The study evaluated proposed changes to the U.S. childhood hepatitis B vaccination schedule that would affect infants born to women without hepatitis B infection. The baseline strategy was vaccination of every newborn. One alternative was deferred vaccination at two months for infants whose mothers did not have hepatitis B infection, consistent with an Advisory Committee on Immunization Practices recommendation from December 2025. The second alternative used shared decision-making for vaccination at two months among the same group, reflecting a Centers for Disease Control and Prevention proposal from January 2026.

Researchers from Massachusetts General Hospital and Harvard Medical School developed a Markov state-transition model to project the long-term consequences of the three strategies for one birth cohort of 3.6 million infants. The model compared universal vaccination at birth with vaccination deferred to two months and with a shared-decision-making approach at two months. It was not a clinical trial in which infants were assigned to vaccination schedules, and the reported results do not describe outcomes observed under either proposed policy.

The model used chronic hepatitis B infection acquired by age 20 as one principal outcome. It also assessed how many children would enter adulthood vulnerable to hepatitis B infection. Universal birth-dose vaccination served as the reference against which the two proposed alternatives were compared. The release did not provide uncertainty intervals for the reported percentage changes, so the results are best interpreted as projections for the specified strategies and modeled birth cohort rather than precise forecasts of what would occur nationwide.

Deferring the first vaccine dose until age two months for infants born to women without hepatitis B infection was projected to produce a 19% increase in chronic hepatitis B infections acquired by age 20 relative to universal newborn vaccination. This estimate applies to the cohort and policy specification evaluated in the model. The research summary did not report the absolute number of additional infections associated with the projected increase, so the percentage cannot be converted into a reported count of additional cases from the available evidence.

The shared-decision-making strategy yielded the largest projected difference from the birth-vaccination baseline. Under that approach, the model estimated an 83% increase in chronic hepatitis B infections acquired by age 20 compared with vaccinating all newborns. The analysis also projected that more than half of children entering adulthood would be vulnerable to hepatitis B infection. That estimate applies to the shared-decision scenario as modeled; it does not indicate that a majority of U.S. adults are currently vulnerable or that an implemented policy has already produced this outcome.

The contrast between the two alternatives is the central difference in the model results. Deferring vaccination to two months for the specified group was associated with a smaller projected rise in chronic infections, while making the same two-month vaccination contingent on shared decision-making was associated with a substantially larger increase. The release did not report the proportion of parents expected to accept or decline vaccination under the shared-decision strategy, nor did it provide the assumptions used to represent that decision process.

Within the three strategies examined, universal hepatitis B vaccination at birth produced the lowest projected number of chronic infections and the lowest projected adult vulnerability. The authors therefore concluded that universal birth-dose vaccination remained the most effective of the compared strategies for preventing childhood infections and reducing future vulnerability to the virus. This conclusion concerns the model’s comparison of vaccination strategies; the investigators did not directly observe policy outcomes or measure vaccine effectiveness through a prospective or randomized intervention.

The analysis is bounded by several features of the supplied study description. It covered one birth cohort of 3.6 million infants and focused on long-term outcomes through age 20 under specified vaccination policies. The research was a model projection rather than an evaluation of completed vaccination programs, and the news release did not quantify uncertainty around the 19% and 83% percentage changes. It also did not report the model’s full parameter set or provide results for other birth cohorts, regions or schedule scenarios.

The publication examines a specific set of federal policy changes to childhood immunization in the United States. Its scope was the projected effect of changing when or how the first hepatitis B vaccine dose is administered for infants born to women without hepatitis B infection, with chronic infection by age 20 and vulnerability upon entering adulthood as the reported outcomes. The findings quantify modeled differences among the strategies, but they do not establish the causal effects of an implemented policy because all three schedules were evaluated within a model rather than through direct observation of children assigned to each schedule.

The clearest supported result is that the model found a protective advantage for vaccination at birth within the strategies compared. Delaying vaccination to two months was projected to raise chronic infections acquired by age 20 by 19%, while shared decision-making at two months was projected to raise the same measure by 83%. These figures should not be confused with observed national infection trends, completed policy outcomes or clinical recommendations beyond the study. The peer-reviewed modeling article was scheduled to appear in Annals of Internal Medicine on October 20, 2026, following the American College of Physicians news release dated October 19, 2026.

