In recent decades, the Netherlands has been heralded as a model for public health success, largely due to its National Immunisation Programme (NIP), which has offered free and voluntary vaccinations against thirteen serious infectious diseases since its inception in 1957. This comprehensive initiative dramatically lowered childhood and young adult mortality across the country, affirming vaccination as a cornerstone of disease prevention. However, emerging trends now reveal a worrisome decline in vaccination coverage among Dutch children, particularly for critical vaccines such as the diphtheria, tetanus, acellular pertussis, and inactivated poliovirus combination (DTaP-IPV) and the measles, mumps, and rubella (MMR) vaccines. While historically 95% of children born between 2008 and 2010 received these vaccines, recent birth cohorts from 2020 show a reduction with coverage falling to approximately 88–89%, marking a significant public health concern.
This downward trajectory in immunization rates was meticulously analyzed in a study by Pijpers and colleagues, recently published in Eurosurveillance. The team employed a robust retrospective cohort methodology leveraging multiple data sources encompassing over 2.3 million children born from 2008 through 2020. Their statistical analysis uncovered nuanced sociodemographic variables that contribute to diminishing vaccination uptake, including parental education levels, household income, and the parents’ migration backgrounds. These factors create complex social dynamics influencing vaccine acceptance and access, reflecting broader health inequalities within Dutch society.
By the age of two, the study reports that 94% of children, numbering over two million, had received the MMR vaccine, with 93% having obtained the DTaP-IPV vaccine. Among the 2.3 million children eligible for both vaccines, an overwhelming 97% exhibited matched vaccination status—they either completed both vaccinations or none at all. However, a small but significant minority displayed discordance; about 1.4% were vaccinated only for MMR, while 1.3% received only DTaP-IPV. Such discrepancies underscore the fragmented immunization compliance that challenges herd immunity and complicates public health efforts geared toward comprehensive coverage.
The decline observed in the Netherlands mirrors troubling European trends. Data from the European Centre for Disease Prevention and Control (ECDC) reveal a continental drop in coverage for the first dose of measles-containing vaccines, slipping from 95% in 2018 to 92% by 2022. Researchers attribute this drop to multifaceted causes, including reduced trust in vaccines and governmental institutions, rampant misinformation, and the amplifying effects of social media platforms. The COVID-19 pandemic further inflamed public skepticism and misinformation, eroding the foundations of vaccine confidence that previously sustained high coverage rates.
In the Netherlands, trust in governmental bodies, particularly among lower maternal education groups, has dipped beneath pre-pandemic levels. This decline correlates with decreased COVID-19 vaccine uptake, signaling a broader erosion of confidence that extends into routine childhood immunization programs. Parental attitudes toward the childhood vaccination have subtly shifted towards negativity post-pandemic, yet troublingly, the decline in coverage predates COVID-19, indicating persistent underlying societal issues that pandemic conditions exacerbated but did not exclusively cause.
The role of social media in shaping vaccine perceptions cannot be overstated. Qualitative analyses of Dutch Twitter activity in 2019 revealed the increasing prominence of anti-vaccine narratives. Exposure to selective and often misleading anti-vaccine content fosters and fortifies vaccine hesitancy. Unlike traditional media, social media’s decentralized and largely unregulated environment allows misinformation to spread rapidly and uncontrollably, bypassing scientific vetting and amplifying fear-based decision-making. This digital landscape presents a formidable challenge for public health communicators striving to convey evidence-based vaccine benefits.
The decrease in vaccination coverage is not evenly distributed across all demographic groups. Significant disparities appear among children of non-Dutch backgrounds, those who do not attend daycare, offspring of self-employed mothers, and residents of lower-income households. Specifically, children from Moroccan, Turkish, Dutch-Caribbean, and Surinamese backgrounds manifest markedly lower vaccination rates. These patterns are likely driven by intersecting barriers including language obstacles, differing cultural beliefs, and reduced access or familiarity with health infrastructure.
