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Strengthening vaccination programmes and health systems in the European Union: A framework for action


  • Siciliani, Luigi
  • Wild, Claudia
  • McKee, Martin
  • Kringos, Dionne
  • Barry, Margaret M.
  • Barros, Pedro Pita
  • De Maeseneer, Jan
  • Murauskiene, Liubove
  • Ricciardi, Walter


Vaccination is one of the most cost-effective public health interventions. However, the EU is facing increasing outbreaks of vaccine preventable diseases, with some fatal cases of measles. This paper reviews the main factors influencing vaccination uptake, and assesses measures expected to improve vaccination coverage. Obstacles to vaccination include concerns about vaccine safety and side effects, lack of trust, social norms, exposure to rumours and myths, and access barriers. Responses fall into three broad categories. Regulation, including the introduction of mandatory vaccination, can be justified but it is important to be sure that it is an appropriate solution to the existing problem and does not risk unintended consequences. Facilitation involves ensuring that there is an effective vaccination programme, comprehensive in nature, and reducing the many barriers, in terms of cost, distance, and time, to achieving high levels of uptake, especially for marginalised or vulnerable populations. Information is crucial, but whether in the form of public information campaigns or interactions between health workers and target populations, must be designed very carefully to avoid the risk of backfire. There is no universal solution to achieving high levels of vaccine uptake but rather a range or combinations of options. The choice of which to adopt in each country will depend on a detailed understanding of the problem, including which groups are most affected.

Suggested Citation

  • Siciliani, Luigi & Wild, Claudia & McKee, Martin & Kringos, Dionne & Barry, Margaret M. & Barros, Pedro Pita & De Maeseneer, Jan & Murauskiene, Liubove & Ricciardi, Walter, 2020. "Strengthening vaccination programmes and health systems in the European Union: A framework for action," Health Policy, Elsevier, vol. 124(5), pages 511-518.
  • Handle: RePEc:eee:hepoli:v:124:y:2020:i:5:p:511-518
    DOI: 10.1016/j.healthpol.2020.02.015

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    References listed on IDEAS

    1. Laetitia Duval & François-Charles Wolff & Martin Mckee & Bayard Roberts, 2016. "The Roma vaccination gap: Evidence from twelve countries in Central and South-East Europe," Post-Print hal-01385007, HAL.
    2. Björkman, Ingeborg & Sanner, Margareta A., 2013. "The Swedish A(H1N1) vaccination campaign—Why did not all Swedes take the vaccination?," Health Policy, Elsevier, vol. 109(1), pages 63-70.
    3. Laetitia Duval & François-Charles Wolff & Martin Mckee & Bayard Roberts, 2016. "The Roma vaccination gap: Evidence from twelve countries in Central and South-East Europe," Working Papers hal-01378176, HAL.
    4. Ian Skurnik & Carolyn Yoon & Denise C. Park & Norbert Schwarz, 2005. "How Warnings about False Claims Become Recommendations," Journal of Consumer Research, Journal of Consumer Research Inc., vol. 31(4), pages 713-724, March.
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    Cited by:

    1. Sebastian Neumann-Böhme & Nirosha Elsem Varghese & Iryna Sabat & Pedro Pita Barros & Werner Brouwer & Job Exel & Jonas Schreyögg & Tom Stargardt, 2020. "Once we have it, will we use it? A European survey on willingness to be vaccinated against COVID-19," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(7), pages 977-982, September.
    2. Julio Emilio Marco-Franco & Pedro Pita-Barros & Silvia González-de-Julián & Iryna Sabat & David Vivas-Consuelo, 2021. "Simplified Mathematical Modelling of Uncertainty: Cost-Effectiveness of COVID-19 Vaccines in Spain," Mathematics, MDPI, vol. 9(5), pages 1-15, March.
    3. Ruth Waitzberg & Noa Triki & Sharon Alroy-Preis & Tomer Lotan & Liat Shiran & Nachman Ash, 2021. "The Israeli Experience with the “Green Pass” Policy Highlights Issues to Be Considered by Policymakers in Other Countries," IJERPH, MDPI, vol. 18(21), pages 1-9, October.
    4. Casula, Mattia & Toth, Federico, 2021. "The 2017 Italian reform on mandatory childhood vaccinations: Analysis of the policy process and early implementation," Health Policy, Elsevier, vol. 125(1), pages 7-11.
    5. Galdikiene, Laura & Jaraite, Jurate & Kajackaite, Agne, 2022. "Trust and vaccination intentions: Evidence from Lithuania during the COVID-19 pandemic," EconStor Open Access Articles and Book Chapters, ZBW - Leibniz Information Centre for Economics, vol. 17(11), pages 1-1.
    6. Rajan, Selina & McKee, Martin & Hernández-Quevedo, Cristina & Karanikolos, Marina & Richardson, Erica & Webb, Erin & Cylus, Jonathan, 2022. "What have European countries done to prevent the spread of COVID-19? Lessons from the COVID-19 Health system response monitor," Health Policy, Elsevier, vol. 126(5), pages 355-361.
    7. Talia Goren & Itai Beeri & Dana R. Vashdi, 2023. "Framing policies to mobilize citizens' behavior during a crisis: Examining the effects of positive and negative vaccination incentivizing policies," Regulation & Governance, John Wiley & Sons, vol. 17(2), pages 570-591, April.

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