Over two-and-a-half years have passed since the beginning of the COVID-19 pandemic, and with many countries rolling out mass vaccination programmes, there is an end in sight for what has been a devastating public health crisis.

But with much of the attention being placed on COVID-19 vaccines, there is a concern that other vaccination programmes are being forgotten. As a result of lockdowns and social distancing measures, many health services have seen their capacities reduced. The opportunity for people to receive crucial life course immunisations has been severely affected.

A key focus of public health authorities and national governments now needs to be on ensuring that people receive the vaccinations which they may have missed during the pandemic. Statistics from the WHO suggest that over 25 million infants have missed out on receiving childhood vaccinations that would have otherwise been administered.[1] This presents a potential public health emergency with children starting school or socialising with others without being immunised. In London and New York, cases of polio have even re-emerged,[2] highlighting the dangers of complacency and not taking preventative measures to prevent diseases. One programme which has seen a particular drop in coverage is measles vaccination. Despite strides being made before the pandemic, first-dose coverage of a measles-containing vaccine has fallen 5% since 2019, while second-dose coverage has plateaued:

Figure 1: Global Measles vaccination coverage, 2017-2021[3]

Even before COVID-19, declines in measles vaccination were recorded in some parts of Europe due to hesitancy among parents and misinformation reducing confidence in the programme. Countries such as Romania recorded the highest number of measles cases in the EU in 2017[4] while achieving only 75% second-dose coverage.[5] Evidently, vaccination is an important tool in preventing severe disease in childhood populations, and there is a concern that a global fall in measles vaccination could see a rise in cases once again.

It’s not just children who have been put at risk from vaccine-preventable diseases. Millions of teenagers were unable to attend school during much of 2020 due to COVID-19 restrictions, meaning they were unable to receive information about human papillomavirus (HPV) vaccination or the vaccine itself. In the UK, HPV vaccination has dropped by more than 25% compared to pre-pandemic levels:

Figure 2: Annual UK HPV vaccine coverage (2 doses) by academic year, 2015-2021[6] (red line indicates the beginning of the COVID-19 pandemic)

Yet among older adults, uptake of some routine vaccinations has increased. For example, seasonal influenza (flu) vaccination has gone up since the beginning of COVID-19. Across Europe, there has been a gradual increase in uptake among over-65s over the past five years, with a sharp increase in some countries since 2020:

Figure 3: Seasonal flu vaccination uptake in over-65s, 2017-2022[7] [8]

Denmark and England have met the WHO’s 75% uptake target, with countries such as Ireland and Spain not far behind. Norway’s flu vaccine uptake in older adults has almost doubled compared to five years ago. Potentially, there is a lot to be said about the impact that COVID-19 has had on people’s awareness and attitudes towards flu and flu vaccination.

But beyond this pandemic, there is still a long way to when it comes to achieving better uptake across all vaccination programmes. If we want to achieve high levels of immunisation throughout the life course, we must ensure people of all ages have access to the vaccinations they need. To fill the vaccination void caused by COVID-19, governments need to make sure vaccination programmes are widened, communication is ramped up, and funding is sustained well beyond the pandemic.

Providing vaccines in locations other than medical settings is pivotal to ensure children and adolescents receive missed immunisations. One lesson that can be taken from the COVID-19 pandemic is the ease with which people were able to book a vaccination appointment, at a time and a place that suited them. Allowing parents to get their children vaccinated in places such as nurseries, schools, pharmacies, supermarkets, and other public spaces will make it more convenient and easier to access vaccines.

A renewed focus is also needed on ensuring HPV vaccination is rolled out in schools once more, and in countries where it is only offered to young women and girls, the programme should be expanded to male populations. With vaccination proving vital in curbing COVID-19 infections, the same awareness needs to be applied to other vaccine-preventable diseases: HPV is no exception, and universal recommendations are necessary to prevent HPV and HPV-related cancers in both male and female populations.

