Routine vaccinations

Up to 50 million people annually are infected with seasonal influenza (flu) in EU countries, Iceland, Norway, Switzerland and the United Kingdom, and between 15 000 and 70 000 people die due to related causes (ECDC, 2022[1]). Older people and immuno-compromised individuals are at greatest risk of developing serious flu-related complications such as pneumonia and sepsis, which can result in severe illness or death. Although influenza vaccination is never wholly protective against all influenza viruses that may spread in a given year, it does offer some protection and can effectively reduce disease severity. WHO recommends that at least 75% of older people should be vaccinated against seasonal influenza. A 2009 EU Council Recommendation also set a goal of 75% vaccination coverage among older people (European Union, 2009[2]). All EU countries have national recommendations to promote influenza vaccination among older people, although the specific age threshold varies across countries.

Before the pandemic, in 2019, the flu vaccination coverage among people aged 65 and over was below 50% in most EU countries. The EU average was only 36%, and no country reached the 75% target (Figure 6.3). Vaccination rate against influenza among older people was particularly low in Central and Eastern European countries, with rates below 25% in all countries except Croatia.

In 2020, however, the pandemic helped to increase flu vaccination rate among older people in many countries, as countries sought to avoid a flu epidemic on top of the COVID-19 pandemic and the additional pressure that this would put on hospitals and other parts of health care systems. Denmark was the EU country that managed to increase its flu vaccination coverage among older people the most in 2020, with an increase of more than 20 percentage points to reach 75% coverage. Greece, Ireland, Spain, Malta, Romania and Norway also managed to increase substantially their vaccination rates in this age group. By contrast, some countries with already low influenza vaccination rates among the older population before the pandemic, such as Estonia and Latvia, did not see any increase during the first year of the pandemic, but rather some reductions.

Although the number and type of compulsory or recommended vaccines vary slightly across countries, all EU countries have established childhood vaccination programmes to reduce the spread of preventable infectious diseases and related mortality. Even before COVID-19, some parts of Europe had experienced resurgences of vaccine-preventable diseases due to declining vaccine coverage, driven to some extent to declines in public perceptions of vaccine safety. To counter these alarming trends, over the past years the European Commission has repeatedly called for the implementation of national policies and increased international co-operation to reduce vaccine hesitancy and improve vaccination coverage rates (European Commission, 2018[3]).

Figure 6.4 shows vaccination coverage for diphtheria, tetanus and pertussis (DTP) at 1 year of age. DTP vaccination requires three doses, and is an indicator of care continuity and access to primary care. Across EU countries, vaccination levels are high, with around 95% of children receiving the recommended DTP in 2020. Romania and Austria are the only two countries that do not meet the minimum immunisation level recommended by WHO for DTP (90%). This relatively low level of immunisation in Austria dates back to before the pandemic.


[1] ECDC (2022), Factsheet about seasonal influenza.

[3] European Commission (2018), Proposal for a Council Recommendation on Strengthening Cooperation against Vaccine Preventable Diseases,

[2] European Union (2009), “Council Recommendation of 22 December 2009 on Seasonal Influenza Vaccination (2009/1019/EU)”, Official Journal of the European Union.

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