Subject of Research: Modeled effects of proposed U.S. childhood hepatitis B vaccination policy changes on chronic infections by age 20

Article Title: Proposed changes to hepatitis B vaccination schedule could significantly increase infections, model suggests

Article References: Proposed changes to hepatitis B vaccination schedule could significantly increase infections, model suggests. Original publication (Bibliographic details unavailable.)

Image Credits: AI Generated

DOI: Not provided

Keywords: hepatitis B, childhood vaccination, birth-dose vaccination, chronic infection, US immunization policy, shared decision-making, Markov model, infectious disease, public health, Proposed, changes, hepatitis

Japanese encephalitis is a mosquito-borne viral encephalitis caused by a flavivirus transmitted predominantly by Culex mosquitoes, and it remains the leading vaccine-preventable cause of viral encephalitis in the Asia-Pacific region. An estimated 3 billion people living in 24 countries are at risk of infection. In 2019, an estimated 57,000 cases and 20,642 deaths occurred globally, with India contributing the largest share of the burden at 39.1 percent, followed by Bangladesh and China. Although most infections are asymptomatic, roughly one in 250 infected people develop severe neuroinvasive disease. Among those who develop encephalitis, case fatality rates range between 20 and 30 percent, and 30 to 50 percent of survivors are left with long-term neurological, cognitive, or psychiatric sequelae. Childhood vaccination therefore remains the cornerstone of prevention in endemic countries.

India’s Universal Immunization Programme relies on two inactivated Vero cell-derived vaccines. JENVAC, manufactured by Bharat Biotech, is derived from an Indian JE virus strain known as Kolar-821564XY, while JEEV, produced by Biological E, is based on the SA 14-14-2 strain that underpins several internationally used JE vaccines. Both are administered as a two-dose intramuscular schedule, with the first dose given at 9 to 12 months of age and the second at 16 to 24 months. Although individual states generally receive a single vaccine type for routine immunization, programmatic realities mean that some children inevitably receive a second dose of a different product. Until now, no trial had evaluated such mixed-product schedules under India’s routine two-dose program, and previous studies of JE vaccine interchangeability had mostly examined other vaccine platforms or shorter dosing intervals.

The trial was conducted between November 2023 and September 2025 at hospitals in Kolkata, Wardha, Bhubaneswar, Bibinagar, and Patna. Healthy infants aged 9 to 12 months attending immunization clinics were eligible, while those with severe malnutrition, systemic disorders, neurological conditions, or prior JE vaccination were excluded. A total of 937 infants were screened and 911 were randomly assigned in equal proportions to one of four schedules: JENVAC followed by JEEV, JENVAC followed by JENVAC, JEEV followed by JENVAC, or JEEV followed by JEEV. Randomization was performed centrally using a computer-generated permuted block sequence, and although the study was open-label, laboratory staff performing the immunogenicity assays were masked to treatment allocation. The trial was funded by the Indian Council of Medical Research, which had no role in the design, analysis, or reporting.

The vaccines themselves differ subtly in composition. Each 0.5 milliliter dose of JENVAC contained 5 micrograms of purified inactivated JE virus protein from the Kolar strain, adsorbed onto 0.25 milligrams of aluminum hydroxide with thiomersal as a preservative, whereas each dose of JEEV contained 3 micrograms of inactivated virus from the SA 14-14-2 strain with aluminum hydroxide. Participants received their assigned vaccine in the thigh alongside the routine vaccines scheduled at the same visits, including measles-rubella vaccine, fractional inactivated polio vaccine, and pneumococcal conjugate vaccine at the first visit, and measles-rubella and DPT booster at the second. Blood samples were collected before vaccination, after the first dose, before the second dose, and 28 days after the second dose.

The primary outcome was seroconversion, measured by the 50 percent plaque reduction neutralization test, or PRNT50, against a wild-type JE virus strain isolated during a large 2005 outbreak in Uttar Pradesh. Seroconversion was defined as a rise in antibody titer from below 1:10 to at least 1:10, or a four-fold or greater rise among children with detectable baseline antibodies. In the modified intention-to-treat analysis of 841 children with evaluable samples, seroconversion 28 days after the second dose reached 89.8 percent in the JENVAC-JEEV group, 90.2 percent in the JENVAC-JENVAC group, 90.9 percent in the JEEV-JENVAC group, and 89.2 percent in the JEEV-JEEV group. The differences between mixed and same-product schedules were small and their confidence intervals fell entirely above the prespecified non-inferiority margin of minus 10 percentage points, in both the intention-to-treat and per-protocol analyses.

