Overview of the implementation of COVID-19 vaccination strategies and deployment plans in the EU/EEA

Technical report
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European Centre for Disease Prevention and Control. Overview of the implementation of COVID-19 vaccination strategies and vaccine deployment plans in the EU/EEA – 23 September 2021. ECDC: Stockholm; 2021.

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This report provides an updated overview of the progress of national COVID-19 vaccination strategies in EU/EEA countries, including updates on: vaccine uptake overall and by target group; current vaccination phases and priority groups, as well as any adjustments made to priority groups during the rollout; vaccination strategies and policies in place; and the use of vaccination certificates and challenges countries face with the rollout and good practices to mitigate these challenges.

Executive summary

Key messages

This report provides an updated overview of the progress of national COVID-19 vaccination strategies in European Union/European Economic Area (EU/EEA) countries, including updates on:

  • overall vaccine uptake and uptake by target group;
  • vaccination strategies and policies;
  • challenges and good practices with the rollout, including vaccine acceptance and hesitancy; and
  • strategies to increase vaccination uptake.

Vaccine COVID-19 rollout overview

  • As of 12 September 2021, a total of 671 767 335 COVID-19 vaccine doses have been distributed by manufacturers to EU/EEA countries, including over 17 million in the last week. Comirnaty (BNT162b2), developed by BioNTech/Pfizer, represents 69% of all doses distributed to EU/EEA countries via the European Commission’s Vaccine Strategy, followed by Vaxzevria (AZD1222) (14%), Spikevax (12%), and COVID-19 Vaccine Janssen (3%).
  • A total of 540 115 965 vaccine doses have been administered in the EU/EEA, including over 8 million in the last week. Based on data available from 29 countries, 85% of the doses distributed in the EU/EEA since the beginning of the rollout have been administered.
  • Since the start of COVID-19 vaccine deployment in the EU/EEA in December 2020, the cumulative vaccine uptake in the adult population (aged 18 years and older) in the EU/EEA has progressed, reaching 78.1% for at least one vaccine dose (range: 23.3-96.9%) and 71.6% for the full vaccination course (range: 21.7-90.5%) (30 reporting countries). However, as of 12 September 2021, across all age groups in the 30 reporting countries there are approximately 27 million people who have received a first dose and have yet to complete their primary vaccination course.
  • Cumulative vaccine uptake is higher in those target groups that have been prioritised since the beginning of the vaccine rollout, in particular the elderly and healthcare workers.
  • In people aged 80 years and above, 15 countries have administered the full vaccination course to more than 80% of this population. However, there are still gaps, with 12 countries still not reaching 80% of their population of 80-year-olds and above with the full vaccination course. Eleven countries have administered full vaccination to over 80% of healthcare workers.
  • Overall, the level of weekly increases of uptake is decreasing in most age groups and appears to have been plateauing since week 23. 
  • There are significant differences in vaccination uptake between countries, with some countries reporting very high uptake of full vaccination in adults over 18 years, in healthcare workers, those aged 80 years and above, and in long-term care facilities (LTCFs), while in some other countries the uptake is still generally very low compared to the EU/EEA median.

Vaccination strategies and policies during rollout

  • From the start, vaccinations have been rolled out in phases through various priority groups. Countries have primarily prioritised elderly people, residents and personnel of LTCFs, healthcare workers, social care personnel, and people with certain comorbidities. As of 20 September 2021, all EU/EEA countries have opened vaccination to the general population, with the majority offering vaccination to all those aged 12 years and over.
  • In June, 16 countries had extended the timing between vaccine doses to provide the first dose to as many people in the priority groups as possible for vaccines with a two-dose schedule. The timing between first and second doses varies by country and by vaccine product. As of September, seven countries who had extended the timing between doses earlier in the vaccination campaign had decreased the timing between doses of some vaccine products.
  • For individuals previously infected with SARS-CoV-2, 14 countries currently recommend only one dose (for vaccines with a two-dose schedule).
  • Twenty countries recommend specific COVID-19 vaccine products for specific population groups. The adaptation is mainly based on age-specific recommendations for both the Vaxzevria and COVID19 Vaccine Janssen.
  • A minority of countries (n=8) reported that they have adapted their COVID-19 vaccination strategy due to the circulation of new variants of concern, mainly by reducing the timing between vaccine doses.
  • Twenty-eight countries recommend vaccination for all adolescents aged 12-17 years, while two countries are currently recommending vaccination of 12-17-year-olds in risk groups. Most countries are administering vaccines for adolescents in vaccination centres.
  • Most countries (n=23) recommend the vaccination of pregnant women, most of them following the first trimester with mRNA vaccines.
  • Thirteen countries recommend an additional dose as an extension of the primary series (i.e. to immunocompromised individuals), and nine countries recommend both an additional dose as an extension of primary series and a booster dose for waning immunity. Seven countries are currently discussing additional and booster dose recommendations, and one country does not currently have recommendations.
  • Sixteen countries are generally administering a heterologous combination of vaccine doses, with the majority administering mRNA vaccines as second dose.
  • The majority of countries do not have mandatory vaccination in place for any population groups. Four countries have mandatory vaccination in place for healthcare workers and/or workers in long-term care facilities.

Challenges and good practices with the vaccine rollout

  • Only two countries reported a challenge with limited vaccine supply; for the other 15 reporting countries this was no longer considered an issue. The main challenge countries face is around communication and with the uptake of vaccines in different population groups.

Vaccine acceptance, hesitancy, and uptake

  • With vaccination uptake plateauing, and with some countries lagging behind in increasing uptake, many countries are now trying to reach those population groups that still have low uptake, such as under-served and vulnerable groups and young people.
  • Countries are using a range of strategies to encourage vaccine acceptance and address vaccine hesitancy or uptake. These include measures such as: targeted communication campaigns; increasing knowledge and information; ensuring easier access to vaccinations; partnerships with stakeholders, including engaging with communities; sending vaccination reminders; incentives; and addressing vaccinations in workplaces.
  • Increasing vaccination coverage, closing the immunity gap, and ensuring all eligible individuals are fully vaccinated, especially those at higher risk of severe disease, is the highest priority at this stage of the vaccination rollout in the EU/EEA. 

The rollout of national vaccination campaigns is a continuously moving process, and this report provides a snapshot of the progress to date. 

Monitor the COVID-19 vaccine roll-out

COVID-19 Vaccine rollout overview

This report provides an overview of the progress in the rollout of COVID-19 vaccines in adults (aged 18 years and above) across EU/EEA countries.

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