From Confidence to Coverage: A Multi-Stakeholder Perspective on Vaccination in Central and Eastern Europe

Central and Eastern Europe (CEE) carries some of the widest immunisation gaps in Europe, and improving coverage there is often treated as a problem of access infrastructure. On 14 May 2026, a multi-stakeholder meeting hosted at the Romanian Parliament brought together around twenty-five speakers, among some fifty participants in all, from Romania, Poland, the Czech Republic, and Bulgaria, together with international contributors, to agree which barriers to vaccine confidence matter most in the region, which interventions are deliverable within 12 to 24 months, and how responsibility for them should be divided among stakeholders. This Perspective synthesises that discussion as a set of strategies for coverage. Meeting-derived priorities are set against published coverage and confidence data for the region and against the published intervention literature. We argue that the central problem across the region is eroded trust rather than missing information, because misinformation succeeds mainly where trust has already broken down, a process deepened by a historically conditioned, post-communist distrust of public institutions. The two recommendations carried most strongly, as both high in expected impact and achievable within 12 to 24 months, were continuing professional education for primary care on vaccine communication and the resourcing of locally trusted community figures, including health mediators working with marginalised populations. We then show how system-design reforms already demonstrated in the region, in particular pharmacy-based vaccination, direct reimbursement, and targeted outreach to under-vaccinated and marginalised groups, turn restored confidence into measurable coverage while narrowing inequities. We close with a 12-to-24-month agenda for CEE, organised around a clear multi-stakeholder division of labour. These are stakeholder-derived priorities that now require implementation and evaluation.