Proposal for a COUNCIL RECOMMENDATION on Strengthened Cooperation against Vaccine Preventable Diseases
Date: 2018-04-26
Institutions: Directorate-General for Health and Food Safety, European Commission
Subjects: EU Member State, access to information, cross-border cooperation, epidemic, infectious disease, information system, public health, research and development, vaccination, vaccine

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   EUROPEAN COMMISSION  Brussels, 26.4.2018  COM(2018) 244 final 2018/0115 (NLE)  Proposal for a COUNCIL RECOMMENDATION on Strengthened Cooperation against Vaccine Preventable Diseases {SWD(2018) 149 final}  
 
 
EXPLANATORY MEMORANDUM 

1. 

• 

CONTEXT OF THE PROPOSAL 

Reasons for and objectives of the proposal 

Vaccination  is  one  of  the  greatest  successes  of  medicine.  Vaccination  saves  lives, 
protects  our  societies,  reduces  illness  and  contributes  to  longer  life  expectancy. 
Before vaccines existed, many children would die young, or become crippled for life. 
Vaccination has led to the eradication of smallpox, near elimination of polio and has 
prevented countless deaths from many other diseases such as measles, diphtheria and 
meningitis. 

Worldwide,  every  year,  vaccination  prevents  2.7  million  people  from  contracting 
measles,  2  million  from  getting  neonatal  tetanus,  and  1  million  from  getting 
pertussis. In Europe, seasonal influenza vaccination prevents around 2 million people 
from getting influenza each year. 

And  yet,  as  mentioned  in  the  President  Juncker  State  of  the  Union  speech  of  13 
September 2017, today, in the European Union, children are still dying from diseases 
such as measles that can easily be prevented with vaccines. This is unacceptable.  

Vaccination programmes have become increasingly fragile; in the face of low uptake 
of vaccines, vaccine hesitancy, the increasing cost of new vaccines and shortages in 
vaccine production and supply in Europe. 

This proposal is a call for joint action to increase vaccination coverage and to ensure 
that everybody in the European Union has access to vaccination bridging inequalities 
and  gaps  in  immunisation.  The  genuine  questions  and  doubts  surrounding 
vaccination,  expressed  by  citizens  throughout  Europe,  signal  the  urgent  need  for 
Member States and the health community to recognise and respond accordingly. This 
proposal is a concerted effort to respond to such concerns.  

Several  EU  Member  States  and  neighbouring  countries  are  currently  facing 
unprecedented  outbreaks  of  vaccine-preventable  diseases,  due  to  insufficient 
vaccination  coverage.  In  2017  alone,  in  the  EU,  over  14,000  people  contracted 
measles - more than three times the number reported in 2016. In the past two years, 
50  persons  died  due  to  measles  and  two  due  to  diphtheria.  Europe  is  failing  to 
eliminate measles in line with agreed WHO targets. 

The risk of poliovirus reintroduction in the EU persists, putting the Union's polio-free 
status  at  risk.  Seasonal  influenza  vaccination  coverage  rates  remain  significantly 
below  the  75%  coverage  target  for  older  age  groups  set  out  by  the  2009  Council 
Recommendation  on  seasonal  influenza  vaccination.  In  fact,  seasonal  influenza 
vaccination coverage in older age groups has decreased in the past few years in the 
majority of EU Member States.  

While  national  vaccination  programmes  are  planned,  organised,  and  conducted 
differently across Member States, all EU countries are grappling with these common 
challenges: declining coverage, supply shortages and growing vaccine hesitancy.  

There  are  several  drivers  contributing  to  low  levels  of  vaccine  coverage  and 
preventable immunisation gaps: 

Vaccine  hesitancy  and  waning  confidence.  Misconceptions  about  vaccination  have 
shifted the public focus away from the benefits of vaccination, towards a distrust in 

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science and fear of possible side effects. There are a number of factors at play in this 
increased reticence: a lack of reliable information and, in some cases, distrust in the 
providers  of  available  information;  a  lower  acceptance  of  any  potential  risks 
associated  with  vaccines  administered  to  healthy  persons  (in  particular  children);  a 
lack  of  understanding  on  the  individual  versus  community  benefits  of  vaccination; 
and  media  controversies  on  vaccine  safety  fuelled  by  misinformation.  As  vaccine-
preventable  diseases  have  decreased  thanks  to  routine  vaccination  in  the  past, 
citizens are not sufficiently aware of the vital role of vaccination in saving lives and 
the risks of nonvaccination.  

Vaccination policies and programmes vary considerably between countries regarding 
the  selection  of  vaccines,  type  of  vaccine  used,  number  of  doses  administered,  and 
timing.  This  variance  between  Member  States  is  often  due  to  social,  economic,  or 
historical factors, or simply due to how the healthcare system is organised at national 
level.  However,  such  variances  across  countries  have  added  to  a  perception  of 
diverging  opinions  on  the  vaccines  themselves,  which  in  turn  contributes  to  the 
growing  levels  of  vaccine  hesitancy.  The  rapid  spread  of  disinformation  through 
online media and vocal vaccine deniers has also fuelled misconceptions. In addition, 
given  such  differences  in  national  vaccination  schedules,  citizens  who  live  in  a 
number  of  EU  Member  States 
in 
throughout 
understanding which vaccine to take when, which can result in children not taking all 
the vaccines they need. 

lives  face  difficulties 

their 

A  number  of  countries  are  also  facing  vaccine  shortages  due  to  both  supply  and 
demand  issues.  There is an industry disinvestment in  vaccines  in  the EU, allegedly 
due to a fragmented and partially unpredictable demand. In addition, legal difficulties 
persist  in  sharing  vaccines  across  borders  in  case  of  crisis.  At  the  same  time, 
production  capacity  is  limited  by  long  lead  times;  procurement  processes  remain 
cumbersome  and  inefficient  and  the  lack  of  forecast  planning  coupled  with  the 
variance of vaccination schedules render the demand unpredictable. Changes in the 
demography  of  the  target  population  due  to  migration  and  ageing  are  further 
hampering accurate forecast planning.  

As  a  result,  some  Member  States  are  experiencing  problems  with  vaccines 
availability  or  face  high  costs  of  vaccines  –  which  in  turn  means  that  national 
stockpiles  are  often  not  available  or  limited  in  scope.  In  this  context,  if  a  Member 
State is  not able to  control an outbreak on its own, in  the absence  of European  co-
operation  in  this  area,  such  outbreak  is  likely  to  spread  across  borders  to  other 
Member states, putting citizens' health and security at risk throughout the Union. 

