From long-term progress to alarming setback: four decades of Childhood Vaccination Trends in the EU

Introduction

In recent years, vaccine hesitancy has increased across the European Union (EU), contributing to declining immunization coverage and the resurgence of vaccine-preventable diseases. This study aims to assess vaccination trends over the past forty years, with a focus on recent fluctuations, to inform policy actions.

Methods

Data were extracted from the WHO/UNICEF Estimates of National Immunization Coverage database, for the period 1980–2024, including all 27 EU countries. Coverage indicators for seven vaccinations scheduled in the first year of life were considered (DTP-3, HEPB-3, HIB-3, POL-3, PCV-3, MCV-1, and RCV-1). Data were analyzed using Joinpoint regression analysis. . For each coverage indicator, we evaluated the overall trend using the Average Annual Percent Change (AAPC), while recent changes were assessed through the Annual Percent Change (APC) derived from the last two segments identified by the joinpoint regression model.

Results

A total of 183 vaccination–country trends were analyzed across 27 EU countries and seven vaccines. Overall, 128 trends showed positive AAPCs, indicating increasing coverage over time, while 55 showed negative AAPCs. In 2024, 71 country–vaccine combinations achieved coverage ≥95%, and 62 were between 90% and 95%; only Luxembourg reached ≥95% for all vaccinations. Long-term positive trends were observed in most countries, with nine showing increases for all seven vaccines. However, analysis of recent APCs revealed a predominance of decreasing trends, with 17 countries showing declines in four or more vaccines, including Germany, Greece, the Netherlands, Romania, and Sweden. Declines were most frequent for HIB-3, POL-3, HEPB-3, and DTP-3, whereas MCV-1 and RCV-1 displayed more stable and balanced patterns.

Conclusions

Recent declines in vaccination coverage across the EU highlight the need for coordinated action at national and community levels to reverse these trends and restore high immunization coverage.

Key messages

• Despite four decades of overall improvement in childhood immunization coverage across the EU, recent trends show a concerning reversal, with declines observed in multiple countries and vaccines.

• Urgent, coordinated policy action at both national and EU levels is needed to address vaccine hesitancy, strengthen immunization systems, and restore coverage to ≥ 95% targets.