1. Introduction
1. On 20 May 2019, the Committee
on Social Affairs, Health and Sustainable Development tabled a motion for
a resolution on “Vaccine hesitancy: a major public health issue”.
Across the world, immunisation rates
are declining due, to a great extent, to misinformation spread by
anti-vaccination movements. To address this concern, the motion
stressed the importance of Council of Europe member States working
closely together in combating vaccine hesitancy through awareness-raising
and educational measures aimed at the general public. The motion
was referred to the committee for report, and Mr Igor Kagramanyan
(Russian Federation, NR) was appointed rapporteur on 13 September
2019. Following Mr Kagramanyan’s resignation from the Parliamentary
Assembly, Mr Vladimir Kruglyi (Russian Federation, NR) was appointed
as rapporteur on 22 September 2020. Mr Kruglyi ceased to be a member
of the Assembly, as a result of the exclusion of the Russian Federation
from the Council of Europe, and I was subsequently appointed rapporteur
on 17 March 2022.
2. On 9 February 2021, the Sub-Committee on Public Health and
Sustainable Development of the Committee on Social Affairs, Health
and Sustainable Development held a hearing entitled “Overcoming vaccine
hesitancy: strategies for parliaments and parliamentarians” with
the following experts: Ms Lisa Menning, acting Team Lead, Demand
and Behavioural Sciences, Department of Immunization, Vaccines and Biologicals,
World Health Organization (WHO), Ms Dolores Utrilla, Associate Professor
of Public Law at the University of Castilla-La Mancha, Spain and
Assistant Editor at EU Law Live, Mr Neil Datta, Secretary of the European
Parliamentary Forum for Sexual & Reproductive Rights, Ms Janne
Bigaard, Kræftens Bekæmpelse (Danish Cancer Society), Mr Robert
Kanwagi, World Vision programme co-ordinator for Ebola Vaccine Deployment,
Acceptance and Compliance and Civil Society Organisation Representative
to the COVAX (Covid-19 Vaccines Global Access) Demand working group,
and Ms Laurence Lwoff, Head of the Bioethics Unit of the Council
of Europe.
3. In the context of preparing this report, Mr Kruglyi conducted
a fact-finding visit to WHO Headquarters in Geneva, Switzerland
on 20 July 2021. There, he met with experts Ms Lisa Menning, Mr Tim
Nguyen and Ms Aleksandra Kuzmanovic, to discuss ways to ensure higher
vaccine uptake and overcome vaccine hesitancy. During his fact-finding
visit to Geneva, Mr Kruglyi and a representative from the Secretariat
also had the pleasure of meeting with Mr Gaudenz Silberschmidt,
Director on Health and Multilateral Partnerships, to discuss future
collaboration between WHO and the Assembly. On 6 May 2022, I had
online meetings with experts of the WHO Europe Office, Mr Siddhartha
Datta, Ms Siff Malou Nielsen and Mr Brett Craig, to learn more about
the Tailoring Immunization Programme (TIP). I very much appreciated
the input from the technical experts, which I have incorporated
into this report. I am also grateful for the assistance that WHO
has given us so far, and I am convinced that the visit to Geneva
and our work on this report is only the first step in this broader collaboration
between our two organisations.
4. The secretariat of the committee distributed a survey on vaccine
hesitancy through the European Centre for Parliamentary Research
and Documentation (ECPRD) network in the summer of 2020, receiving
37 replies all in all by the end of November 2020, from the parliaments
of the following member States: Albania, Andorra, Austria, Belgium,
Bulgaria, Croatia, Cyprus, the Czech Republic, Denmark, Estonia,
Finland, France, Georgia, Germany, Greece, Hungary, Iceland, Ireland,
Latvia, Lithuania, the Republic of Moldova, the Netherlands, Norway,
Poland, Portugal, Romania, the Russian Federation, San Marino, Slovenia,
the Slovak Republic, Spain, Sweden, Switzerland, Turkey, and the
United Kingdom. I am grateful for their collaboration on this important
topic.
5. The topic of vaccination has drawn considerable attention
due to the Covid-19 pandemic, proving that our global health security
requires improvements. Given recent developments and following discussions
with WHO, I suggest changing the title of the report to “Fighting
vaccine-preventable diseases through quality services and anti-vaccine
myth-busting”. Suboptimal vaccine coverage is a complex issue and
cannot be explained only by looking at vaccine hesitancy. Confidence
in vaccines and their uptake is influenced by a range of factors,
including easiness and convenience of getting vaccinated and other
social, economic, and cultural factors. I hope that the present
report will be a useful step in addressing inadequate vaccine uptake and
ensuring higher immunisation rates in Europe and in the world.
