Vaccinations are one of the most important tools of primary prevention. All countries in the European Union (EU) have a long tradition of implementing vaccination programmes. The level of control over diphtheria, Haemophilus influenzae type b (Hib) infections, hepatitis B, polio and tetanus is excellent in many countries. The burden of measles, mumps, rubella, and pertussis decreased dramatically over the last decades, but there is still room for improvement in those programmes in many EU countries. Strong efforts are being made to accelerate the implementation of newly introduced vaccines against pneumococcal, meningococcal and human papillomavirus disease.
In the presence of such a large variety of vaccines on offer, the way vaccination programmes are organised differs considerably between countries. The vaccines included in the programme, the type of vaccine used, the total number of doses administered, and the timing of the vaccinations vary. Vaccines can also be offered in many different ways: usually, the vaccines included in the routine (childhood) vaccination programme are paid for by the national healthcare system, whereas in some countries other vaccines need to be paid for up front by the recipient. There are also large differences in whether vaccinations included in the national programmes are recommended or mandatory. Mandatory vaccination can be enforced by legislation, even though the term ‘mandatory’ has to be interpreted differently in different countries.
The Vaccine European New Integrated Collaboration Effort (VENICE) is a European network of experts working in the field of immunisation. All 27 EU Member States plus Iceland and Norway participate in VENICE. In each country a so called gatekeeper for VENICE is identified among the national experts in vaccine-preventable diseases. In 2007, VENICE conducted a survey on immunisation programmes. The survey also included some questions whether vaccinations were recommended or mandatory.
In total 15 countries do not have any mandatory vaccinations; the remaining 14 have at least one mandatory vaccination included in their programme. Vaccination against polio is mandatory for both children and adults in 12 countries; diphtheria and tetanus vaccination in 11 countries and hepatitis B vaccination in 10 countries. For eight of the 15 vaccines considered, some countries have a mixed strategy of recommended and mandatory vaccinations. Mandatory vaccination may be considered as a way of improving compliance to vaccination programmes. However, compliance with many programmes in Europe is high, using only recommendations. More information about the diversity in vaccine offer at European level may help countries to adapt vaccination strategies based on the experience of other countries. However, any proposal on vaccine strategies should be developed taking into consideration the local context habits.