When we talk about medicine and public health, rather than considering a snapshot of a particular moment, we need to look at trends over time to truly understand what is happening. This rule is even more valid when we talk about protection from infectious diseases through vaccinations in childhood. Only by observing trends over time can we have a perception of what is really happening.
Unfortunately, the answer that comes from the data is not comforting, at least according to research that analyzed over forty years of data in the 27 countries of the European Union. After decades of progress, childhood vaccination coverage shows signs of slowing or decreasing in most European Union countries. The study was published on The Lancet Regional Health – Europecreated by a group of Italian researchers with an important contribution from the Università Cattolica del Sacro Cuore.
A unique investigation
The study, entitled Trends in childhood vaccination coverage in the European Union, 1980–2024: an ecological time-series studybears the signature of Leonardo Villani, Luigi Russo, Francesco Andrea Causio, Cosimo Savoia, Roberta Pastorino, Chiara De Waure, Walter Ricciardi and Stefania Boccia. The work offers one of the most extensive analyzes conducted so far on the evolution of pediatric vaccinations in the European Union. Above all, the results of the study also constitute a reference for the work of the Observatory on Common Good Health, directed by Walter Ricciardi, committed to promoting a vision of health as a shared responsibility and collective heritage.
The Observatory contributes to bringing scientific evidence into public and institutional debate, encouraging discussion between research, decision-makers, health professionals and civil society, with particular attention to prevention, equal access and citizen trust. The researchers examined data from the World Health Organization and UNICEF relating to the 27 member states, observing the trend in coverage from 1980 to 2024 for seven vaccinations or vaccination cycles: diphtheria, tetanus and whooping cough; hepatitis B; Haemophilus influenzae type b; pneumococcus; polio; measles and rubella.
The trend is worrying
The analysis confirms the great results obtained in over forty years by European vaccination policies, but signals a recent change in direction. In fact, in 16 of the 27 countries of the European Union, decreasing trends were detected for at least four of the seven indicators considered. The most widespread declines were in vaccinations against Haemophilus influenzae type b and polio, both decreasing in 20 countries. This is followed by hepatitis B, with a negative trend in 18 states, and vaccination against diphtheria, tetanus and whooping cough, decreasing in 17.
Many of the trend reversals began between 2019 and 2022, a period coinciding with the pandemic and the resulting difficulties in the ordinary provision of vaccination services. The authors point out, however, that the research describes the trend of coverage and does not allow a direct causal relationship to be established. Several factors may have contributed to service disruptions, including access barriers, social inequalities, communication difficulties, misinformation and reduced confidence in vaccines.
“The main message is not that childhood vaccination in Europe has suddenly collapsed, but that the trend has changed in many countries. We are seeing recent warning signs that overlap with decades of important public health achievements. It is essential that the high levels of coverage achieved do not lead to underestimation of the problem”
underlines Leonardo Villani.
The situation in various countries
The European situation remains heterogeneous. In many countries, absolute coverage continues to exceed 90%, but only Luxembourg and Portugal reach at least 95% for all seven indicators analyzed. Even in territories characterized by high national values, a progressive reduction can create local pockets of unprotected populations and increase the risk of new outbreaks. Italy presents a relatively more favorable picture compared to other European states, with a recent positive trend for at least half of the vaccinations considered. The data, however, must not reduce attention to territorial differences and the need to maintain high and homogeneous coverage.
“The value of this study lies in the ability to jointly read over forty years of data and to identify the changes taking place early. National averages alone are not sufficient: it is necessary to recognize the territorial and social inequalities that can leave specific communities without adequate protection. Vaccination policies will have to be increasingly targeted, accessible and based on timely and reliable monitoring systems”.
reports Stefania Boccia, professor of Hygiene and Public Health at the Catholic University of the Sacred Heart.
The Italian research published by The Lancet Regional Health – Europe provides institutions with a solid scientific basis to strengthen surveillance, promptly identify areas of vulnerability and plan targeted interventions. In this process, the Observatory on Common Good Health can carry out a coordination and awareness-raising function, supporting vaccination policies based on evidence, accessible in the territories and capable of combating inequalities and misinformation.
“This research shows that we cannot consider the results achieved thanks to vaccinations to be irreversible. When coverage begins to decrease, even starting from high levels, the conditions are progressively created for the return of diseases that we thought we had brought under control. The Observatory’s task is to help transform these signals into awareness and public initiative, strengthening the dialogue between science and institutions. We need to intervene immediately on local services, on surveillance and on authoritative, transparent and understandable scientific communication”
comments Walter Ricciardi, professor of Hygiene and Public Health at the Catholic University of the Sacred Heart and director of the Observatory on Common Good Health.
