Several countries expanded their influenza jab guidelines this year, but vaccination rates remain sub-optimal, health experts say.
The flu season is in full swing, but Europeans are less protected due to falling vaccination levels among at-risk groups.
An estimated 27,600 people die from the flu every year in the European Union and United Kingdom, and hospitals are currently stretched thin as they grapple with a cocktail of respiratory illnesses, including the flu, COVID-19, the vomiting bug norovirus, and respiratory syncytial virus (RSV).
Meanwhile, human metapneumovirus (HMPV), which typically peaks in late winter, is making headlines due to an outbreak in China.
Older adults, very young children, pregnant women, and people with weakened immune systems or chronic health conditions are at higher risk of getting seriously sick from influenza, and public health authorities typically recommend they get the flu jab every year.
Several countries even expanded their vaccine guidelines this year – but influenza vaccination rates are down across Europe, particularly for older adults and healthcare workers, according to a report from the European Centre for Disease Prevention and Control (ECDC).
As a result, immunisation levels in most countries are far below what is recommended to protect public health, prompting European health officials to raise the alarm about the low rates in October.
“Often what we see in the general public is a misrecognition of risk” from influenza, which can be “extremely severe,” Ben Kasstan-Dabush, an assistant professor at the London School of Hygiene and Tropical Medicine, told Euronews Health.
While vaccines are updated based on the influenza strains expected to circulate that year, “people may feel that they can manage their symptoms, and perhaps don’t need a vaccination,” Kasstan-Dabush added.
Among older adults in the 2023-2024 season, influenza vaccinations ranged from 12 per cent in Slovakia to 78 per cent in Denmark, which was the only country along with Ireland to reach the EU target of 75 per cent over the past three flu seasons.
Immunisation rates remained relatively stable this year in some countries, but fell among older adults in Croatia, France, Iceland, Italy, Portugal, Romania, Slovenia, and Spain, the ECDC found.
The trends last season were not always uniform.
For example, while Denmark tends to have higher vaccination levels, its coverage fell last year for pregnant women and adults overall. And in Spain, where children were much more likely to get immunised last year compared with the season before, the vaccination rate fell among health workers.
Why vaccine rates are down
Low vaccine uptake has been a long-term challenge for Europe, but it took on new urgency amid the COVID-19 pandemic – and then fell off many people’s radars once the threat had dissipated.
In Belgium, for example, vaccinations rose sharply from 2019 to 2020 and then fell again in 2021, a report on the Belgian healthcare system found.
“A legacy of the COVID-19 era [is that] people are tired of the vaccine message,” Kasstan-Dabush said, but “I don’t think it necessarily is the dominant factor” driving down immunisation rates.
The public’s confidence in vaccines overall varies greatly across Europe.
In Latvia, for example, 42 per cent of people believe vaccines are generally safe, compared with 84 per cent in Portugal, according to the Vaccine Confidence Project led by researchers in the UK, Belgium, and Hong Kong.
Even many healthcare workers are wary of vaccines, according to a 2023 study that found that male health personnel and doctors were more likely to get the flu jab than women and other health workers.
The pandemic also played a role, unsurprisingly, with flu vaccine uptake higher among health workers who were open to COVID-19 vaccines.
“Another important problem is the absence of the culture of vaccination among healthcare workers,” particularly those who have been practising medicine for decades and may not be fully aware of the latest recommendations, Dr Silvio Tafuri, a public health professor at the University of Bari Aldo Moro in Italy who led the study, told Euronews Health.
Even so, focusing on vaccine hesitancy alone “often puts the emphasis on people as problems,” Kasstan-Dabush said, overlooking “how influenza vaccinations are actually integrated into chronic disease care for the at-risk groups”.
How to improve influenza vaccine uptake
Several countries have taken steps to make the flu vaccine more widely available, for example by expanding their recommendations for children.
Twenty European countries now have age-based vaccination guidelines for children, up from five countries in the 2017-2018 flu season, according to the ECDC.
However, the data suggests national policies “still fall short of meeting sufficient levels of uptake across key target groups,” the agency said.
To boost influenza vaccination levels, Kasstan-Dabush said that the jabs should be integrated into regular medical care for high-risk patients, such as people with chronic diseases.
An ECDC spokesperson told Euronews Health that strategies “may need to be adapted at sub-national or local level as there is no ‘one-size-fits-all’ approach”.
Meanwhile, Tafuri said that increasing vaccine uptake among younger healthcare workers, combating misinformation around the jabs, and making healthcare less of a political issue could help improve immunisation rates.
Tafuri’s colleague Dr Antonio Di Lorenzo, a resident in public health at the same Italian university, added that more specific public health messaging is needed to reach groups with lower vaccination levels.
“We are currently risking leaving some people behind because we cannot communicate to them,” Di Lorenzo told Euronews Health.
Taking the time to get the message out to people “is something that produces an avalanche effect”.