Geometric mean neutralizing antibody titers followed the same pattern, climbing from around 2 before vaccination to between roughly 68 and 74 after the second dose across all four groups, with no meaningful separation between mixed and same-product schedules. Among children who were seronegative at baseline, seroconversion rates after two doses ranged from about 92 to 95 percent. Among the smaller subset who were seropositive at baseline, fewer met the strict four-fold rise criterion, but the overwhelming majority nonetheless remained seroprotected. In a randomly selected subset, responses were also tested against the two vaccine-homologous strains, and titers were generally higher against these than against the wild-type strain, particularly after the first dose, a pattern consistent with the strain-specific bias that earlier trials using homologous assays may have introduced.

Safety results were reassuring. Roughly 36 percent of children in each group reported at least one solicited adverse event within seven days of vaccination, with fever the most common, followed by runny nose and cough. The vast majority of events were mild and resolved without sequelae. Twenty participants experienced 23 serious adverse events during follow-up, but none was assessed as related to vaccination according to the World Health Organization causality assessment algorithm. A Data and Safety Monitoring Board oversaw participant safety throughout the trial, and written informed consent was obtained from a parent or legal guardian of every enrolled child.

One finding warrants attention: only about a third of children, between 34 and 41 percent, remained seroconverted just before receiving the second dose, roughly seven months after the first. This suggests a possible window of reduced antibody-mediated protection in the second year of life. Surveillance data from India’s Virus Research and Diagnostic Laboratory Network indicate that children aged 12 to 24 months accounted for 3.4 to 6.5 percent of JE cases diagnosed annually between 2014 and 2025, without an apparent increasing trend, but the trial’s authors note that age-specific incidence data are needed to determine whether the longer dosing interval increases risk. They emphasize that timely completion of both doses remains essential.

The public health implications extend well beyond immunology. In large-scale programs, children may not always receive the same product for both doses because of migration, stock availability, procurement cycles, or supply changes, and in the absence of interchangeability evidence, program managers might defer or withhold second doses unnecessarily. By showing that JENVAC and JEEV can be swapped without sacrificing short-term immunogenicity or safety, the trial removes a barrier to maintaining high two-dose coverage in endemic districts. The authors caution that immune responses were assessed only one month after the second dose, leaving the durability of protection after the extended-interval schedule an open question, and that cell-mediated immunity, which may contribute to protection, was not measured. Still, for the hundreds of millions of children living in JE-endemic Asia, the message from this trial is straightforward: whichever of the two licensed inactivated vaccines is available when the second dose falls due, it can be given with confidence.

Subject of Research: Interchangeability of two inactivated Japanese encephalitis vaccines in India's childhood immunization schedule

Article Title: Immunogenicity and safety of an interchangeable vaccination schedule of two inactivated Japanese encephalitis vaccines: a multicentric, phase IV, open-label, randomized controlled trial

Article References: Vivian Thangaraj, J. W., Reddy, H., Sapkal, G. N., Velusamy, S. K., Jain, M. A., Dwibedi, B., Kanungo, S., Kundapur, R., Pandey, S., Deshpande, G. R., Saritha, A., Kadavath, V., Kanagasabai, K., Maliye, C., Parida, S. P., Majumdar, A., Reddy, M., Singh, C., Lade, A. R., … Murhekar, M. V. (2026). Immunogenicity and safety of an interchangeable vaccination schedule of two inactivated Japanese encephalitis vaccines: a multicentric, phase IV, open-label, randomized controlled trial. eClinicalMedicine, 100, Article 104235. https://doi.org/10.1016/j.eclinm.2026.104235

Image Credits: AI Generated

DOI: 10.1016/j.eclinm.2026.104235

Keywords: Japanese encephalitis, JENVAC, JEEV, vaccine interchangeability, immunogenicity, PRNT50, non-inferiority trial, India, Universal Immunization Programme, flavivirus, childhood vaccination, vaccine safety

The stakes are considerable. Vaccination schedules recommended by the World Health Organization require doses at birth, six weeks, ten weeks, and fourteen weeks, with measles-containing vaccine delivered around nine months. Missing those windows leaves infants exposed during the most vulnerable months of life. Yet the study found that 55.83 percent of children in the sampled agricultural households were entirely unimmunised, a figure that underscores how far rural Nigeria remains from universal coverage. Even partial protection, the data showed, is unevenly distributed across households, and the reasons for that unevenness are social and behavioural as much as they are logistical.