There  are  also  challenges  related  to  research  and  development  of  vaccines. 
Substantial financial investment and expertise is needed for the development of new 
innovative  vaccines  and  the  improvement  or  adaptation  of  existing  ones  (e.g. 
improved  safety  profile,  adaptation  to  different  ages,  risk  groups  or  pathogens), 
which makes research and development much more complex, costly and risky. 

Finally,  on  the  resource  side,  there  are  constraints  linked  to  public  financing. 
Vaccination  currently  represents  a  minor  fraction  of  prevention  budgets  in  EU 
countries, accounting for up to 0.5% of the healthcare budgets and there is evidence 
that  spending  is  further decreasing. Spending  on  vaccination  should  be  regarded as 
an essential and smart investment in health, given its broader economic impact and 
societal value. 

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This  Council  Recommendation, 
is  aimed  at  strengthening  cooperation  and 
coordination between EU countries, industry and other relevant stakeholders to help 
increase  vaccination  coverage,  foster  the  possibility  of  alignment  of  vaccination 
schedules across the EU, promote vaccine acceptance, support vaccine research and 
development  and  strengthen  vaccine  supply,  procurement  and  stock  management, 
including  in  cases  of  emergency.  These  activities  should  ultimately  decrease  the 
incidence  of  vaccine  preventable  diseases  and  increase  the  health  prospects  of 
European citizens, and improve health security in the European Union as a whole.  

The  proposal  sets  out  recommendations  to  the  Member  States,  joint  actions  by  the 
Member  States  and  the  Commission,  and  welcomes  the  Commission's  intention  to 
carry our a number of initiatives, taking into account ongoing UN and other global 
health initiatives.  

The  Recommendation  envisages  a  possibility  of  establishing  a  European  Vaccine 
Information  Sharing  System  with  a  view  to  developing  guidelines  on  a  EU 
common  vaccination  schedule,  an  EU  vaccination  card  and  a  web-portal  with 
reliable updated information on the benefits and safety of vaccinations.  

Providing  possible  options  towards  developing  a  common  EU  vaccination  card 
would  ensure  the  continuty  of  immunisation  when  citizens,  in  particular  children, 
move from one Member State to another. Currently, the wide variety in vaccination 
schedules  and  recording  poses  practical  issues  for  effectively  tracking,  monitoring 
and  documenting  immunisation  history,  as  well  as  for  communication  between 
different  vaccine  providers  within  and  across  countries.  Key  issues  include: 
vaccination  documentation  in  national  language  only;  issues  around  recalling 
whether vaccinations were given and which doses; lack of recognition and ability to 
continue an immunisation series already initiated in the country of origin, especially 
if the child is in the middle of a vaccination course that is part of the schedule of the 
country of origin but not of the country of destination. A common EU card with an 
agreed core set of information for each vaccination could facilitate interpretation of 
vaccination records, facilitate movement of citizens and lower barriers to vaccination 
while providing both citizens and health providers with the relevant information they 
need  to  ensure that citizens are immunised against  vaccine preventable diseases. In 
the 2009 Commission stakeholder consultation on childhood vaccination, 87% of the 
respondents were positive towards having a common EU vaccination card.  

The  Recommendation  further  advocates  creating  a  virtual  data  warehouse  of 
vaccine needs and stocks which could enable Member States and the Commission 
to identify available stocks of vaccines in cases of outbreaks or severe shortages and 
to mutually exchange the surpluses. In addition, it envisages identifying the options 
for a physical stockpile of vaccines to be available in cases of serious outbreaks or 
global  shortages.  Furthermore,  it  foresees  a  Coalition  for  Vaccination  bringing 
together  representatives  of  healthcare  workers  associations  and  relevant  student 
associations to commit to increasing vaccination coverage in Europe.  

The  proposed  identification  of  options  for  a  possible  vaccine  stockpile  stems  from 
the fact that many EU Member States are experiencing shortages of routine vaccines. 
Each  Member  State  needs  to  have  preparedness  plans  in  place  and  hence  the 
Recommendation calls for improving forecasting processes. To assist Member States 
in  covering  short  term  shortages  as  a  result  of,  for  example,  disease  outbreaks, 
underestimating stocks or manufaturing disruptions or extraordinary events, such as 
an influx of  migrants, a concerted EU assistance  would be very beneficial. A 2015 

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risk  assessment  report  on  vaccine  shortages  by  the  European  Centre  for  Disease 
Prevention and Control concludes that vaccine shortages in the EU/EEA appeared to 
be more significant than in the past and concluded it is advisable for countries to plan 
for stockpiles  for routine programmes to avoid disruptions of immunisation in case 
of  future  shortages.  Member  States  have  already  requested  vaccines  from  the 
Commission  to  overcome  shortages  via  the  EU  Health  Security  Committee. 
However, the current EU health funding instruments do not enable the procurement 
of vaccines. For this reason, the Commission now plans to work with Member State 
experts and in dialogue with industry to identify options for a stockpile at EU level, 
also taking into account the call by the European Parliament on the Commission and 
the Member States to develop solutions to increase vaccine supply and availability, 
including arrangements for stockpiling vaccines.  

• 

Consistency with existing policy provisions in the policy area 

The  Council  Recommendation  on  vaccination  is  consistent  with,  and  builds  further 
upon, the existing policies in the area of vaccination. The Recommendation will aim 
to  set  out  policy  orientations  for,  and  better  coordination  of,  the  implementation  at 
Member  State 
the  Council 
recommendation  on  seasonal  influenza  vaccination  (2009),  the  Council  conclusion 
on childhood immunisation (2011) and the Council conclusions on vaccination as an 
effective tool in public health (2014). 

level  of  existing  policy 

instruments, 

including 

The  Recommendation  also  takes  into  account  the  report  on  the  implementation  of 
Decision 1082/2013 on serious cross-border threats to health (2015); the report of the 
high-level  hearing  on  the  implementation  of  the  Council  recommendation  on 
seasonal influenza vaccination (2015); the European Court of Auditors Special report 
28/2016 "Dealing with serious cross-border threats to health in the EU" (2016); the 
final  report  of  the  SANTE  high-level  workshop  "Seeking  new  partnerships  for  EU 
action on vaccination" (May 2017); Joint Procurement Agreement to procure medical 
countermeasures and the objectives of the Joint Action on Vaccination (start 2018), 
co-funded by the Health Programme. 

The  Recommendation  is  consistent  with  EU  actions  and  policy  in  the  area  of 
occupational  safety  and  health  and  with  the  principles  of  the  European  Pillar  of 
Social Rights, especially Principle 10 on health and safety at work and Principle 16 
on universal access to preventative and curative health care. 