2. The history of vaccines and how they
work
6. Vaccination is a routine medical
intervention. To date, it remains the safest and most effective
method of protection against many infectious diseases. According
to WHO, it prevents 2 to 3 million deaths a year.
It is estimated that an improvement
in the global coverage of vaccinations could save a further 1.5
million lives.
7. The history of vaccines begins with the long history of infectious
diseases in humans. Evidence exists that inoculation against smallpox
was practiced in India and China over 2 000 years ago. The first
modern concept of vaccination as we know it, was developed by Edward
Jenner in 1796, as he successfully used material from cowpox pustules
to create protection against smallpox. Jenner’s innovation made
the practice widespread, and his method underwent medical and technological
changes over the next two hundred years.
The author of the modern scientific
approach to vaccination is Louis Pasteur, who invented a way to
prevent infectious diseases by introducing weakened pathogens into
the body. This method served as a breakthrough in medicine and gave
rise to a new era of immunisation, which made it possible to stop
deadly epidemics around the globe.
8. By 1900, the scientific world had developed five vaccines:
two human virus vaccines, one against smallpox and another against
rabies, and three bacterial vaccines against typhoid, cholera, and
plague. During the 20th century, other
vaccines were developed against what were once commonly fatal infections,
including pertussis, diphtheria, tetanus, polio, measles, and rubella,
as well as other communicable diseases. With the availability of
more vaccines, high-income countries began recommending routine
vaccination for children.
9. Between 2000 and 2015, the measles vaccine alone prevented
an estimated 20.3 million deaths, according to a joint report by
UNICEF, WHO, Gavi – the Vaccine Alliance – and Centers for Disease
and Control and Prevention.
It is further estimated that vaccines
against 10 major diseases have saved over 37 million lives in nearly
a hundred low- and middle-income countries since 2000. The study,
which was published in
The Lancet, estimates
that the numbers could double by 2030. Thus, there is no doubt that
vaccination is a crucial global health investment.
10. Vaccines work by preparing a person’s immune system, the body’s
natural defences, to recognise and defend itself against a specific
disease. Vaccines often contain weakened or inactive parts of a
particular micro-organism or toxin (antigen) that trigger an immune
response within the body. Newer vaccines contain the blueprint for
producing antigens, instead of the antigen itself.
The vaccine will prompt the immune
system to respond as much as it would on its first reaction to an
actual pathogen. Vaccination is therefore a safe and clever way
of preventing us from getting sick in the first place, rather than
treating the disease after it occurs.
11. When a sufficient number of people have been vaccinated, this
creates what is called “herd immunity”.
This implies that vaccines not only
protect the person who is vaccinated, but also other people who
cannot be vaccinated because of age, health conditions (namely,
immune deficiencies or allergies) or other factors. The people who
have been vaccinated act as a “buffer” between infected persons
and those who are vulnerable. Each individual vaccination is therefore
beneficial for society as a whole. The percentage of people who
need to be vaccinated to achieve herd immunity varies with each
disease and depends on the contagiousness of the virus. Thus, to
achieve herd immunity against influenza, 75% of the population must
be vaccinated against the disease, for measles this figure reaches
95% of the population.
12. Suboptimal rates of vaccine coverage are a threat to public
health, as society becomes more vulnerable, both with respect to
new diseases (for example, it appears that countries without universal
policies of BCG vaccination might be more severely affected by Covid-19
compared to countries with universal and long-standing BCG policies
) and to diseases that have previously
been under control but may resurge because of reduced immunisation.
In 2018, our continent saw a dramatic resurgence of measles, with
the total number of cases being the highest in the decade, due to
declining immunisation rates.
3. Vaccine
hesitancy
13. According to WHO, vaccine hesitancy
refers to the delay in acceptance or refusal of vaccination, despite the
availability of vaccination services. Hesitancy is often context-specific
and affected by how people think and feel about vaccines, vaccine-preventable
diseases, safety issues, other programmes concerns, social influences,
and anti-vaccination activism. In some settings, hesitancy is assumed
to be the cause of poor uptake, but closer study often reveals the
greater importance of factors such as accessibility, availability,
and quality of services.
