, surveillance for severe diseases (essential for guidance on risk groups) and developing mechanisms for monitoring vaccine effectiveness and investigating possible safety signals.

The data included in this report is drawn from two primary sources: 1) The annual survey by the VENICE projectii , which collects data from ‘gatekeepers’ in public health institutes, who work with their national authorities (e.g. Ministries of Health) on their country’s seasonal influenza vaccination policies, practises and coverage; and 2) a Supplementary Questionnaire developed and implemented by ECDC to collect additional data especially relevant to the Council Recommendation. A separate independent scientific review of the literature funded by ECDC on barriers and drivers related to seasonal influenza vaccination is also cited in the report.

Almost all countries reported having in place national and/or regional vaccination policies or strategies for seasonal influenza. Of the four countries reporting not having these policies or strategies, two reported that the existence of national and/or regional vaccination policies or strategies would have a positive effect on vaccination efforts in the country.

Eighteen countries were able to provide vaccination coverage data for the older age groups for the 2011–2012 influenza season. Only one country (Netherlands) meets or exceeds the 75% threshold included in the Recommendation for the cohort of older age groups. The United Kingdom (England) is close to the threshold at 74%. Among the other countries reporting coverage data, the percentages range from 1.7% to 64.1%. The trend data on this population shows no discernible momentum toward increasing coverage rates in most countries. In a number of countries, there have actually been declines in coverage among this population since the 2009 pandemic.

Only five countries reported vaccination coverage data for the population of people with chronic conditions for the 2011-12 influenza season. Of these countries, only the Netherlands is close to reaching the 75% target in the Council Recommendation. The reported coverage rates ranged from 31% to 73.6%. The lack of data on coverage rates for this population in the significant majority of countries reinforces the perception that little or no progress is being made.

Only six countries reported coverage data for health care workers for the 2011-12 influenza season. The reported coverage rates ranged from 6.4% to 54.4%. Again, the lack of data on coverage rates in the significant majority of countries reinforces the perception that little or no progress is being made to improve vaccination coverage among a population highlighted in the Council Recommendation.

The Recommendation asks countries to ‘analyse the reasons why some people do not wish to receive vaccinations’. Twenty-three countries reported in the Supplementary Questionnaire that there are known and/or perceived barriers in their country, which deter vaccination among key risk populations. Twenty-five countries reported known and/or perceived barriers to vaccination among healthcare workers. 

Many of the specific barriers reported by countries seem to be persistent problems: low perception of risk, including the risk of infecting others, particularly in healthcare settings; fear of possible and perceived side effects from vaccination, including contracting influenza; questions about the effectiveness of the influenza vaccine; broader anti-vaccine sentiments; issues of cost, availability and convenience; misleading reports in the mainstream media; and a general lack of accurate information about influenza and vaccination.

The Council Recommendation encourages countries to foster education, training, and information exchange on seasonal influenza and vaccination. For the past 24 months, a majority of countries reported implementing significant initiatives in communication, education, training and information exchange to reduce and/or remove barriers to seasonal influenza and promote appropriate attitudes and behaviours about vaccination among key populations.

In general, countries have made only limited progress in achieving the aims outlined in the Council Recommendation on seasonal influenza vaccination. In most countries, vaccination coverage rates are either low or unreported for the key populations covered by the Recommendation. More importantly, there appears to be little movement toward strengthening vaccination programmes, overcoming barriers to vaccination and increasing coverage rates.