• 

Consistency with other Union policies 

The  Recommendation  will  exploit  synergies  with  related  EU  actions  and  policies 
e.g.,  the  Agenda  on  Security,  the  2030  Agenda  for  Sustainable  Development,  the 
European  One  Health  Action  Plan  against  Antimicrobial  Resistance, 
the 
Communication on digital transformation of health and care, the Communication on 
online  disinformation,  current  and  future  EU  framework  programmes  for  Research 
and Innovation, and the European Structural and Investment Funds. 

2. 

• 

LEGAL BASIS, SUBSIDIARITY AND PROPORTIONALITY 

Legal basis 

A  high  level  of  human  health  protection  shall  be  ensured  in  the  definition  and 
implementation  of  all  Union  policies  and  activities  as  referred  to  in  Article  168(1) 
TFEU.  Union  action,  which  shall  complement  national  policies,  shall  be  directed 

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towards improving public health, preventing physical and mental illness and disease, 
and obviating sources of danger to physical and mental health. 

In  accordance  with  Article  168(6)  TFEU  the  Council,  on  a  proposal  from  the 
Commission may adopt recommendations for the purposes of that Article to improve 
public  health,  in  relation  to  in  particular  fight  against  major  health  scourges, 
monitoring,  early  warning  of,  and  combating  serious  cross-border  threats  to  health. 
Vaccine-preventable  diseases  are  considered  major  health  scourges.  The  Union 
action  in  the  field  must  respect  the  responsibilities  of  the  Member  States  for  the 
definition  of  their  health  policy  and  for  the  organisation  and  delivery  of  health 
services and medical care. 

• 

Subsidiarity (for non-exclusive competence)  

Vaccination programmes are the responsibility of Member States. However, vaccine 
preventable  diseases  are  not  confined  within  national  borders.  One  Member  State's 
immunisation weakness puts at risk the health and security of citizens across the EU, 
and all Member States are facing the vaccination challenges highlighted above. Due 
to  the  cross-border  nature  of  vaccine-preventable  communicable  diseases,  Member 
States have requested intensified EU level support, and stressed the need for common 
EU  action  and  more  coordinated  approaches  to  limit  the  spread  of  vaccine-
preventable diseases across borders.  

There is clear added value in strengthening cooperation among all relevant sectors at 
EU level, including health authorities, the vaccine industry, research and innovation, 
requires  engagement, 
and  healthcare  actors.  A  Council  Recommendation 
commitment and endorsement by the Member States. Moreover, Member States are 
broadly  united  on  the  benefits  of  vaccination  and  a  Council  Recommendation  will 
enable  the  presentation  of  a  joint  EU  position  reflecting  science-based  risk 
assessments  and  risk  management,  reducing  the  impact  of  vaccine  hesitancy, 
building  public  confidence  and  cooperation  and  improving  the  effectiveness  of  EU 
vaccine  research  and  development.  At  the  same  time,  it  respects  Member  States 
competence  for  the  definition  of  their  health  policy  and  for  the  organisation  and 
delivery of health services and medical care. 

Proportionality 

The proportionality principle is fully respected as the recommendations put forward 
are  limited  to  actions  within  the  respective  scope  and  mandates  of  the  European 
institutions and the Member States.  

Choice of the instrument 

The  instrument  appropriate  for  the  initiative  is  a  Council  Recommendation, 
providing  guidance  to  Member  States  on  how  to  strengthen  cooperation,  improve 
vaccination  coverage,  and  as  a  result,  reduce  the  impact  and  severity  of  vaccine-
preventable diseases. 

The  Recommendation  allows  the  EU  level  and  the  Member  States  to  work  further 
together to address the different dimensions of the problem at the appropriate level.  

The  key  added  value  of  a  Recommendation  is  to  call  for  action  and  galvanise 
political support to reboost policies and actions on vaccination and immunisation in 
Europe.  This  focused  approach  will  provide  the  necessary  political  visibility,  raise 
awareness  and  build  momentum.  Concerted  efforts  are  needed  from  all  Member 

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3. 

• 

States  and  stakeholders  to  boost  vaccine  coverage,  reduce  immunisation  gaps  and 
increase confidence and trust in vaccination. 

RESULTS 
CONSULTATIONS AND IMPACT ASSESSMENTS 

EX-POST 

EVALUATIONS, 

OF 

STAKEHOLDER 

Stakeholder consultations 

Several stakeholder consultations have been conducted to inform this initiative over 
the course of 2017 and in early 2018. This included an open public consultation and 
targeted meetings  with representatives of Member  States through  the Health Policy 
Platform.  

Specifically,  a  public  consultation  took  place  between  21  December  2017  and  15 
March 2018, during which 8,984 responses were received1.  

A  stakeholder  consultation  took  place  in  January  and  February  2018,  with  33 
responses to a questionnaire and six targeted meetings with healthcare professionals 
associations, international organisations, non-governmental organisations working on 
public health, the scientific community and the vaccine industry.  

There  was  a  clear  call  for  more  transparent  and  easily  accessible  information  on 
vaccination  in  general  and  in  particular  on  the  safety  and  potential  side  effects  of 
different vaccines. The pivotal role of healthcare workers in explaining vaccination 
to their patients was highlighted whilst at the same time the need for more emphasis 
on  vaccination  in  medical  curricula  and  continued  professional  training  was 
mentioned.  There  was  also  broad  agreement  that  vaccination  should  be  offered  in 
different settings and that there is a need to simplify the process.  

The  consultations  carried  out  showed  that  there  is  a  high  degree  of  Member  States 
interest in more EU-level action on this issue, while also showing the extent of the 
concerns expresed by those who refuse or who are reluctant to accept vaccination as 
well as who oppose mandatory vaccination in some societal groups.  

• 

Collection and use of expertise 

The Recommendation relies on a thorough scientific basis and expertise, a review of 
established  scientific  consensus,  an  analysis  of  current  vaccination  trends  derived 
from comparative data, and the results of a public and stakeholder consultation.  

The  collaboration  with  international  expert  groups,  such  as  the  World  Health 
Organisation’s  Strategic  Advisory  Group  of  Experts  on  Immunization  (SAGE)  and 
the European Technical Advisory Group of Experts on Immunization (ETAGE), and 
the  Global  Health  Security  Initiative  and  Agenda  processes  has  added  to  the  EU 
expertise. 

• 

Impact assessment 

No  impact  assessment  is  needed  for  this  initiative  as  it  will  not  introduce  new 
regulatory  requirements  beyond  what  already  provided  or  planned  through  relevant 
existing policy instruments. 

1 

https://ec.europa.eu/info/consultations/open-public-consultation-strengthened-cooperation-against-vaccine-preventable-diseases_en; 
Commission 
Staff Working Document. Synopsis Report Accompanying the Council recommendation on Strengthened Cooperation against Vaccine Preventable 
Diseases 

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• 

• 

Regulatory fitness and simplification 

Some  key  expected  impacts  stemming  from  this  Recommendation  would  be 
improved coordination within and among Member States and simplified monitoring 
and reporting criteria for vaccination and vaccine-preventable diseases.  

