When President Juncker singled out vaccine preventable diseases in his September 2017 ‘State of the European Union’ speech, it opened up a vital opportunity for the EU institutions to show what they can do to protect and improve health and to demonstrate an awareness of the health challenges faced in every member state.
“In a Union of equals, there can be no second class citizens. It is unacceptable that in 2017 there are still children dying of diseases that should long have been eradicated in Europe. Children in Romania or Italy must have the same access to measles vaccines as children in other European countries. No ifs, no buts. This is why we are working with all Member States to support national vaccination efforts. Avoidable deaths must not occur in Europe.”
During European Immunization Week at the end of April 2018, the European Commission followed up with a suite of actions intended to improve vaccination coverage, including tackling access barriers and shortages. The package includes a Commission Communication on strengthening European cooperation and a proposal for a Council Recommendation (measures to be agreed by national Ministers) with the same focus. The European Parliament also adopted a resolution on vaccine hesitancy at the April 2018 plenary session.
Declining coverage over recent years has led to outbreaks of preventable diseases, including deaths, and particularly a resurgence of measles. Cases of measles in the EU more than tripled between 2016 and 2017, according to ECDC figures, as vaccination coverage slipped below minimum recommendations to ensure ‘herd immunity’. President Juncker recognised that Europe as a whole is failing its children, and particularly the most vulnerable, if we don’t act together. Older people are also particularly at risk from flu, which leads to 40,000 deaths every year in Europe, and yet vaccination rates remain below the coverage target, with trends pointing to a further decline in uptake. As the proposed Council Recommendation makes clear, Europe cannot even take for granted that polio has been permanently eradicated, until that’s achieved worldwide. Infectious diseases are not contained by borders – and neither is “fake news” regarding risks of vaccination – so it makes sense to work together to tackle the root causes throughout Europe.
Grasping the opportunity to discuss the benefits and (perceived) risks of vaccination at the European level also creates an opportunity to highlight the rigorous EU regulatory checks and balances which ensure that only safe and effective medicines are approved. As is so often the case in public health policy, today’s regulatory system is borne of earlier tragedies, to make sure that episodes like the Thalidomide scandal can never happen again. Given that the success of the regulatory framework can only be judged by the relative absence of such tragedies, the wider public might often take this vital safety net provided by the EU for granted.
Health workers are a welcome focus in the package, with an important recognition that investment is needed (by national governments) in increasing uptake of immunizations within the health sector, including continuous training to ensure health workers are well informed. This is essential to protect workers and the functioning of health systems as a whole, and therefore doubly important for patients and their families. The Communication recognises that health workers are a most trusted source of information for the general public, who can discuss concerns with patients and families and combat myths.
An issue that EPHA particularly highlighted is barriers to accessing vaccinations. In some EU countries, out-of-pocket payments and informal payments (even bribes) remain a real barrier to accessing any medical treatment, which keeps many people away from preventative programmes. We also pointed out the access barriers to healthcare in general which face marginalised groups, as revealed by EPHA’s recent survey of Roma communities, and the work of EPHA members including Medecins du Monde and Praksis with people without health coverage and refugees. We emphasised that low uptake in these groups can only be tackled by removing the barriers to accessing healthcare and that there are practical case studies of working with communities via health mediators, to assure them of their rights and allay specific concerns. The Commission has committed to “Identify the barriers to access and support interventions to increase access to vaccinations for disadvantaged and socially excluded groups” and the draft Council recommendation includes a focus on “community-based providers” to reach the most vulnerable.
The package also includes some very practical proposals, reflecting some suggestions from EPHA, for example exploring how EU funds can better support national and regional health service capacities, looking into the high cost of vaccines in some countries, enabling national governments to work together to build up emergency stocks, data sharing on coverage of different population groups to identify gaps, monitoring public confidence in vaccines, and exploring the potential of big data to monitor for any potential side-effects. Perhaps most noticeable to the public, there is a proposal to set up a electronic vaccination card, recognisable across the EU, as part of a broader push for electronic patient records. Meaning that vaccination records don’t get lost when travelling or moving between countries and health workers can easily check vaccination status.
Top-level EU interest and action on infectious diseases is a welcome signal. This raises expectations for overdue action on HIV, TB and Hepatitis, in line with the SDG target 3.3 to end preventable epidemics. Whilst recognising that the EU may not interfere with the way national governments run or fund their health services, this package shows the vital supporting role of the EU when it comes to common health threats. But there are other areas where the EU must also act to prevent even greater suffering and loss of life, notably chronic diseases and antimicrobial resistance (AMR), which are an even bigger cross-border challenge. Indeed the first point of the Parliament’s Resolution notes that vaccines could play a role in heading off the spread of AMR. The vaccination package must only be a first step: the case for action and urgency to tackle other causes of premature mortality are even stronger.