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