Fundamental rights 

The initiative strengthens the entitlement of the European citizens to preventive and 
curative  health  care  of  good  quality,  as  enshrined  in  the  European  Pillar  of  Social 
Rights.  

4. 

BUDGETARY IMPLICATIONS 

This  Recommendation  has  no  direct  financial  implications  to  the  EU  budget.  All 
work  related  to  Recommendations  aimed  at  the  Commission  will  be  carried  out 
within existing resources. 

5. 

• 

OTHER ELEMENTS 

Implementation plans and monitoring, evaluation and reporting arrangements 

The  Commission  would  monitor  implementation  in  the  Member  States  and  review 
the Recommendation in cooperation with the Member States and after consulting the 
concerned stakeholders, ensuring a sufficiently long period to evaluate the effects of 
the  initiative  after  it  has  been  fully  implemented.  The  effectiveness  of  the 
Recommendation  could  be  measured  on  the  basis  of  existing  and  new  data  and  of 
information gathered through Member States' reporting.  

At  the  same  time,  one  of  the  current  impediments  to  a  comparative  evaluation  of 
European  protection  against  these  diseases  is  the  absence  of  standardized  tracking 
criteria. More standardized criteria is needed to encourage Member States to collect 
and publish reliable – and comparable – statistics on vaccination.  

• 

Detailed explanation of the specific provisions of the proposal 

Points  #  1  to  9  of  the  Recommendation  are  for  the  consideration  of  the  Member 
States,  aim  to  accelerate  the  development  and  implementation  of  national  vaccine 
action  plans  to  meet  the  goals  and  targets  of  the  World  Health  Organization’s 
European  vaccine  action  plan.  There  is  also  specific  emphasis  on  measles 
vaccination given the current outbreak in Europe. The proposal recognises the need 
to  simplify  and  broaden  the  opportunities  for  vaccination  and  for  targeted  outreach 
towards  vulnerable  groups  in  order  to  close  immunity  gaps.  The  proposal  calls  for 
educational  authorities  to  strengthen  vaccination  training  in  medical  curricula  and 
continuous medical training for all health workers. It further highlights the need for 
increased  communication  and  awareness  raising  activities  on  the  benefits  of 
vaccination.  Exploiting  the  synergies  with  eHealth  and  digital  technologies  to 
establish electronic vaccination records for all citizens is also an important element 
of  the  proposal  that  would  be  included  into  the  information  exchange  between 
healthcare  providers  across  borders  in  the  context  of  the  work  of  the  eHealth 
Network.  

Points # 10 to 16 concern actions that the Commission intends to undertake in close 
cooperation  with  Member  States  and  include  aiming  at  establishing  a  European 
Vaccination  Information  Sharing  system  which  could  bring  together  related 

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vaccination  information  and  expertise  together  with  the  national  public  health 
authorities. Under this system, various stakeholders could come together to develop 
guidelines  for  a  possible  core  EU  vaccination  schedule,  share  common 
methodologies  for  monitoring  coverage,  and  launch  a  web  portal  with  transparent 
evidence  on  vaccines  benefit  and  risks  including  tracking  vaccine  myths  and 
misinformation. The proposal also highlights the need to strengthen the effectiveness 
of the exisiting Directive2 on health and safety at work which guarantees that health 
workers are vaccinated against specific diseases.  

Finally, to address shortages and increase supply, the proposal puts forward the idea 
of  creating  a  virtual  data  warehouse  for  Europe  on  vaccine  needs  and  stocks 
and  a  mechanism  for  mutual  exchange  of  vaccines  among  Member  States; 
identification of options for a physical vaccine stockpile in case of outbreaks or 
global  shortages  of  vaccines  and  envisages  working  with  industry  and  other 
stakeholders to improve EU manufacturing capacity of vaccines.  

Points  #  17  to  25  welcome  the  Commission's  intention  to  carry  out  a  number  of 
activities  including  presenting  options  for  a  common  EU  vaccination  card  with 
standardised  information  on  vaccination  history;  presenting a  report  on  the  State  of 
Vaccine Confidence in the EU is requested in addition to actions to better understand 
the  barriers  and  increase  access  to  vaccination  for  disadvantaged  and  socially 
excluded  groups;  convening  a  Coalition  for  Vaccination  with  associations  of 
European  healthcare  workers  and  relevant  student  associations  aimed  at  promoting 
vaccination  and  strengthening  partnerships  and  collaboration  on  vaccination  with 
international partners is another important element of this propsoal.  

2 

Directive  2000/54/EC  of  the  European  Parliament  and  of  the  Council  of  18  September2000  on  the  protection  of  workers  from  risks  related  to 
exposure to biological agents at work, http://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:32000L0054&from=EN 

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2018/0115 (NLE) 

Proposal for a 

COUNCIL RECOMMENDATION 

on Strengthened Cooperation against Vaccine Preventable Diseases 

THE COUNCIL OF THE EUROPEAN UNION, 

Having  regard  to  the  Treaty  on  the  Functioning  of  the  European  Union,  and  in  particular 
Article 168(6) thereof, 

Having regard to the proposal from the European Commission,  

Whereas:  

(1) 

(2) 

(3) 

Pursuant to Article 168 of the Treaty of Functioning of the European Union (TFEU), a 
high  level  of  human  health  protection  shall  be  ensured  in  the  definition  and 
implementation  of  all  Union  policies  and  activities.  Union  action,  which  shall 
complement  national  policies,  shall  be  directed  towards  improving  public  health, 
preventing physical and mental illness and disease, and obviating sources of danger to 
physical and mental health.  

In  accordance  with  Article  168(6)  TFEU  the  Council,  on  a  proposal  from  the 
Commission may adopt recommendations for the purposes of that Article to improve 
public  health,  in  relation  to  in  particular  fight  against  major  health  scourges, 
monitoring,  early  warning  of,  and  combating  serious  cross-border  threats  to  health. 
Vaccine-preventable diseases are considered major health scourges. 

Vaccination  is  one  of  the  most  powerful  and  cost-effective  public  health  measures 
developed  in  the  20th  century  and  remains  the  main  tool  for  primary  prevention  of 
communicable diseases.  

(4)  While vaccination programmes are the responsibility of the Member States, the cross-
border  nature  of  vaccine-preventable  diseases  and  common  challenges  faced  by 
national  immunisation  programmes  would  benefit  from  more  coordinated  EU  action 
and approaches to prevent or limit the spread of epidemics and diseases with a cross-
border dimension.  