Deeper qualitative research offers valuable perspectives on the vaccination hesitancy experienced by migrant families. For example, a 2015 focus group study involving parents of Moroccan and Turkish origin identified tangible impediments such as difficulties comprehending NIP information, insufficient consultation time during healthcare visits, and logistical challenges in reaching vaccination centers. These findings emphasize that beyond attitudinal resistance, structural and communication gaps critically influence vaccine uptake among migrant populations.
Attending daycare has surfaced as another determinant influencing vaccination coverage. In the Netherlands, immunization is not mandatory for daycare entry; however, requests for vaccination proof are commonplace during enrollment. This informal pressure appears to positively sway parental decisions toward vaccinating their children, highlighting the protective role of structured social environments. Since close-contact settings like daycare facilitate rapid transmission of contagious diseases, reinforcing high vaccine coverage in these venues is essential to prevent outbreaks.
Interestingly, children from larger families, defined as those with four or more siblings, tend to have lower vaccination rates compared to children from smaller households. Part of this trend is attributed to the Orthodox Protestant communities, where vaccine skepticism remains culturally embedded and large families are more prevalent. Meanwhile, changing socioeconomic trends show an emerging shift in family size determinants, with higher maternal income increasingly associated with larger offspring numbers, complicating historical assumptions linking low income to larger family size.
Socioeconomic disparities in vaccination remain a persistent issue not unique to the Netherlands. Systematic reviews of high-income countries consistently reveal lower routine childhood vaccination rates among children from families with lower socioeconomic status. Unlike low-income regions where financial barriers dominate, in affluent societies, vaccine uptake disparities are more strongly linked to confidence, risk perception, and institutional trust. Economic inequality intersects with social determinants of health and psychological factors, indicating that policy responses must encompass more than affordability.
The implications of these findings are profound. The general decline in vaccination coverage coupled with widening inequities heightens the threat of localized outbreaks, especially in social clusters where unvaccinated children congregate. Such environments provide fertile ground for vaccine-preventable diseases to spread rapidly, undermining population-level protections. As Pijpers et al. note, an urgent call exists for future research focusing on the networks of unvaccinated individuals, aiming to quantify transmission risks and guide targeted public health interventions.
Reversing these troubling trends requires a multifaceted approach. Public health authorities must devise strategies that specifically address the social determinants impeding vaccine access and acceptance. Tackling misinformation aggressively, fostering transparent communication, and rebuilding institutional trust are paramount. Simultaneously, ensuring equitable and convenient access to vaccination services across all communities, including marginalized groups, can mitigate systemic barriers. Such concerted efforts will be vital to sustaining the health of Dutch children and safeguarding population immunity against the resurgence of preventable diseases.
The Dutch experience underscores a broader lesson for global vaccination programs: successes in immunization coverage are fragile and contingent on ongoing vigilance against social and structural challenges. Without proactive, culturally sensitive, and evidence-informed responses, health inequities may deepen, compromising the public’s health gains. The fight against vaccine preventable diseases, though anchored in scientific innovation, ultimately hinges on the social fabric’s trust and resilience.
Subject of Research:
People
Article Title:
The decrease in childhood vaccination coverage and its sociodemographic determinants, the Netherlands, birth cohorts 2008 to 2020
News Publication Date:
2-Oct-2025
Web References:
http://dx.doi.org/10.2807/1560-7917.ES.2025.30.39.2500251
References:
[1] Pijpers Joyce et al., Eurosurveillance, 2025;30(39):pii=2500251
[2] European Centre for Disease Prevention and Control (ECDC), Threat assessment brief, 2024
[3] Derksen E et al., COVID-19 vaccination behaviour report, Centraal Bureau voor de Statistiek, 2023
Keywords:
Health and medicine, Epidemiology, Health care, Human health, Public health, Vaccination, Mumps, Measles, Polio, Disease prevention, Immunization
