Since the 1990s, there has been ever-growing social, economic, and political integration between Eastern and Western Europe. The relationship between EU countries is now one of interconnectedness, cooperation, and shared values. Yet when it comes to health, there are still disparities between countries in Central and Eastern Europe and those in the rest of Europe.

• The EU’s average healthcare expenditure relative to GDP is 10.9%, while the 11 countries surveyed in this report (see Introduction) have figures ranging from 6.3% to 9.4%.
• Trust in healthcare is lower in Central and Eastern Europe: while only 21% of all Europeans report low levels of trust in their healthcare system, the figure is 49% in this region.
• Vaccination is inconsistent across the life course: while childhood vaccination uptake and recommendations are strong, recommendations and immunisation rates are much lower among adult populations.

Our research found that vaccine confidence and uptake is lower in this region due to a combination of:

• Low trust: lack of engagement from politicians, and a disjointed response to COVID-19 in several countries, has led to a breakdown in trust and reduced public confidence in vaccination.
• Historical determinants: distrust in authorities often stems from previous forms of government and politics that restricted individual freedoms.
• Poor communication: vaccination communication in Central and Eastern Europe is often too little too late and has been subject to anti-vaccination rhetoric which often goes unchecked.
• Inaccessible health services: inadequate access and poor funding for vaccination is indicative to some that vaccination is not a priority for the government, and therefore individuals need not prioritise it.
• A lack of health education: low awareness and lack of engagement on vaccination means many citizens in this region don’t prioritise it.

To overcome these barriers and instil more confidence in vaccination across the region, local authorities, health leaders, and national and EU policy makers should adopt the following recommendations:

1. Invest in systems designed for prevention: patients, healthcare workers, and policy makers require seamless access to appropriate information to support improved access to, and uptake of, vaccinations.
2. Take actions to inspire and engage: the benefits of immunisation should be clearly communicated and communication should be consistent at all levels of society.
3. Democratise access to prevention: infrastructure at each level of the healthcare system should promote preventative interventions; this is part of the overall effort to ensure that health outcomes do not vary by wealth.
4. Support the effective use of technology: digital communication tools should be used to reach underserved groups and counter anti-vaccine narratives that are too accessible online.

This project was kindly supported by an unrestricted grant from Pfizer.