(5) 

The  rapid  spread  of  disinformation  through  social  media  and  vocal  antivaccination 
activists have fuelled misconceptions that are shifting the public focus away from the 
individual and collective benefits of vaccination and the risks posed by communicable 
diseases,  towards  increased  distrust  and  fears  of  unproven  side  events.  Action  is 
needed  to  strengthen  the  dialogue  with  citizens  and  to  understand  their  genuine 
concerns  or  doubts  about  vaccination  and  to  adequately  address  those  according  to 
their needs. 

EN 

9 

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(6) 

(7) 

(8) 

(9) 

The insufficient vaccination coverage rates of healthcare workers3 and their adequate 
training  on vaccination  must  be  addressed to  ensure  their  own  -  and  their  patients’  - 
protection, in line with national recommendations.  

The  variation  of  vaccination  schedules  between  Member  States  with  regards  to 
recommendations, type of vaccines used,  number of doses administered, and timing4 
increases  the  risk  that  citizens,  in  particular  children,  miss  taking  a  vaccine  while 
moving from one Member State to another.  

The need to bring immunisation services closer to citizens requires dedicated efforts to 
reach  out  to  the  most  vulnerable  of  society,  in  particular  through  community-based 
providers  such  as  pharmacies  and  school  medical  programmes.  The  European 
Structural  Funds,  in  particular  the  European  Social  Fund  and  the  European  Regional 
Development  Fund,  offer  significant  opportunities  for  Member  States  to  strengthen 
vaccine-related 
the  health 
infrastructures capacities in the area of vaccination. 

the  healthcare  workers  and  reinforce 

training  of 

Demographic  changes, mobility  of people, climate change and  waning immunity  are 
contributing  to  epidemiological  shifts  in  the  burden  of  vaccine  preventable  diseases, 
which require vaccination programmes with a life-course approach beyond childhood 
years. This approach aims to ensure a lifelong adequate protection and contributes to 
healthy living and healthy ageing as well as the sustainability of healthcare systems.  

(10)  Vaccine  shortages  have  direct  consequences  for  the  delivery  and  implementation  of 
national  vaccination  programmes5;  Member  States  face  various  vaccine  supply 
disruptions6; production capacities in the EU remain limited7; and difficulties persist in 
sharing  vaccines  across  borders,  while  the  lack  of  coordinated  forecast  planning 
contributes to demand uncertainty. In this context, the European Union and its citizens 
remain vulnerable in case of outbreaks of communicable diseases. 

(11)  The need to rapidly advance research and development of new vaccines and improve 
or  adapt  existing  ones  requires  innovative  partnerships  and  platforms,  high-level 
expertise and stronger interlinks between disciplines and sectors, as well as investment 
in  social  and  behavioural  science  research  to  better  understand  context-specific 
determinants underpinning vaccine-hesitant attitudes. 

(12)  The  Council  Conclusions  on  Vaccination  as  an  Effective  Tool  in  Public  Health8 
already identify some of these key challenges and ways forward, and call on Member 
States  and  the  Commission  to  develop  joint  actions  to  share  best  practices  on 
vaccination policies. 

3

4

5

6

7

8

European Centre for Disease Prevention and Control. Seasonal influenza vaccination in Europe. Vaccination recommendations and coverage rates in 
the 
2017, 
seasons: 
https://ecdc.europa.eu/sites/portal/files/documents/influenza-vaccination-2007%E2%80%932008-to-2014%E2%80%932015.pdf  

EU  Member 

2014–2015. 

Stockholm: 

2007–2008 

influenza 

ECDC; 

States 

eight 

for 

to 

European Centre for Disease Prevention and Control. Vaccine Schedules in All Countries of the European Union Online Platform, https://vaccine-
schedule.ecdc.europa.eu/  

the 

EU/EEA 

European Centre for Disease Prevention and Control. Shortage of acellular pertussis-containing vaccines and impact on immunisation programmes 
in 
2016. 
ECDC; 
https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/RRA-shortage-of-aP-containing-vaccines.pdf  
WHO Regional Office for Europe, Dealing with vaccine shortages: current situation and ongoing activities. Impact of shortages and solutions set up 
by 
Meeting 
http://www.who.int/immunization/sage/meetings/2016/april/2_Benes_shortages_SAGE_Apr2016.pdf  

Stockholm: 

countries, 

February 

SAGE 

20016 

2016. 

April 

– 

2 

Vaccines Europe, The EU Vaccine Industry in Figures 2014, https://www.vaccineseurope.eu/about-vaccines/vaccines-europe-in-figures/  

Council  conclusions  on  vaccination  as  an  effective 
content/EN/TXT/PDF/?uri=CELEX:52014XG1206(01)&from=EN  

tool 

in  public  health 

(2014/C  438/04),  http://eur-lex.europa.eu/legal-

EN 

10 

  EN 

 
                                                 
 
 
 
 
 
 
(13)  The  Council  Conclusions  on  Childhood  Immunisation9  specifically  call  for  the 
refinement  of  immunisation  registers  and  information  systems  to  improve  the 
monitoring  of  vaccination  programmes  and  facilitate  the  exchange  of  information 
between vaccine service providers.  

(14)  The Commission Communication on the implementation of the Digital Single Market 
Strategy10 and the Communication on the eHealth Action Plan 2012-202011 recall the 
importance of the digital health agenda and the need to prioritise the development of 
eHealth  and  Big  Data  based  solutions.  These  initiatives  are  reinforced  by  the 
Commission Communication on enabling the digital transformation of health and care 
in the Digital Single Market12; empowering citizens and building a healthier society, to 
ensure modern and sustainable health care models as well as empowered citizens and 
healthcare workers. 

(15)  Directive 2000/54/EC13 on the protection of workers from risks related to exposure to 
biological  agents  at  work  lays  down  minimum  requirements  to  ensure  workers’ 
protection,  including  the  need  to  offer  vaccines  for  those  not  previously  immunised 
and  Directive  2010/32/EU  14implementing  the  Framework  Agreement  on  prevention 
from sharp injuries in the hospital and healthcare sector concluded by HOSPEEM and 
EPSU foresees that if the risk assessment reveals that there is a risk to the safety and 
health  of  workers  due  to  their  exposure  to  biological  agents  for  which  effective 
vaccines exist, workers should be offered vaccination. 

(16)  Decision  1082/2013/EU15  on  Serious  Cross-border  Threats  to  Health  provides  the 
basis  for  the  establishment  of  a  voluntary  mechanism  for  the  advance  purchase  of 
medical countermeasures for serious cross-border threats to health,. 