While scientists and medical
doctors have spent the better part of the 20th century developing
reliable ways of combating diseases through vaccination, and relevant
services have been made more easily accessible, the number of people
getting vaccinated is currently in decline.
14. Today, suboptimal vaccine coverage is one of the most critical
issues in public health. This is illustrated by the resurgence of
diseases preventable by vaccination, as well as our dependency on
high immunisation rates for Covid-19 for seeing the end of the pandemic.
In 2019, the WHO ranked vaccine hesitancy as one of the top ten
threats to global health.
15. The first opponents of vaccines appeared at the same time
as the vaccines themselves – more than 200 years ago. In general,
the arguments of supporters and opponents of vaccination were the
same as they are now: the first group pointed to a significant decrease
in the incidence of diseases, the second ones – to possible side
effects, and were opposed to the State intervening in their private
sphere.
16. In 1998, The Lancet published
a study on autism by a British former physician named Andrew Wakefield in
which he falsely claimed to link the measles, mumps, and rubella
(MMR) vaccine to autism and colitis in children. The study was later
thoroughly debunked and resulted in The
Lancet formally retracting it in 2010. A few months later,
Wakefield was stripped of his medical licence. The General Medical
Council, the public body to maintain the official register of medical
practitioners in the United Kingdom, wrote that “the children that Wakefield
studied were carefully selected and some of Wakefield’s research
was funded by lawyers acting for parents who were involved in lawsuits
against vaccine manufacturers”. Additionally, there were reports
that Wakefield had a further conflict of interest in the form of
a patent for a single measles vaccine.
17. Today, we know that there is no link between vaccines and
autism or autistic disorders, something which has been demonstrated
in numerous studies conducted across the world in large populations.
Although Wakefield’s study was found to be seriously flawed and
fraudulent, its publication has unfortunately led to dropping immunisation
rates in some countries, and subsequent outbreaks of the three diseases
the MMR vaccine effectively and safely protects against. The most
commonly refused vaccines in our member States are the MMR vaccine
(in Azerbaijan, Cyprus, Poland, San Marino, the Slovak Republic,
and Turkey), human papillomavirus (Denmark, Estonia, Iceland, Ireland
and Latvia), rotavirus (Estonia and Finland), or other influenza
vaccines, according to answers received through the ECPRD questionnaire.
18. The answers received through the questionnaire further reveal
that most of the people who refuse vaccines, be it for themselves
or for their children, fall in the 25 to 40 age group. In other
countries, such as Finland, Latvia or the Slovak Republic non-vaccinated
people are usually young children whose parents are vaccine-sceptics.
A study on the global state of vaccine confidence revealed that
the European region has a higher-than-average percentage of negative
opinions on vaccine importance, safety, and effectiveness.
In fact, 7 of 10 countries with the
worst opinion on vaccine safety belong to this region. Furthermore,
vaccine hesitancy seems to be more present among younger generations.
Older generations tend to have more confidence in vaccines, as they
have witnessed the consequences of outbreaks of contagious diseases
and the way in which they have been combated through vaccination.
19. The same study points out that problems linked to religious
compatibility are not as present in Europe as in some other regions.
Europeans seem to be more concerned about the safety of vaccines
than about the risks of contracting infectious diseases. It remains
to be seen how these attitudes will be affected in the long-term
by the current Covid-19 pandemic.
20. In general, Western and Northern European countries tend to
express less concern about vaccine safety than Southern and Eastern
European countries, with France and Italy having the highest percentage
of vaccine scepticism. Trust towards health authorities appears
to be essential for higher vaccination rates.
Prior negative
developments in the health sector can therefore contribute to vaccine
hesitancy.
4. The
social and economic benefits of vaccination
21. Expanding access to immunisation
is crucial to achieving the UN Sustainable Development Goals (SDGs).
Vaccination reduces healthcare costs and loss of productivity for
the patients and the person caring for them. Not only do vaccinations
prevent sickness and death associated with infectious diseases,
they also contribute to broader gains in social and economic development;
by preventing illness, for example, immunisation may improve a child’s
cognitive skills, physical strength, and performance at school,
thus leading to increased productivity in the long term. Moreover,
by improving financial security and reducing risk, preventing illness
through vaccination may lead to increased investment and improved
political and economic stability.