To measure something as multifaceted as healthcare-seeking behaviour, the researchers turned to multiple correspondence analysis, a statistical technique related to principal component analysis that is designed for categorical data. Rather than collapsing a mother’s behaviour into a single yes-or-no indicator, the method allowed the team to combine several dimensions of maternal healthcare use into a continuous index. Those dimensions included whether the mother received prenatal care, how early in pregnancy she made her first antenatal visit, how many antenatal visits she attended, whether a skilled attendant was present at delivery, and whether she received postnatal care after childbirth. The resulting index ranged across households and averaged 0.54, which the authors characterise as moderate utilisation of maternal healthcare services.

That moderate average conceals a wide spectrum. At one end are mothers who attended the recommended four or more antenatal visits, delivered under the supervision of a trained health worker, and returned for postnatal checks. At the other are women who received none of these services, often because the nearest facility is distant, because farm work and childcare leave no slack in the day, or because the cost of a visit competes directly with household food and input expenses. The index approach matters because it treats healthcare-seeking as a pattern of behaviour rather than an isolated event, recognising that a woman who starts antenatal care early is also more likely to deliver with a skilled attendant and to bring her child forward for immunisation on schedule.

For the core analysis, the team employed an extended ordered probit model, a regression framework suited to outcomes that fall into a natural sequence. Vaccination status was ordered from no vaccination, through partial vaccination, to full vaccination, and the model estimated how each explanatory variable shifted children across those categories. The extension of the model allowed the researchers to account for the structure of the survey data and the possibility that unobserved household characteristics influence both maternal behaviour and child health outcomes. This is a more demanding test than a simple comparison of averages, because it asks whether the association between maternal healthcare use and vaccination holds once other factors are held constant.

The results were revealing in their specificity. Maternal healthcare-seeking behaviour, measured by the index, significantly improved the probability that a child would be partially vaccinated, meaning the child had received some but not all scheduled doses. Husband’s education also emerged as a significant driver of partial vaccination, a finding that points to the influence fathers exert over household health decisions in these communities. For the stricter outcome of full vaccination, the significant predictors were husband’s education and the mother’s full-time employment in agriculture, the latter being associated with improved full vaccination status. That last result is counterintuitive at first glance, since full-time farm work might be expected to compete with clinic visits, but it may reflect greater household resources, autonomy, or exposure to health information among women who work continuously in the agricultural economy.

The mechanism linking maternal care to child immunisation is straightforward but powerful. Antenatal visits are among the few reliable points of contact between rural mothers and the formal health system, and each contact is an opportunity for counselling on vaccination schedules, for the distribution of immunisation cards, and for building the trust that brings a mother back with her infant. A woman who delivers with a skilled attendant is physically present in a facility at a moment when birth doses of vaccines can be administered and follow-up appointments can be arranged. Postnatal care extends that contact into the critical early weeks. In effect, the healthcare-seeking index captures the density of a mother’s connections to the health system, and the study shows that denser connections translate into more vaccinated children.

The prominence of husband’s education carries its own policy weight. In many rural Nigerian households, decisions about spending money, travelling to a clinic, or allocating a woman’s time are made jointly or by the male head of household. An educated father is more likely to understand the value of immunisation, more likely to support the costs and logistics of a clinic visit, and more receptive to health messaging. The finding suggests that interventions aimed only at mothers may miss half of the decision-making structure, and that male involvement, which the authors highlight explicitly in their conclusions, could be a lever with outsized returns.

