A report from Coalition for Life Course Immunisation (CLCI) considers the financial and policy frameworks of various National Immunisation Programmes in Europe with a focus on sustainable financing and informed decision-making. The report addresses access and distribution disparities with “actionable strategies” to ensure everyone receives the vaccinations they need throughout their lives. CLCI describes the analysis as “crucial for stakeholders and policymakers” as a foundation for “advocating for robust, inclusive public health policies” that can be adapting to various healthcare challenges.
Financing and decision-making
The paper presents profiles for 16 European Union Member States: Austria, Belgium, Cyprus, Czechia, Denmark, France, Germany, Greece, Hungary, Italy, Lithuania, Norway, Poland, Romania, Spain, and the Netherlands. These countries are divided into Eastern and Western European nations.
The study finds that the seven Eastern countries had a lower over-65 influenza vaccination coverage rate than the nine Western countries (33% vs 54%). They also spent less of their GDP on healthcare (4.6% vs 6.2%) and less of the healthcare budget on prevention (7.6% vs 10%). Countries with decentralised health systems allocated a higher percentage of their GDP to healthcare and a larger proportion of their healthcare budget to prevention than centralised systems.
7 out of 16 countries reported ringfencing of funds for vaccination and prevention, a common approach for countries that have Ministry of Finance involvement in budgeting. Two countries reported using long-term, multi-year contracts to secure vaccine supply and stabilise financing.
Spotlight on Spain and the Netherlands
As The World Vaccine Congress Europe is taking place in Barcelona this year (2024) and Amsterdam next year (2025) we chose to look more closely at the country profiles of Spain and the Netherlands. The report offers a brief history and an insight into the potential future landscape for both countries:
- Spain – healthcare, including vaccination programmes, has been publicly funded since the establishment of the Spanish National Health System in 1986. Decentralisation in the late 20th century led to “variability” in programme implementation. Spain is “firmly focussed on vaccination as a cost-effective public health measure”. It is increasing investment in public health infrastructure and immunisation coverage will expand to include more diseases and eligible populations. It is also advancing digital transformation through national immunisation registries, enhanced data analytics for decision-making, and digital tools to improve uptake and surveillance.
- The Netherlands – the Dutch National Immunisation Programme (RVP) was established in 1957 to provide free vaccines to all children. This has expanded to include more vaccines. During the COVID-19 pandemic, the budget was allocated “immediately”. Current efforts are underway to “push more proactive allocated budgets to accommodate new vaccines more efficiently”. Demand is driven by an ageing population.
Head-to-head
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Feature |
Spain |
The Netherlands |
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Health system |
Decentralised |
Decentralised |
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Stakeholders |
The Public Health Commission of the Ministry of Health, the National Immunisation Technical Advisory Group (NITAG), and regional health authorities |
The Health Council, Dutch National Institute for Public Health and the Environment (RIVM), Ministry of Health |
|
Introducing a new vaccine |
New vaccines are evaluated by NITAG before the Public Health Commission recommends updates to the National Immunisation Plan (NIP) and final financing decisions made by regional Ministries of Finances. This means vaccine recommendations can vary between regions. |
New vaccine recommendations from the European Medicines Agency (EMA) go through the Minister of Health and State Secretary, who asks the Health Council to evaluate before funding is considered. After a recommendation from the Health Council, the MoH asks the RIVM to implement the vaccine in the National Immunisation Plan (NIP). |
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Primary funding sources |
Regional governments |
Public funding |
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Critical financing challenges |
High cost of new vaccines, decentralised health system, insufficient political will |
No set budget causes delays, economic pressures, and healthcare budget constraints |
|
% of GDP spent on healthcare |
10.4% |
10.2% |
| % of healthcare budget spent on prevention | 9% |
3.5% |
Calls to action
The report concludes that the landscape of vaccine financing and decision-making in Europe is “complex”, with “significant variations”. Notably, Ministries of Finance play a key role in healthcare budgeting.
“While some countries have implemented sustainability mechanisms, such as long-term contracts and split investments, budget limitations and political will remain significant barriers to expanding adult vaccination programmes.”
Decentralised health systems demonstrated higher healthcare spending and more investment in prevention; however, this did not necessarily correlate with broader adult vaccine coverage.
The report “advocates for an EU-wide integrated approach to enhance the efficacy of national vaccination strategies for adults” with four specific “calls to action”:
- Strengthen political commitment and sustainable financing
- Increase prevention budgets and foster unity
- Enhance understand and support for vaccination
- Promote comprehensive immunisation programmes
Is your country profile presented in the report? Do you find any of the results surprising, and do you agree with the calls to action? At the Congress in Barcelona this month we look forward to discussing different financing and decision-making approaches with global health experts. Get your tickets to join us for these conversations, and don’t forget to subscribe to our weekly newsletters here.