22. People from lower socio-economic backgrounds have been found
to be disproportionately affected by vaccine-preventable diseases,
and vaccination has the potential to reduce this inequity. Equitable
vaccine uptake is needed to ensure that underserved and marginalised
communities benefit from vaccination services in the same way as
the rest of the population.
23. Health equity involves everyone being able to achieve their
full health potential, regardless of social position or other socially
determined circumstances. Policies which ensure high and equitable
vaccine uptake generate wider health, social, political, and economic
benefits. Moreover, immunisation can improve coverage of other health
interventions, as well as reducing poverty.
24. A study conducted by Johns Hopkins University in 2016
found that for every dollar invested
in vaccination in the world’s 94 lowest-income countries, US$ 16
was expected to be saved in healthcare costs, lost wages, and lost
productivity due to illness and death. Moreover, when including
broader benefits, such as the value that people place on living
healthier, longer lives and the long-term burden of disability,
the net return increases to US$ 44 per dollar invested, bringing
the overall economic benefit for the 2011–2020 period to more than
US$ 1.5 trillion.
25. Several international organisations have been set up and other
efforts have been made to ensure equitable allocation of vaccines
and to protect the world against infectious diseases. These include
the creation of Gavi, the Vaccine Alliance, in 2000, the Coalition
for Epidemic Preparedness, in 2017, as well as the development of
several action plans, resolutions, and immunisation agendas. The
global co-operation of these agencies together with WHO and UNICEF
was essential to provide a fast and equitable solution to vaccine development
and allocation when the Covid-19 pandemic hit the world.
26. WHO’s Immunization Agenda 2030 aims to address the challenges
related to vaccines over the next decade. The strategy for the Agenda
is to extend the benefits of vaccines to everyone, everywhere. It
is underpinned by four core principles: it puts people at the centre,
it is led by countries, it is implemented through partnerships,
and it is driven by data. The Covid-19 pandemic has laid bare the
fact that our global health security is only as strong as our weakest
link, and thus it is in the interest of us all to ensure a high
and equitable level of immunisation across the globe.
5. Ensuring
higher immunisation rates
5.1. The
right to health and ethical and legal considerations on mandatory
vaccinations
27. The right to health is a fundamental
part of our human rights and of our understanding of human dignity. Article
12 of the International Covenant on Economic, Social and Cultural
Rights recognises that everyone has the right to enjoy the highest
attainable standard of physical and mental health (12.1). Moreover,
States have a responsibility to take necessary steps to achieve
the full realisation of this right by the prevention, treatment and
control of epidemic, endemic, occupational and other diseases (12.2c).
The right to health is also enshrined in Article 11 of the European
Social Charter (revised) (ETS No. 163). It thus follows that States
have a responsibility to ensure public health and high immunisation
coverage.
28. There are difficult ethical and legal issues that need to
be considered when dealing with the issue of vaccine hesitancy and
suboptimal vaccine coverage. There are a range of initial steps
that can be taken to fully understand the exact reasons for low
confidence and uptake, and to then design and evaluate corresponding strategies.
Interventions may include better-tailored communications, community
engagement activities, and service quality enhancement to more adequately
meet the needs of specific populations. Member States must ensure
that measures are democratic and human-rights compliant.
29. In certain circumstances, with the persistent failure of non-coercive
strategies, there may be a need for more drastic measures to address
a sudden decrease in vaccination or other situations where public
health is dependent on an urgent improvement in vaccination coverage.
Following the resurgence of vaccine-preventable diseases and the
decrease in immunisation coverage across Europe, some member States
have imposed stricter measures such as mandatory vaccination programs
to tackle the problem. With Covid-19 specifically, some have also
made it mandatory to be vaccinated against the infectious disease
or to be in possession of a sanitary pass to access certain spaces.
30. Such measures have revived the debate around immunisation
coverage and fundamental rights. The legal implications of such
measures are complex, and often it will be the case that certain
rights and freedoms must be considered and balanced against each
other. Articles 8 and 9 of the European Convention on Human Rights
(ETS No. 5) enshrine the right to respect for private and family
life and respect for freedom of thought, conscience, and religion
respectively. Parents who refuse vaccination for their children
or other individuals who refuse vaccination often argue that mandatory
vaccination is a breach of their rights and freedoms as outlined in
these two articles.