The authors argue that strengthening policies promoting maternal healthcare utilisation is essential, and they point to specific delivery channels: community-based and market-based health centres that sit closer to where agricultural families already gather. Bringing antenatal and vaccination services into markets and village centres reduces the transport and time costs that fall hardest on farming women, whose labour schedules are dictated by planting and harvest seasons. Outreach timed around agricultural calendars, integration of immunisation with antenatal and postnatal contacts, and engagement of male partners through community and religious structures all follow naturally from the study’s evidence base.

Limitations remain, as they do in any secondary analysis. The study relies on self-reported vaccination histories from the 2018 survey round, and recall of doses received years earlier can be imperfect even when vaccination cards are consulted. The cross-sectional design identifies associations rather than proven causal effects, however carefully the model controls for confounding. And the findings speak specifically to agricultural households in rural areas, a population that is large and underserved in Nigeria but not identical to the country as a whole. Still, the combination of a rigorous behavioural index, an ordered outcome model, and a nationally representative survey gives the conclusions unusual credibility for policy work. With more than half of children in these households receiving no vaccines at all, the study’s central message is hard to ignore: every point of contact a mother has with the health system is a point of contact for her child, and expanding those contacts, through accessible community services and the engaged support of fathers, may be one of the most direct routes to closing Nigeria’s immunisation gap.

Subject of Research: The effect of maternal healthcare-seeking behaviour on timely childhood vaccination among agricultural households in rural Nigeria

Article Title: Maternal healthcare-seeking behaviour and timely childhood vaccination among agricultural households in rural Nigeria

Article References: Adejoorin, M. V., Salman, K. K., Salawu, M. B., & Dairo, M. D. (2026). Maternal healthcare-seeking behaviour and timely childhood vaccination among agricultural households in rural Nigeria. BMC Pediatrics. https://doi.org/10.1186/s12887-026-07688-4

Image Credits: AI Generated

DOI: 10.1186/s12887-026-07688-4

Keywords: maternal health, childhood vaccination, Nigeria, agricultural households, healthcare-seeking behaviour, DHS survey, immunisation coverage, public health, antenatal care, rural health, ordered probit model, BMC Pediatrics

The study surveyed 1,734 caregivers of children under five years of age, using a questionnaire adapted from the World Health Organization’s Behavioural and Social Drivers, or BeSD, tool. This instrument is designed to capture not just whether a child is vaccinated, but the psychological and practical factors that drive vaccination behavior, including perceptions of service quality, social norms, and ease of access. The researchers selected one state from each of Nigeria’s six geopolitical zones, giving the survey a geographic breadth that reflects the country’s considerable diversity in culture, health infrastructure, and economic conditions.

A central methodological feature of the study was its measurement of socioeconomic status. Rather than relying on self-reported income, which is often unreliable in settings where much economic activity is informal, the team constructed a wealth index from household assets and living conditions using principal component analysis. Households were then ranked and divided into five socioeconomic quintiles, from the poorest twenty percent to the richest twenty percent. This approach, widely used in health equity research, allows researchers to compare health outcomes across the full wealth spectrum of a population and to detect gradients that would otherwise remain hidden.

The headline findings reveal a stark wealth gradient in access. Among caregivers in the poorest wealth quintile, 56.8 percent reported that accessing vaccination services was very easy, with a 95 percent confidence interval of 51.5 to 62.0 percent. In the richest quintile, that figure rose to 75.6 percent, with a confidence interval of 70.8 to 79.9 percent. In other words, caregivers in the wealthiest households were roughly twenty percentage points more likely to describe vaccination access as effortless than those at the bottom of the wealth distribution. The gap extended to affordability as well: 49.6 percent of the poorest caregivers said vaccination costs were very easy to afford, compared with 68 percent of the wealthiest, a difference that persists even though routine childhood vaccines themselves are typically provided free of charge through Nigeria’s immunization program.

Under-immunization followed the opposite gradient. Among all under-immunized children identified in the survey, 26.0 percent came from the poorest wealth quintile, compared with just 14.6 percent from the richest quintile. This means that children in the poorest fifth of households were substantially overrepresented among those missing vaccinations, a pattern that compounds existing disadvantage. Unvaccinated and under-vaccinated children face elevated risks of diseases such as measles, pertussis, and diphtheria, and clusters of under-immunized children can sustain transmission chains that threaten entire communities, including those with better overall coverage.