(17)  The  Council  Conclusions  on  Common  values  and  principles  in  European  Union 
Health Systems16 endorse the principles and overarching values of universality, access 
to  good  quality  care,  equity  and  solidarity,  which  are  of  paramount  importance  to 
ensure  equity  of  access  to  vaccination  services  regardless  of  age,  social  status,  or 
geographic  location,  in  accordance  with  national  and  regional  immunisation 
programmes. 

(18)  Regulation (EC) No 851/200417 mandates the European Centre for Disease Prevention 
and Control to support the prevention and control of communicable diseases and foster 

9

10

11

12 

13

14 

15

16

17

Council  conclusions  on  childhood  immunisation:  successes  and  challenges  of  European  childhood  immunisation  and  the  way  forward  (2011/C 
202/02), http://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:52011XG0708(02)&from=EN  

Communication from the Commission to the European Parliament, the Council, the European Economic and Social Committee and the Committee 
of the Regions on the Mid-Term Review on the implementation of the Digital Single Market Strategy A Connected Digital Single Market for All, 
COM/2017/0228, http://eur-lex.europa.eu/legal-content/EN/TXT/HTML/?uri=CELEX:52017DC0228&from=EN  

Communication from the Commission to the European Parliament, the Council, the European Economic and Social Committee and the Committee 
of 
COM/2012/736, 
Action 
https://ec.europa.eu/health/sites/health/files/ehealth/docs/com_2012_736_en.pdf  

2012-2020, 

Regions 

eHealth 

Plan 

the 

the 

on 

Communication from the Commission to the European Parliament, the Council, the European Economic and Social Committee and the Committee 
of the Regions on enabling the digital transformation of health and care in the Digital Single Market; empowering citizens and building a healthier 
society, COM(2018)233 

Directive  2000/54/EC  of  the  European  Parliament  and  of  the  Council  of  18  September2000  on  the  protection  of  workers  from  risks  related  to 
exposure to biological agents at work, http://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:32000L0054&from=EN  
Directive 2010/32/EU of 10 May 2010 implementing the Framework Agreement on prevention from sharp injuries in the hospital and healthcare 
sector concluded by HOSPEEM and EPSU, http;//eur-lex.europa.eu/legal-content&&EN/TXT/HTML/?uri=CELEX:32010L0032&from=EN 

Decision 1082/2013/EU of the European Parliament and of the Council of 22 October 2013 on serious cross-border threats to health and repealing 
Decision 
2119/98/EC, 
No 
https://ec.europa.eu/health/sites/health/files/preparedness_response/docs/decision_serious_crossborder_threats_22102013_en.pdf  

Council  Conclusions  on  Common  values  and  principles 
lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:C:2006:146:0001:0003:EN:PDF 

in  European  Union  Health  Systems 

(2006/C  146/01),  http://eur-

Regulation  (EC)  No  851/2004  of  the  European  Parliament  and  of  the  Council  of  21  April  2004  establishing  a  European  Centre  for  Disease 
Prevention and Control, http://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:32004R0851&from=EN 

EN 

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the exchange of best practices and experience with regard to vaccination programmes. 
In  addition,  the  Centre  coordinates  data  collection,  validation,  analysis  and 
dissemination at EU level, including on vaccination strategies.  

(19)  Directive  2001/83/EC18  and  Regulation  (EU)  No.726/200419  on  the  community  code 
relating to medicinal products for human use and establishing a European Medicines 
Agency, provide regulatory authorities with the mandate to promote and protect public 
health  by  authorising  the  use  of  safe  and  effective  vaccines,  and  by  continuously 
assessing  their  benefit  and  risk  profile  following  the  granting  of  marketing 
authorisation. 

(20)  The  Commission  One  Health  Action  Plan20  supports  the  EU  Member  States  in  their 
fight  against  antimicrobial  resistance  (AMR)  and  calls  for  streamlined  pathways  for 
the  authorisation  of  new  antibacterial  agents,  and  to  boost  the  research  and 
development of new vaccines for pathogens associated with antimicrobial resistance.  

(21)  The  European  Parliament  Motion  for  a  Resolution  of  19  April  2018  on  vaccine 
hesitancy  and  the  drop  in  vaccination  rates  in  Europe21  calls  on  Member  States  to 
ensure  sufficient  vaccination  of  healthcare  workers,  take  effective  steps  against 
misinformation,  and  implement  measures  for  improving  access  to  medicines.  It  also 
calls  on  the  Commission  to  facilitate  a  more  harmonised  schedule  for  vaccination 
across the EU. 

(22)  The  Commission  Action  Plan  on  Fake  News  and  online  disinformation22  aims  to 
contribute to the development of an EU-level strategy on how to tackle the spreading 
of  disinformation,  and  the  Commission  Communication  on  tackling  disinformation23 
addresses online platform challenges as regards the spreading of disinformation. 

(23)  The  Commission  supports  improving  access  to  modern  and  essential  vaccines  in  the 
77 poorest countries through GAVI the Vaccine Alliance since its inception in 2000. 
EUR  83  million  have  been  contributed  until  2015  and  another  EUR  200  million 
pledged for the period 2016-2020, which contributed to fully immunising 277 million 
children in the period 2011-2015, with plans to immunise another 300 million children 
in 2016-2020. 

(24)  The  Ministers  of  Health,  at  the  2012  World  Health  Assembly,  endorsed  the  Global 
Vaccine Action Plan, to ensure that no one misses out on vital immunisation by 2020. 
In 2014 the European Regional Committee of the World Health Organisation adopted 
the European Vaccine Action Plan 2015-2020. 

(25)  The 2030 Agenda for Sustainable Development24 Goal three - to 'Ensure healthy lives 
and promote well-being for all at all ages' - underlines the importance of vaccines in 
protecting  people  against  diseases.  And,  through  the  European  Consensus  on 

18

19

20

21

22

23 
24 

Directive 2001/83/EC of the European Parliament and of the Council of 6 November 2001 on the Community code relating to medicinal products 
for human use, http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2001:311:0067:0128:en:PDF  

Regulation 726/2004 of the European Parliament and of the Council of 31 March 2004 laying down Community procedures for the authorisation 
and 
for  human  and  veterinary  use  and  establishing  a  European  Medicines  Agency, 
https://ec.europa.eu/health/sites/health/files/files/eudralex/vol-1/reg_2004_726/reg_2004_726_en.pdf  

supervision  of  medicinal  products 

Commission  Communication  on  a  One  Health  action  plan  to  support  Member  States  in  the  fight  against  antimicrobial  resistance  (2017), 
https://ec.europa.eu/health/amr/sites/amr/files/amr_action_plan_2017_en.pdf  

European Parliament. Committee on the Environment, Public Health and Food Safety. Draft Motion for a Resolution on vaccine hesitancy and the 
drop in vaccination rates in Europe (2017/2951RSB) 19 04 2018 
Commission High-Level group on Fake News and online disinformation, https://ec.europa.eu/digital-single-market/en/news/high-level-group-
fake-news-and-online-disinformation  
Commission Communuication on Tackling Online Disinfornation: a European Approach, COM(2018)236 
Resolution  70/1  adopted  by  the  General  Assembly  of  United  Nations  on  25  September  2015:  Transforming  our  world:  the  2030  Agenda  for 
Sustainable Development 

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Development "Our World, Our Dignity, Our Future"25, the EU and its Member States 
reaffirm  their  commitment  to  protecting  the  right  of  everyone  to  enjoy  the  highest 
attainable  standard  of  physical  and  mental  health,  including  by  helping  to  secure 
access to affordable essential medicines and vaccines for all. 