31. These are, however, not absolute rights and can be limited
where it is prescribed by law, to pursue a legitimate aim which
is necessary in a democratic society. Among the reasons for interference
with these rights are the protection of health, whether it is individual
health or public health, and the protection of the rights and freedoms
of others. In the case of parents refusing vaccination of their
children, the right to health and the protection of rights and freedoms
must be recognised both for the child who remains unvaccinated because
of his or her parents’ refusal, as well as others in the community
who will encounter the unvaccinated child. As the refusal of vaccination
can have profound consequences and may put lives at risk, the exercise
of the rights provided for in articles 8 and 9 of the Convention
may be legitimately restricted.
32. In April 2021, the Grand Chamber of the European Court of
Human Rights delivered a much-anticipated judgement in Vavřička and Others v. the Czech Republic on
mandatory childhood vaccination, in which parents who failed to
comply, without good reason, with the legal duty to vaccinate their
children against nine diseases, were fined and their children were
not accepted in nursery schools. The Court clarified that, ultimately,
the issue to be determined was not whether a different, less prescriptive
policy might have been adopted, as had been done in some other European
States. Rather, it confirmed that States enjoy a wide margin of
appreciation when it comes to determining vaccine policies, which
in the Court’s opinion the Czech authorities had not exceeded. It
thus concluded that the measures could be regarded as “necessary
in a democratic society”.
33. Despite the Court’s judgement, when considering the necessity
of mandatory vaccination programs, I urge member States to rather
investigate the fact that the countries that enjoy the highest levels
of immunisation coverage do not operate with mandatory vaccination.
It seems that the legitimate aim sought by mandatory vaccination
programs, namely for States to reach higher levels of immunisation
coverage, and thus to protect the public health, can in fact be
accomplished by less-constraining measures.
34. In cases concerning mandatory vaccination for children, the
best interests of the child must be a primary consideration, as
confirmed also by the Court, and must be used as a legal principle
of interpretation of other rights and freedoms. One must also evaluate
the child’s own right to health and to the impact of any sanctions and
exclusions that the child may endure because of his or her parents’
choice of refusing vaccination. In doing so, one must take into
account the health risks that a child may be exposed to if he or
she remains unvaccinated, and moreover that a child may be put in
a vulnerable situation following sanctions such as exclusion from
schools, kindergartens and other public spaces. Member States should
review their legislation to allow children to be vaccinated in their
best interest in situations where one or both parents are against
such vaccination, including by ensuring that the right of children
to be heard on all matters concerning their own health is duly taken
into account, in accordance with their age and maturity.
5.2. Promoting
non-partisan continuity in vaccination policies and accelerating
efforts to fight misinformation and false information on vaccines
through evidence-based and transparent communication
35. Vaccines have historically
been highly regulated by governments, recommended by governments
and sometimes even required and mandated by governments. Thus, guidance
and information from trusted sources are fundamental to ensure high
immunisation rates. I therefore note with concern that public debate on
vaccines has become highly polarised and politicised in recent years.
During the pandemic some member States have communicated important
information on vaccines almost exclusively through government officials. Given
that health care workers are some of the most trusted sources in
regard to vaccination, such an approach could risk reducing important
public health decisions which are meant to save millions of lives
to a question of politics. Member States should thus actively include
and follow advice from public health experts and health authorities,
such as national health institutions and WHO, in decision-making
processes and communication to the public, as well as promoting
non-partisan continuity in public health policies.
36. The spread of intentionally false and misleading information,
in particular online, poses a serious threat to public health. We
have learned from the hearings held with experts that antivaccination
groups tend to be better at reaching the undecided on social media
platforms, than the public authorities are. Facebook, Twitter, and
Google play an important role in the dissemination of fake news,
in particular because they connect ad placement to traffic.
The current organisation of the ad
tech industry, through the use of intermediaries, encourages the
spreading of false information, as businesses behind the advertisements
rarely know where their ads end up and thus indirectly fund intentionally
misleading and false information.
37. At the national level, governments should review the legislation
to place due diligence obligations on businesses within their jurisdiction
so that they do not contribute to and profit from the spread of
intentionally misleading and false information on vaccines, which
endangers public health. However, co-ordination at the international
level is also needed in order to hold platforms accountable. The
international community should thus come together and look at policies
and regulations to address this issue. This must, however, be based on
full respect for human rights and freedom of speech. As those who
intend to spread false and misleading information about vaccines
will find alternative ways of doing so, it is equally important
to build resilience and improve health literacy, including by working
with the education sector, and to ensure access to reliable and trustworthy
information to today and tomorrow’s generations.