To move beyond simple descriptive comparisons, the researchers employed concentration indices, a standard tool in health economics for quantifying the degree to which a health outcome is distributed across the socioeconomic spectrum. For binary outcomes such as ease of access, they used the Erreygers-corrected concentration index, which corrects for the bounded nature of such variables and allows fair comparisons across studies. For ordinal variables, they used bounded concentration indices. The results were statistically unambiguous. Ease of access showed a concentration index of 0.035, significant at p less than 0.001, indicating a pro-rich distribution: the better the access, the more it was concentrated among wealthier households. Affordability showed a nearly identical index of 0.034, also highly significant. Under-immunization, by contrast, showed a negative concentration index of -0.048, with p equal to 0.005, confirming that the burden of incomplete vaccination was concentrated among the poor.

The directionality of these findings matters for policy. A pro-rich concentration index for access combined with a pro-poor concentration index for under-immunization describes a classic inequity trap: the children who most need the protective benefits of vaccination are precisely those whose families face the greatest barriers to obtaining it. Barriers for poorer households in Nigeria typically include longer travel distances to functional health facilities, unreliable service availability, out-of-pocket costs for transport and incidental fees, and opportunity costs of time lost from work or trading. Each of these weighs more heavily on a household with few resources, and the new study confirms that these burdens translate into measurable differences in immunization outcomes.

Nigeria’s immunization landscape provides important context for interpreting these results. The country operates an Expanded Programme on Immunization, administered through the National Primary Health Care Development Agency, delivering vaccines including the diphtheria-tetanus-pertussis-containing vaccine through primary health centers and periodic outreach campaigns. Despite decades of investment, national coverage has historically lagged behind targets, and progress has been uneven across regions and social groups. Previous studies have documented geographic disparities between northern and southern states and between rural and urban areas, but the new analysis adds a rigorous socioeconomic dimension, showing that even within the same zones, wealth itself is a powerful predictor of vaccination access and status.

The authors argue that reducing these inequities requires equity-focused immunization strategies that harness resources across all sectors, not just the health system. In practice, this could mean targeting the poorest quintiles with intensified outreach, removing informal costs at the point of service, compensating caregivers for transport, aligning vaccination sessions with market days to reduce opportunity costs, and systematically monitoring socioeconomic disparities so that adaptive strategies can be mobilized early. The study’s call for systematic monitoring is particularly significant: concentration indices can be recalculated with each new survey round, giving program managers a quantitative yardstick for whether equity is improving or deteriorating over time, and whether societal disruptions such as economic shocks or insecurity are reinforcing under-immunization among vulnerable groups.

The research was supported by the Alliance for Health Policy and Systems Research, with funding from the National Institute for Health and Care Research using UK international development funding, and it passed ethical review both at the University of Nigeria Teaching Hospital and in each of the six study states. Its message is ultimately one of both warning and opportunity. Nigeria will not close its immunization gap by improving average coverage alone; the averages conceal a persistent wealth divide that leaves the poorest children behind. By measuring inequity directly and embedding equity targets into immunization planning, health authorities can direct resources where they will save the most lives, ensuring that no child’s protection against vaccine-preventable disease depends on the size of their family’s wealth.

Subject of Research: Socioeconomic inequities in childhood vaccination access and under-immunization in Nigeria

Article Title: Pro-rich or pro-poor? socioeconomic inequities in under-immunization and access to childhood vaccination services in Nigeria

Article References: Agu, I. C., Ekwueme, C. N., Mbachu, C. O., Ezue, U. N., Obiobasi, I., & Onwujekwe, O. (2026). Pro-rich or pro-poor? socioeconomic inequities in under-immunization and access to childhood vaccination services in Nigeria. International Journal for Equity in Health. https://doi.org/10.1186/s12939-026-03046-z

Image Credits: AI Generated

DOI: 10.1186/s12939-026-03046-z

Keywords: childhood vaccination, Nigeria, socioeconomic status, health equity, under-immunization, concentration index, access to health services, wealth index, immunization policy, low- and middle-income countries, BeSD tool, primary health care

