The European Health Union: Why a Shared Vision for Immunization beyond pandemic times is needed?
With discussions ongoing regarding the creation of a European Health Union, it is time to put routine immunization and other preventative services at the forefront of the pandemic recovery and post-pandemic European health systems. Immunization has a key role to play to protect EU citizens, now and in the future; vaccines are one of the most cost-effective public health interventions providing proven social and economic returns across all stages of life at both the individual and societal level.1 Apart from safe water, no other public health intervention has had a greater effect on overall mortality reduction and population health than vaccines.2
In response to the impact of the pandemic, EU Commission President Von der Leyen called on Europe to build a European Health Union in her 2020 State of the Union address. Efforts are underway to update and reinforce the mandates of the ECDC and EMA and create a new European Health Emergency Response Authority (HERA).
Investing in prevention including immunization can have a positive impact on the overall healthcare budget and, as seen with the COVID19 pandemic, on the economy and societal well-being. The public health impact of vaccination strengthens and sustains health systems, directly and indirectly. On average, EU member states spend less than 3% of their health budgets on prevention and less than 0.5% on immunization.3 Underinvestment in immunization programs leads to gaps in the fully reimbursed public immunization schedule and is one of the drivers of falling vaccination coverage rates. EU member states provide varying levels of access to vaccines through publicly funded programmes, particularly when it comes to adolescent and adult vaccines. Fewer countries achieved 95% coverage of the second dose of the measles vaccine each year between 2007-2017 leading to an increased number of cases and outbreaks across the region.4 Flu vaccination coverage rates across member states are well below the EU Council’s recommended 75% target, costing EU27 countries an estimated €190 to €226 million annually.5 Vaccination is an investment, with wider benefits that accrue across a lifetime. For example, every €1 invested in adult vaccination starting at age 50 would yield €4.02 of future economic revenue for the government over the lifetime of the person6.
Immunization budgets need to be dynamic, integrating demographics and new vaccines that may become available.
As the COVID-19 pandemic has made painfully clear, member states are all vulnerable to communicable disease outbreaks and cannot solve common challenges in silos. A more coordinated approach to strengthening and financing immunization programs that can deliver for EU citizens is needed.
The European Commission and the ECDC in particular can play this role of greater coordination and support to member states encouraging more sustainable and smarter immunization financing and other important public health programs with cross-border implications. Immunization financing decisions lie at the level of member states, however, as stated in Article 6 TFEU, the EU has a limited, supplementary competence in the area of the protection and improvement of human health. This competence enables the EU to adopt “actions to support, coordinate or supplement the actions of the member states”. This support and coordination could be strengthened by:
1. Establishing shared definitions:
Provide guidance for member states on what a sustainable and strong immunization program should entail. Establish a shared vision for national/regional preventative services that deliver efficiently as part of resilient health systems.
2. Collecting and sharing information on vaccine coverage rates across the life-course:
There is currently no structured approach to tracking vaccine coverage rates at EU level. Though studies are done to track changes in coverage for certain vaccines, the data collected cannot be easily comparable.
Efficient surveillance systems and detailed monitoring of vaccine coverage are vital to predict the risk of vaccines preventable diseases outbreaks.
The revision of the mandate of the ECDC is an opportunity to improve the monitoring of vaccination coverage by member states, develop initiatives and tools to expand vaccination coverage across Europe and improving the quality and availability of data.
3. Provide funding for structural investments:
Like the EU4Health programme, the Recovery and Resilience Facility (RRF) and others mentioned in recent policy documents such as Europe’s Beating Cancer Plan, EU funded instruments constitute an important step in accompanying structural changes at national level, in particular when aimed at strengthening prevention systems structures. The European Semester process could be the vehicle to encourage prevention in member states, building on the RRF spending now aligned with the country specific recommendations.
As the EU is putting resources together to recover and learn from the COVID19 pandemic, there is an opportunity to look at how sustainable immunization programs in a post-pandemic era could help deliver on the objective we are setting collectively: building a stronger and more resilient union, and a healthier and prosperous society.
1 World Health Organization. 2015. How to present the wider societal benefits of immunization. Copenhagen: WHO Regional office for Europe 2015. Accessed April 2021. Available at: www.euro.who.int/__data/assets/pdf_file/0020/281522/How-present-wider-societal-benefits-immunization-.pdf?ua=1.; Ozawa S, Clark S, Portnoy A, et al. Return on investment from childhood immunization in low- and middle-income countries,2011–20. Health Aff. 2016;35(2):199-207.
2 Pollard, AJ. 2007. “Childhood immunization: what is the future?” Arch Dis Child, vol 92:426-433
3 Pascaline Faivre, Goran Benčina, Rosanne Campbell, Sibilia Quilici, Nicolas Dauby, Goran Tešović, Paolo Bonanni & Rosybel Drury (2021): “Immunization funding across 28 European countries”, Expert Review of Vaccines, https://doi.org/10.1080/14760584.2021.1905257
4 ECDC Coverage reports. Accessed May 2021. Available at: www.ecdc.europa.eu/en/all-topics-z/immunisation-and-vaccines/vaccination-coverage.; WHO. 2019. “Measles – European Region”. Emergencies preparedness, response. Accessed May 2021. Available at: www.who.int/csr/don/06-may-2019-measles-euro/en/.
5 Preaud E, Durand L, Macabeo B, Farkas N, Sloesen B, Palache A, Shupo F, Samson SI, & Vaccines Europe influenza working group. 2014. “Annual public health and economic benefits of seasonal influenza vaccination: a European estimate”. BMC public health, vol 14(813). doi.org/10.1186/1471-2458-14-813.
6 Supporting Active Ageing Through Immunisation. Adultvaccination: a key component of healthy ageing. The benefits of life-course immunisation in Europe. Supporting Active Ageing Through Immunisation; 2018