38. In this regard, it is also worth mentioning the WHO experience,
as it works with social media platforms on targeted campaigns to
change perceptions and to improve knowledge. They conduct daily
monitoring of media and social media outlets to see what health-related
conversations are ongoing. This allows them to better address particular
issues. Based on topics that are trending, WHO then steps in with
advice to prevent misinformation from spreading, for example by
producing “myth busters”. There is a recognised need to invest in
a strong digital presence of trusted sources and voices from each
country. At the national level, I think that our member States have
a lot to learn from this approach, and we need to invest in more
research on digital behaviour.
5.3. Barriers
to vaccine uptake and practical measures to increase confidence
in vaccines
39. To better understand how to
combat vaccine hesitancy, as well as to ensure higher and more equitable vaccine
uptake, it is essential that we examine different reasons why some
people are hesitant towards vaccinating themselves and their children.
Better knowledge of who these people are will help us understand in
what way we should address their concerns and thus what the most
efficient ways of reaching out to these people are. The Tailoring
Immunization Programmes (TIP) of WHO Europe offers a model for population segmentation,
diagnosis of underlying causes of under-vaccination in hesitant
subgroups, as well as tailoring of interventions to address the
underlying factors.
40. The logic of the TIP approach is to first identify susceptible
or lower coverage population groups. The second step is to determine
barriers and drivers to vaccination. Importantly, the process closely
involves recipients of vaccination and their community representatives
as partners in the process, to contribute important insights, but
also harness their participation. In the third step, this insight
is then used to design evidence-based interventions for high and
equitable vaccine uptake. By promoting high and equitable vaccine uptake,
TIP processes contribute to the achievement of no less than 14 out
of the 17 UN SDGS.
41. WHO does not yet have data on the effect of the Covid-19 pandemic
on attitudes to vaccination. Some few preliminary insights may indicate
that there has been a decrease in uptake of routine immunisation. However,
during my fact-finding meeting with the WHO Europe Office, it was
noted that this may not necessarily indicate an increase in hesitancy,
as many healthcare services were disrupted due to the pandemic.
This issue will have to be further explored by conducting insights
studies. Based on data on Covid-19 vaccination so far, there are
different barriers among different population groups (namely, older
adults and those with underlying conditions, pregnant women, rural
residents, etc.). When planning activities and measures to increase
confidence and uptake in vaccines, member States should use the
insights in the second step of the TIP approach to ensure they are
tailored specifically for the population groups in question.
42. Apart from hesitancy, there may also be practical issues influencing
uptake, such as easiness and convenience of getting vaccinated.
This may include supply, ease of access and cost of vaccines. It
is important to differentiate between these drivers so that strategies
can be targeted to the different problems or barriers, and therefore
contribute to closing gaps and increasing vaccine uptake. Hesitancy
could become a tempting explanation for low uptake when authorities
seek to deflect attention from health system problems. Focusing
only on hesitancy may also mistakenly place responsibility on populations
to be “less hesitant”, rather than on programmes and systems in
our member States to become more accessible and trustworthy. Some of
the countries with low immunisation coverage, such as Romania, lack
vaccine supplies.
43. We should strive to create an enabling environment by reducing
barriers and making it easy, quick and, ideally, free to get vaccinated.
This recognises that sometimes reluctance or resistance may actually
be a response to the burdens or inconvenience of getting vaccinated
or poor experiences at the point of vaccination. As underlined by
our colleague Ms Jennifer De Temmerman (France, ALDE), in her report
entitled “Covid-19 vaccines: ethical, legal and practical considerations”,
engagement with non-governmental
organisations, trusted persons within communities and other local
efforts in developing and implementing tailored strategies to support
vaccine uptake is of utmost importance.
44. Further to this, it is of utmost importance that our member
States build strong health systems and offer universal health care
for their populations. Through the analysis of the ECPRD questionnaire,
for example, it became apparent that the fact that vaccines are
not covered by State healthcare in all member States is a concrete
barrier to ensuring higher vaccine uptake. Moreover, it is not sufficient
to look at only demand and supply of vaccines. Going through all
the different technical components of immunisation programmes, including
planning, training on safety and management, is indispensable in
this regard. Member States should make full use of the technical
assistance of WHO both through the TIP programme and various online
tools. Member States may also look at the practical recommendations
and strategies proposed by the former Council of Europe Committee
on Bioethics (DH-BIO) (now the Steering Committee for Human Rights
in the fields of Biomedicine and Health (CDBIO)) on equity in access
to vaccines
and
health literacy.