The scientific case for immunisation has never been stronger. Modelling of fifty years of the Expanded Programme on Immunization shows that vaccines have made a major contribution to improved survival and health worldwide. Recent evaluations of meningococcal B vaccines demonstrate how careful development, rigorous surveillance and real-world data can produce highly effective and safe products that substantially reduce severe childhood disease. Human papillomavirus vaccination has been associated with a substantial reduction in invasive cervical cancer risk, and rotavirus vaccination is recognised as a highly effective tool against severe gastroenteritis and hospitalisation in young children. The economic returns are equally striking: a recent American Academy of Pediatrics policy statement estimates that from 1994 to 2003 vaccination averted 500 million cases of vaccine-preventable disease, 32 million hospitalisations and 1.1 million deaths in the United States, saving 540 billion dollars in direct costs and 2.7 trillion dollars in indirect costs. European studies confirm similar reductions in disease and economic burden, and the World Health Organization has recognised that vaccines also curb antimicrobial resistance by preventing infections that would otherwise require antibiotics.

Yet the academy argues that this evidence base is being undermined by two interacting sets of barriers: access and acceptance. Access barriers include missed opportunities for vaccination during routine health visits, long travel distances and transportation costs in rural or underserved settings, weak follow-up and reminder systems, and limited timeliness in completing vaccine series. Socioeconomic position, maternal education and health literacy shape both the ability to navigate services and the capacity to interpret vaccination information. Marginalised and mobile groups, including migrants, refugees and displaced persons, face additional structural and administrative obstacles, fragmented care and legal and language barriers. Systematic reviews show that migrant and refugee populations in Europe often experience lower vaccination coverage than host populations, and recent register-based evidence among Ukrainian refugee children in Norway illustrates how mobility and incomplete records leave significant gaps in documented immunisation.

Acceptance barriers compound the problem. Parental confidence in vaccines varies between countries and communities and can be weakened by institutional mistrust, pandemic fatigue, inconsistent policy messaging and misinformation. In Europe, false claims are commonly amplified through social media, messaging applications and politicised narratives, gaining traction when families encounter access barriers, receive contradictory advice or perceive vaccine-preventable diseases as remote threats. The academy stresses that effective responses require far more than fact sheets: they demand social listening, pre-bunking and rapid correction of false claims, multilingual community engagement, trusted clinicians and community messengers, and transparent policy decisions visibly aligned with scientific evidence. Vaccine confidence, the paper argues, must be treated as a dynamic challenge that shifts with events rather than a static attitude to be measured once.

The consequences of these immunity gaps are no longer hypothetical. A comprehensive review in The New England Journal of Medicine documented a dramatic resurgence of measles, with more than 395,000 confirmed cases worldwide in 2024 and a further sharp increase in early 2025. Measles is emphatically not a benign childhood illness: it can cause encephalitis, post-infectious immune amnesia and subacute sclerosing panencephalitis, a devastating late complication. In the WHO European Region, more than 127,000 measles cases were recorded in 2024, double the number in 2023 and the highest figure since 1997, with children under five accounting for more than 40 percent of cases and 38 deaths reported. Pertussis has surged in parallel, with nearly 300,000 cases reported in the European Region in 2024, more than a three-fold increase on the previous year. Earlier joint statements by the European Commission, WHO Europe and UNICEF had already linked missed measles vaccination during and after the COVID-19 period to an up to sixty-fold increase in reported cases in 2023 compared with 2022.

The position paper sets out the cost of inaction in stark terms. Epidemiologically, clusters of susceptible children drive recurrent outbreaks, cross-border transmission and avoidable deaths. Individually, children who contract vaccine-preventable diseases may suffer acute illness, hospitalisation, long-term disability or death, along with interrupted education and psychological and financial burdens for families. Economically, outbreaks divert resources from routine care into emergency response, contact tracing, post-exposure prophylaxis and catch-up campaigns. At the system level, failure to invest in surveillance, digital records, workforce training and tailored communication perpetuates a reactive cycle in which gaps are detected late, responses are mounted under pressure, and the same vulnerabilities recur. Beyond the return of disease itself, the academy warns that inaction erodes trust and resilience in preventive child-health systems.