(26)  A  Joint  Action  on  Vaccination,  co-funded  by  the  third  Programme  for  the  Union´s 
action in the field of health26, starting in 2018, is to focus on sharing of best practices 
on  national  vaccination  policies  and  identifying  technical  requirements  regarding 
electronic  immunisation  information  systems,  vaccine  forecasting,  prioritisation  of 
vaccine research and development, and research to address vaccine hesitancy. 

(27)  The  actions  put  forward  in  this  Recommendation  aim  to  increase  public  health 
security,  reduce  inequalities  between  Member  States,  and  increase  the  security  of 
vaccine  supply  within  the  Internal  Market.  They  complement  and  reinforce  national 
policies  and  actions  in  all  Member  States  while  taking  into  account  their  different 
starting  points  as  regards  their  immunisation  policies,  institutional  set-up,  regional 
differences, and healthcare capacities. 

(28)  This Recommendation is in line with the principles of subsidiarity and proportionality. 

HEREBY RECOMMENDS THAT THE MEMBER STATES: 

1. 

2. 

3. 

Develop  and  implement  national  and/or  regional  vaccination  plans,  aimed  at 
increasing vaccination coverage towards reaching the goals and targets of the World 
Health  Organization’s  European  vaccine  action  plan  by  2020.  These  plans  should 
include provisions for sustainable funding and vaccine supply, a life-course approach 
to vaccination, capacity to respond to emergency situations, and communication and 
advocacy activities. 

Ensure  for measles  in  particular,  by  2020,  the 95%  vaccination  coverage  rate,  with 
two  doses  of  the  vaccine  for  the  targeted  childhood  population,  and  close  the 
immunity gaps across all other age groups in view of eliminating measles in the EU.  

Introduce routine checks of vaccination status and regular opportunities to vaccinate 
across  different  stages  of life, through the routine visits  to the primary care  system 
and through additional measures such as at (pre) school entry, in the workplace or in 
care facilities.  

4. 

Facilitate access to national and/or regional vaccination services, by: 

a. 

b. 

Simplifying  and  broadening  opportunities  to  offer  vaccination,  leveraging 
community-based  providers  such  as  pharmacies,  nurses,  and  school  and 
workplace medical services;  

Targeted  outreach  to  the  most  vulnerable  groups  including  the  socially 
excluded  and  minorities,  so  as  to  bridge  inequalities  and  gaps  in  vaccination 
coverage. 

Ensure,  in  cooperation  with  higher  education  institutions  and  stakeholders,  that 
national  medical  curricula  and  any  continuous  medical  education  programmes 
include  or  strengthen  training  on  vaccine-preventable  diseases,  vaccinology,  and 
immunisation for healthcare workers across all sectors.  

Joint  Statement  by  the  Council  and  the  representatives  of  the  governments  of  the  Member  States  meeting  within  the  Council,  the  European 
Parliament and the Commission (2017/C 210/01) the new European Consensus on Development “Our World, Our Dignity, Our Future” 

Regulation 282/2014 of the European Parliament and of the Council of 11 Marg 2014 on the establishment of a third Programme for the Union’s 
action in the field of health (2014-2020) and repealing Decision No 1350/2007/EC 

5. 

25 

26 

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13 

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6. 

Increase  communication  activities  and  awareness-raising  on  the  benefits  of 
vaccination by: 

a. 

b. 

Presenting  scientific  evidence  to  counter  the  spread  of  disinformation, 
including  through  digital  tools  and  partnerships  with  civil  society  and  other 
relevant stakeholders; 

Engaging with healthcare workers, education stakeholders, social partners and 
the  media  as  multipliers,  to  fight  complacency  and  increase  trust  in 
immunisation.  

Develop  the  capacity  of  healthcare  institutions  to  have  up-to-date  electronic 
information  on  the  vaccination  status  of  citizens,  based  on  information  systems 
providing reminder functionalities, capturing vaccination coverage data in real-time 
across all age groups, and allowing data linkages and exchanges across the healthcare 
systems. 

Exploit the opportunities offered by the European Social Fund (ESF) and European 
Regional  Development  Fund  (ERDF)  in  order  to  support  the  training  and  skills 
development  of  the  healthcare  workers  on  vaccinology,  immunisation  and  vaccine-
preventable  diseases,  and  to  reinforce  national  and  regional  health  infrastructures 
capacities in the area of vaccination. 

Increase  support to  vaccine  research  and  innovation  so  that sufficient  resources  are 
available  for  a  rapid  advancement  of  new  or  improved  vaccines,  and  facilitate  the 
promptly  uptake  of  the  vaccine  research  for  better  informed  national  or  regional 
vaccination programmes and policies. 

7. 

8. 

9. 

HEREBY  WELCOMES  THE  COMMISSION'S  INTENTION  TO  TAKE  THE 
FOLLOWING  ACTIONS,  IN  CLOSE  COOPERATION  WITH  THE  MEMBER 
STATES: 

10. 

Aim  at  establishing  a  European  Vaccination  Information  Sharing  (EVIS)  system, 
coordinated by the European Centre for Diseases Prevention and Control (ECDC), in 
order to:  

a. 

Together with the national public health authorities, 

i. 

ii. 

iii. 

examine  the  options  of  establishing,  by  2020,  guidelines  for  a  core  EU 
vaccination  schedule,  aiming  to  facilitate  the  compatibility  of  national 
schedules  and  promote  equity  in  Union  citizens´  health  protection,  and 
subsequently  ensuring  broad  uptake  of  the  core  schedule  as  well  as  a 
common vaccination card; 

strengthen  the  consistency,  transparency,  and  methodologies  in  the 
assessment  of  national  and  regional  vaccination  plans,  by  sharing 
scientific evidence and tools with the support of National Immunization 
Technical Advisory Groups (NITAGs);  

design  EU  methodologies  and  guidance  on  data  requirements  for  better 
monitoring of vaccination coverage rates across all age groups, including 
healthcare  workers,  in  cooperation  with  the  World  health  Organisation 
(WHO). Collect such data and share them at EU level; 

b. 

