Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Dec 31;18(1):2031776.
doi: 10.1080/21645515.2022.2031776. Epub 2022 Feb 18.

Evolving measles status and immunization policy development in six European countries

Ivo Vojtek  1 , Heidi Larson  2 , Stanley Plotkin  3   4 , Pierre Van Damme  5
Affiliations
Review

Evolving measles status and immunization policy development in six European countries

Ivo Vojtek et al. Hum Vaccin Immunother. .

Abstract

Developing and implementing new immunization policies in response to shifting epidemiology is a critical public health component. We adopted a mixed-methods approach (via narrative literature review [101 articles] and 9 semi-structured interviews) to evaluate policy development in response to shifting measles epidemiology in six European countries (Italy, Belgium, Germany, Romania, UK, and Ukraine); where policies and strategies have evolved in response to country-specific disease and vaccination patterns. Periodic outbreaks have occurred in all countries against a background of declining measles-containing-vaccine (MCV) uptake and increasing public vaccine hesitancy (with substantial regional or social differences in measles burden and vaccine uptake). Health-care worker (HCW) vaccine skepticism is also seen. While many outbreaks arise or involve specific susceptible populations (e.g., minority/migrant communities), the broader pattern is spread to the wider (and generally older) population; often among incompletely/non-vaccinated individuals as a legacy of previous low uptake. Immunization policy and strategic responses are influenced by political and social factors, where public mistrust contributes to vaccine hesitancy. A strong centralized immunization framework (allied with effective regional implementation and coherent political commitment) can effectively increase uptake. Mandatory vaccination has increased childhood MCV uptake in Italy, and similar benefits could be anticipated for other countries considering vaccine mandates. Although possible elsewhere, socio-political considerations render mandating impractical in other countries, where targeted immunization activities to bolster routine uptake are more important. Addressing HCW skepticism, knowledge gaps, improving access and increasing public/community engagement and education to address vaccine hesitancy/mistrust (especially in communities with specific unmet needs) is critical.

Keywords: Measles; decision-making; policy; routine immunization.

PubMed Disclaimer

Conflict of interest statement

IV is employed by the GSK group of companies and holds shares in the GSK group of companies. SP has received fees from Sanofi, Merck, Janssen, Inovio, Moderna, Astra Zeneca, Rational Vaccines, NTxBio, Seqirus, Codagenix, Vaxinnity, and Valneva outside the submitted work. HL has received grants from the GSK group of companies, Merck and Janssen and payment from the GSK group of companies for presentations outside the submitted work. IV, SP and HL declare no other financial and non-financial relationships and activities. PVD declares no financial and non-financial relationships and activities and no conflicts of interest.

Figures

Figure 1.
Figure 1.
Flow diagram for study selection.
Figure 2.
Figure 2.
Measles case numbers and vaccine coverage for first and second MCV dose in selected countries 2001–2019.
Figure 3.
Figure 3.
Current measles vaccination schedule in selected countries.
Figure 4.
Figure 4.
Emergent themes.
See this image and copyright information in PMC

References

    1. Perry RT, Gacic-Dobo M, Dabbagh A, Mulders MN, Strebel PM, Okwo-Bele JM, Rota PA, Goodson JL.. Global control and regional elimination of measles, 2000-2012. MMWR Morb Mortal Wkly Rep. 2014;63:103–15. - PMC - PubMed
    1. Patel MK, Antoni S, Nedelec Y, Sodha S, Menning L, Ogbuanu IU, Gacic Dobo M. The changing global epidemiology of measles, 2013-2018. J Infect Dis. 2020;222:1117–28. doi: 10.1093/infdis/jiaa044. - DOI - PubMed
    1. Zimmerman LA, Muscat M, Singh S, Ben Mamou M, Jankovic D, Datta S, Alexander JP, Goodson JL, O’Connor P. Progress toward measles elimination - European Region, 2009-2018. MMWR Morb Mortal Wkly Rep. 2019;68:396–401. doi: 10.15585/mmwr.mm6817a4. - DOI - PMC - PubMed
    1. Khetsuriani N, Deshevoi S, Goel A, Spika J, Martin R, Emiroglu N. Supplementary immunization activities to achieve measles elimination: experience of the European Region. J Infect Dis. 2011;204(Suppl 1):S343–52. doi: 10.1093/infdis/jir074. - DOI - PubMed
    1. Datta SS, O’Connor PM, Jankovic D, Muscat M, Ben Mamou MC, Singh S, Kaloumenos T, Reef S, Papania M, Butler R. Progress and challenges in measles and rubella elimination in the WHO European Region. Vaccine. 2018;36:5408–15. doi: 10.1016/j.vaccine.2017.06.042. - DOI - PMC - PubMed

Publication types

Substances