A central technical recommendation concerns documentation. Across Europe, increasing cross-border mobility makes reliable vaccination records essential, yet documentation remains fragmented, often non-digital and non-interoperable, making immunity gaps difficult to detect when children move between health systems. The academy calls for a pan-European digital vaccination-record standard: not a single central database, but an agreed minimum interoperable dataset, mapped to national schedules, protected by data-governance safeguards, and usable in routine care and catch-up vaccination, especially for mobile children and displaced families. It likewise urges expansion of national Immunisation Information Systems capable of real-time or at least quarterly coverage monitoring, detection of missed doses, automated reminders and recalls, and rapid outbreak response. Higher-resource systems may expand such infrastructure directly, while more decentralised or resource-constrained systems may need a staged approach beginning with a core dataset, regional pilots and paper-to-digital transition plans.

Measurement of behavioural barriers is another priority. The academy recommends embedding the WHO Behavioural and Social Drivers of Vaccination tools, the European Centre for Disease Prevention and Control’s 2025 social and behavioural science toolkit, and the Vaccine Barriers Assessment Tool into routine programme assessments, so that interventions are tailored to measured confidence, social norms, practical obstacles and trust rather than generic campaigns. It proposes a minimum monitoring framework tracking coverage for MMR, DTP, polio, HPV and other recommended vaccines by age, geography and equity strata, alongside timeliness, zero-dose and under-immunised children, stock-outs, outbreak incidence, reasons for under-vaccination and the proportion of vaccinators trained in evidence-based communication. Similar proposals have suggested that countries be assessed on their capacity to use social and behavioural data as a fourth indicator in the Joint External Evaluation tool.

Because vaccination is delivered by different professionals across Europe, the recommendations extend beyond paediatricians to general practitioners, nurses, school-health services, public-health teams and community health workers. Preventive paediatric care remains highly heterogeneous across the continent, and not all professionals involved in vaccine delivery have received formal immunisation training. The academy calls for structured education in vaccinology, contraindications, safety communication, motivational interviewing, culturally competent care and outbreak communication, drawing on the WHO Regional Office communication training module and the WHO Pocket book of primary health care for children and adolescents. On the contested question of mandates, the paper holds that compulsory vaccination can be ethically defensible only under strict conditions: when voluntary approaches have failed, disease risk is substantial, access barriers have been addressed, the measure is proportionate, time-limited and legally authorised, and medical exemptions and transparent monitoring protect public trust. Empathetic, patient-centred communication remains the first-line response, supported by narratives of preventable complications that illustrate, but never replace, scientific evidence.

The position paper concludes with a call to shift from high-level advocacy to measurable implementation. It urges harmonised Europe-wide surveillance, interoperable digital records, routine measurement of behavioural and access barriers, equity-focused catch-up schedules that screen for missed doses at primary-care, emergency, school-entry and adolescent contacts, and outreach to migrants, refugees, underserved urban districts and remote rural areas. It also warns that recent legal, regulatory and political shifts, combined with the spread of misinformation, have weakened long-standing protections for immunisation programmes, and that policy choices diverging from scientific evidence can rapidly undermine public health gains. Grounding its appeal in the WHO/UNICEF strategy for child and adolescent health adopted by all 53 Member States of the European Region, the academy frames the issue as a matter of children’s fundamental rights: every child deserves scientifically proven, safe interventions that protect them from avoidable harm. Protecting children today, the paper argues, safeguards the health, trust and resilience of future generations.

Subject of Research: Barriers to paediatric immunisation coverage and strategies to restore childhood vaccination rates in Europe

Article Title: Improving paediatric immunisation coverage rates: a position paper of the European Academy of Paediatrics

Article References: Dornbusch, H. J., Pana, Z. D., Torso, S. D., Hadjipanayis, A., Brierley, J., Karara, N., De Guchtenaere, A., Buttigieg, M., Grossman, Z., Kantor, I., Titomanlio, L., Wyder, C., Jullien, S., Craig, B. J., Pastore, R., Benes, O., Heininger, U., & Koletzko, B. (2026). Improving paediatric immunisation coverage rates: a position paper of the European Academy of Paediatrics. The Lancet Regional Health – Europe, 70, Article 101851. https://doi.org/10.1016/j.lanepe.2026.101851

Image Credits: AI Generated

DOI: 10.1016/j.lanepe.2026.101851

Keywords: childhood vaccination, vaccine hesitancy, measles, pertussis, European Academy of Paediatrics, immunisation coverage, digital vaccination records, misinformation, vaccine equity, public health, migrant health, Immunisation Information Systems