Flu vaccine: did your country hit its target?

On 22 December 2009, health ministers from every EU Member State made a new commitment: to vaccinate at least three quarters of all residents aged 65 years and older. Now new data from Eurostat, the EU statistics agency, shows governments have failed.

Story highlights

• 44% of people in Europe aged 65 years and older are vaccinated
• No EU country has hit its target to vaccinate three out of four people in that risk group
• There are no penalties for missing this target
• Older people are just one key target group
• WHO says pregnant women are the top priority, followed by health workers and people with chronic diseases such as diabetes, asthma and heart failure

No EU Member State has reached its 75% target and the rate across the EU is 44.3%. However, there are no political consequences: while there are penalties for breaching EU rules on carbon emissions, budget deficits or employment regulations, there is no sanction for missing vaccination targets.

The flu vaccination targets are considered to be ‘soft law’ rather than ‘hard law’, meaning they are not legally binding. Strict EU health targets are rare because health is a matter for national governments rather than a European responsibility.

44% of those aged 65 and over in the EU vaccinated against influenza

➡️ For more information: https://t.co/m9PyVTepfc pic.twitter.com/q2thQKHpMZ

— EU_Eurostat (@EU_Eurostat) December 9, 2019

It may have sounded like a modest goal. After all, reaching just three quarters of a key target group is still a long way short of protecting all at-risk citizens.

It would still leave 25% of older people unvaccinated. And the agreement reached at the 2009 European Council of health ministers ignored other key groups such as pregnant women and people with chronic conditions.

However, some countries were working from a very low base, with flu vaccination rates in single digits – hence the compromise agreement not to aim for universal vaccination in risk groups. There was a clear East-West divide: most EU members in the east had very low flu vaccination rates but boasted infant immunisation rates that were often the envy of their western neighbours.

Unhappy anniversary

Fast forward a decade and the East-West divide remains. Top of the table for 2018/2019 is the UK at 72.6%, followed by the Netherlands with 64%. These countries are the only ones to have ever crossed the 75% threshold – but have not sustained earlier progress.

And yet, they are the best of a bad bunch. Six countries (Romania, Lithuania, Slovakia, Slovenia, Latvia and Estonia) report flu vaccine uptake rates below 20%. A further six countries (Austria, Belgium, Bulgaria, Cyprus, Greece and Poland) did not report 2017/2018 data.

Modest improvements have also been recorded by Iceland, Ireland, Finland and Portugal but, overall, the picture is discouraging. 

As experts call on policy makers to focus on life-course immunisation, the dire flu stats show much work remains to be done. In its latest report on the 2019/2020 flu outbreak, the European Centre for Disease Prevention & Control (ECDC) says older people are at particularly risk from the strain of flu virus currently circulating.

While the ECDC guidelines follow the European Council’s target of reaching 75% of older people, the WHO lists pregnant women as the top priority for flu vaccination. Some countries in Europe are rolling out campaigns aimed at boosting flu vaccine uptake during pregnancy, but others are less active.

Despite the apparent lack of urgency in some European countries, flu remains a serious burden on individuals, communities and health systems. Each year, it affects 5-10% of the world’s population resulting in up to 650,000 deaths and 3 to 5 million cases of severe illness worldwide.

In Europe, flu puts significant pressure on hospital systems during the winter months and is responsible for thousands of ‘excess deaths’ i.e. people who would not have otherwise died at that time.

Dr Pasi Penttinen, ECDC Head of Influenza Disease Programme, acknowledged that improving vaccine uptake is the best way to address the annual epidemic. ‘Achieving high vaccination coverage rates for those particularly at risk of developing severe complications remains a serious public health challenge,’ he said.

‘The best way to prevent or minimize severe disease from influenza among vulnerable groups is timely vaccination, even though the effectiveness of the vaccine varies depending on the virus in circulation. Sufficient vaccination coverage also saves healthcare systems money in decreased consultation rates and hospitalisations.’

An event will be held in the European Parliament on 21 January to mark the 10-year anniversary of the European Council commitment to improve flu vaccination rates in older people. Find out more