By 2019, establish a European vaccination information portal, with the support 
of  the  European  Medicines  Agency,  to  provide  online  objective,  transparent 

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and  updated  evidence  on  vaccines,  their  benefit  and  safety,  and  the 
pharmacovigilance process.  

c.  Monitor  online  vaccine  misinformation  and  develop  evidence-based 
information tools and guidance to support Member States in countering vaccine 
hesitancy,  in  line  with  the  Commission  Communication  on  tackling  online 
disinformation. 

With  the  support  of  the  European  Medicine  Agency,  continuously  monitor  the 
benefits and risks of vaccines, at EU level. 

Work  towards  developing  common  methodologies  and  strengthen  the  capacities  to 
assess the relative effectiveness of vaccines and vaccination programmes, including 
as part of the European cooperation on health technology assessment. 

Strengthen the effective application of Union rules on the protection of workers from 
risks  related  to  exposure  to  biological  agents  at  work,  as  laid  down  in  Directive 
2000/54/EC and Directive 2010/32/EU, in particular by ensuring adequate training of 
healthcare  workers,  monitoring  their  immunisation  status  and  actively  offering 
vaccination  where  necessary,  to  ensure  adequate  levels  of  patient  and  healthcare 
workers’ safety. 

Provide  evidence  and  data,  including  through  the  European  Schoolnet,  to  support 
Member  States'  efforts  to  strengthen  the  aspects  related  to  vaccinology  and 
immunisation in their national medical curricula as well as postgraduate education. 

11. 

12. 

13. 

14. 

15. 

Strengthen vaccine supply and mitigate risks of shortages by aiming at: 

a.  Developing a virtual European data warehouse on vaccine needs and stocks, to 
facilitate the voluntary exchange of information on available supplies, possible 
surpluses and global shortages of essential vaccines; 

b.  Developing a concept for a  mechanism for exchanging vaccine supplies from 
one  Member  State  to  another  in  case  of  an  outbreak,  improving  the  links 
between supply and demand of vaccines; 

c. 

d. 

e. 

f. 

Identifying the options for physical stockpiling and engaging in a dialogue with 
vaccine producing companies on a mechanism to facilitate the stockpiling and 
availability  of  vaccines  in  case  of  outbreaks  taking  into  account  global 
shortages of essential vaccines; 

Jointly with stakeholders and industry, improving EU manufacturing capacity 
and ensuring continuity of supply; 

Exploiting the possibilities of joint procurement of vaccines or antitoxins to be 
used in cases of pandemics, unexpected outbreaks and in case of small vaccine 
demand (small number of cases or very specific populations to be covered); 

Supporting  the  EU  Official  Medicines  Control  Laboratories  network  and  its 
work to ensure the high quality of vaccines put on the EU market.  

g.  Monitoring  the  obligation  of  continuous  supply  of  medicines  placed  on 

marketing authorisation holders (Article 81 of Directive 2001/83/EC) 

16. 

Increase  the  effectiveness  and  efficiency  of  EU  and  national  vaccine  research  and 
development funding by efforts to: 

a. 

Reinforcing  and  establishing  new  partnerships  and  research  infrastructures, 
including for clinical trials, facilitating – together with the European Medicines 

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15 

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Agency - early dialogue with developers, national policy makers and regulators 
in  order  to  support  the  authorisation  of  innovative  vaccines,  including  for 
emerging health threats; 

b.  Developing  a  roadmap  of  unmet  population  needs  and  agreed  priorities  for 
vaccines  that  can  be  used  to  inform  future  vaccine  research  funding 
programmes at national and EU level, including leveraging the advantages  of 
the  Coalition  for  Epidemic  Preparedness  Innovations  (CEPI)  and  the  Global 
Research Collaboration for Infectious diseases Preparedness (GloPID-R); 

c. 

Investing  in  behavioural  and  social  science  research  on  the  determinants  of 
vaccine hesitancy across different subgroups of the population and healthcare 
workers. 

HEREBY WELCOMES THE COMMISSION'S INTENTION TO:  

17. 

18. 

19. 

20. 

21. 

22. 

23. 

24. 

Examine  issues  of  insufficient  vaccine  coverage  caused  by  cross-border  movement 
of  people  within  the  EU  and  look  into  options  to  address  them,  including 
developping  a  common  EU  citizens'  vaccination  card/passport,  compatible  with 
electronic immunisation information systems and recognised for use across borders.  

Aim  at  producing  on  a  regular  basis,  in  the  context  of  State  of  Health  in  the  EU 
process, a Report on the State of Vaccine Confidence in the EU, to monitor attitudes 
towards vaccination. Based on that report, present guidance that can support Member 
States in countering vaccine hesitancy. 

Convene  a  Coalition  for  Vaccination  to  bring  together  European  associations  of 
healthcare workers as well as relevant students’ associations in the field, to commit 
to  delivering  accurate  information  to  the  public,  combating  myths  and  exchanging 
best practice.  

Strengthen the impact of the annual European Immunisation Week by hosting an EU 
public awareness initiative and supporting Member States' own activities. 

Identify  the  barriers  to  access  and  support  interventions  to  increase  access  to 
vaccination for disadvantaged and socially excluded groups including by promoting 
health mediators and grassroots community networks.  

Develop  guidance  to  overcome  the  legal  and  technical  barriers  impeding  the 
interoperability of national immunisation information systems, having due regard to 
rules  on  personal  data  protection,  as  set  out  in  the  Commission  Communication  on 
enabling  the  digital  transformation  of  health  and  care  in  the  Digital  Single  Market, 
empowering citizens and building a healthier society. 

Continue to support research and innovation through the EU framework programmes 
for Research and Innovation for the development of safe and effective new, and the 
optimisation of existing, vaccines  

Strengthen  partnerships  and  collaboration  with  international  actors  and  initiatives, 
such as the World Health Organisation and its Strategic Advisory Group of Experts 
on  Immunization  (SAGE),  the  European  Technical  Advisory  Group  of  Experts  on 
Immunization (ETAGE), the Global Health Security Initiative and Agenda processes 
(Global  Health  Security  Initiative,  Global  Health  Security  Agenda),  UNICEF  and 
financing and research initiatives like GAVI the Vaccine Alliance, the Coalition for 
epidemic  preparedness  innovations  (CEPI)  and  the  Global  Research  Collaboration 
for Infectious disease Preparedness (GloPID-R). 

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25. 

Report on a regular basis on progress in implementing this Recommendation on the 
basis of data made available by the Member States and other relevant sources.  

Done at Brussels, 

For the Council 
The President 

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