45. Insufficient awareness of the need for vaccination and doubts
about the safety of immunisation (for instance fear of the occurrence
of adverse events in the post-vaccination period) are among the
reasons for refusal of carrying out routine immunisation. Open and
transparent dialogue and communication about uncertainties and risks,
including around the safety and benefits of vaccination, are important
for building confidence in vaccines and thus increasing motivation
and ensuring higher vaccine uptake. In this regard, it is important
for member States to have in place independent vaccine injury compensation
programmes, to ensure compensation for undue damage resulting from
vaccination, in line with Article 24 of the Convention on Human Rights
and Biomedicine (ETS No 164, Oviedo Convention).
46. Acknowledging that not everyone has the same level of scientific
literacy, we need to put more efforts into making correct information
available to everyone, including by translating technical language
in a way that can be understood by the public and which is culturally
appropriate. Moreover, important public health information should
be made available also in non-official languages, so as to ensure
that those who are not proficient enough in the national language(s)
have access to the same information. WHO has developed several online
trainings for healthcare workers and others in order to more effectively
communicate on the risks and benefits of vaccination, building trust
and having conversations in this respect with patients and caregivers.
47. When it comes to child vaccination, healthcare workers should
be able to spend more time with parents, both before and after the
birth of the child, to discuss with them any concerns that they
may have regarding vaccination. This would allow parents to be better
informed about the risks of not vaccinating their children. Such
support is likely to improve parents’ trust in public health authorities
and to improve vaccination rates. Other effective measures include
using mass media to inform parents about the need for immunoprophylaxis, as
well as investing more in educational measures for the younger generation
(future parents) by integrating knowledge on the benefits and necessity
of vaccination in education, including primary school, to build
social acceptance and foundational knowledge.
48. Special attention should be paid to the training of doctors
of all specialties on immunoprophylaxis in medical universities.
It seems appropriate to introduce Immunoprophylaxis as an independent
discipline into the curricula of students studying in all medical
specialties. Within the framework of conferences and congresses
on epidemiology, it is necessary to organise schools on immunoprophylaxis.
6. Concluding
remarks
49. The resurgence of vaccine-preventable
diseases in the European region is alarming. To date, vaccination
remains the safest and most effective method of protection against
infectious diseases, preventing millions of deaths each year. Moreover,
vaccinations contribute to broader gains in social and economic development
and expanding access to immunisation is crucial to achieving the
UN Sustainable Development Goals.
50. In order to ensure higher immunisation rates, member States
should first and foremost use awareness-raising activities, educational
measures and enhancements to service quality that are democratic
and human rights compliant.
51. Suboptimal vaccine coverage is a complex issue and cannot
be explained only by looking at vaccine hesitancy. Confidence in
vaccines and their uptake are influenced by a range of factors,
including easiness and convenience of getting vaccinated and other
social, economic, and cultural factors. We should strive to create an
enabling environment by reducing barriers and making it easy, quick
and, ideally, free to get vaccinated. Building stronger health systems
and ensuring that vaccines are covered by State healthcare are important factors
in increasing equitable access to vaccines for all population groups.
52. Sufficient time and resources must be invested in order to
acquire better knowledge of who is hesitant towards vaccinating
themselves and their children, and their concerns must be listened
to in order to develop and implement tailored strategies for specific
population groups. In this regard, engagement with non-governmental
organisations, trusted persons within communities and other local
organisations is of utmost importance.
53. Transparent communication on the risks and benefits of vaccination,
training of healthcare workers, and strengthening health literacy
are all indispensable measures that member States must prioritise.
Healthcare workers should be able to spend more time with parents,
both before and after the birth of the child, to discuss with them
any concerns that they may have regarding vaccination. The spread
of intentionally misleading and false information, in particular
online, poses a serious threat to public health. At national levels
member States should invest in more research on digital behaviour
and accelerate their efforts in dissemination of information on
social media platforms. At the international level, States should
come together to look at policies and regulations that would hold
platforms and other actors profiting from the spread of dangerous
misinformation accountable.