Broadening access to vaccination must also come with increased communication. National governments and healthcare stakeholders must work with civil society groups to ensure information is disseminated among local populations across all communities. Targeted communication that resonates with the individual and understandably explains the value of vaccination will help to encourage populations to get vaccinated.

Finally, increasing funding is critical to ensure better performance of existing programmes, as well as timely access to novel vaccines. As a proportion of national healthcare budgets, only 0.4% is spent on immunisation across the EU; only two countries spend more than 1% (Latvia and Luxembourg).[9] Funding should be increased to ensure that we are better prepared for the next pandemic and able to prevent more diseases through vaccination. The economic and social value of vaccination is enough of a reason to invest more: every €1 spent on immunisation can yield €4 in economic returns.[10]

The Immunisation for All Ages manifesto[11] sets out similar aims, calling for:

1. Prioritise immunisation throughout life as a key pillar of expanded prevention strategies and a central component of universal health coverage
2. Remove barriers to access for appropriate immunisation throughout life to ensure all people are protected and no one is left behind
3. Reduce inequities in timely, appropriate, and affordable access to immunisation throughout life

While we have a long way to go in ensuring better uptake of vaccination throughout the life course, what is clear is that vaccination has proven to be an effective way of protecting large populations and reducing the economic and social burden of disease. Vaccination is a key component of healthy ageing and is important for everyone – regardless of age. Beyond COVID-19, we must continue to remind people of the value of vaccination, ensure vaccines are easy to access and make sure governments commit to spending more on prevention.

COVID-19 has unravelled large swathes of the work achieved through immunisation, but it has also acted as a timely reminder about the importance of vaccination and the amazing value of vaccines. Now is the time to recognise this and take action.

What happens next?

ILC is currently conducting a programme of work on vaccine confidence in Central & Eastern Europe (CEE). As part of this project, we are looking to speak with stakeholders from the region to develop an informed policy report, outlining the challenges, opportunities and policy recommendations for CEE countries. We will also be hosting a roundtable discussion in Romania in April 2023. If you are interested in taking part in the project, please visit our programme page. This project has been made possible by an unrestricted educational grant from Pfizer and is being produced in partnership with the Coalition for Life Course Immunisation and the ILC Europe Network.

ILC’s Healthy Ageing and Prevention Index, which will be launched alongside the 76th World Health Assembly next year, aims to hold governments to account by ranking them on key healthy ageing indicators. Alongside the index, ILC is building a Coalition of expert stakeholders to influence change at the global and national level to ensure prevention is at the heart of global health policy. An important opportunity for us to engage world leaders on healthy ageing will be at the G20 Summit next year in India. If you would like to be involved in our global programme, please contact Arun Himawan, Senior Health Research Lead.

[1] https://www.who.int/news/item/15-07-2022-covid-19-pandemic-fuels-largest-continued-backslide-in-vaccinations-in-three-decades

[2] https://www.reuters.com/business/healthcare-pharmaceuticals/why-has-polio-been-found-london-new-york-jerusalem-how-dangerous-is-it-2022-08-15/

[3] https://immunizationdata.who.int/pages/coverage/mcv.html?CODE=Global&ANTIGEN=MCV2+MCV1&YEAR=

[4] http://atlas.ecdc.europa.eu/public/index.aspx

[5] https://immunizationdata.who.int/pages/coverage/mcv.html?CODE=ROU&ANTIGEN=MCV2&YEAR=

[6] https://www.gov.uk/government/statistics/human-papillomavirus-hpv-vaccine-coverage-estimates

[7] https://ec.europa.eu/eurostat/databrowser/view/hlth_ps_immu/default/table?lang=en

[8] https://www.gov.uk/government/statistics/seasonal-flu-vaccine-uptake-in-gp-patients-monthly-data-2021-to-2022

[9] https://www.tandfonline.com/doi/full/10.1080/14760584.2021.1905257

[10] https://ilcuk.org.uk/wp-content/uploads/2018/11/Adult-vaccination_a-key-component-of-health-ageing.pdf

[11] https://www.vaccines4life.com/vaccinet/database/immunisation-for-all-ages/