All EU countries have established childhood vaccination programmes to reduce the spread of many infectious diseases and related deaths, although the number and type of recommended vaccines vary across countries. The WHO recommends 95% coverage with two doses of measles-containing vaccine and three doses of the hepatitis B vaccine with the first dose at birth (<24 hours). It also recommends reaching 90% coverage of girls aged 9‑14 with vaccination against human papillomavirus (HPV) to prevent cervical and other cancers.
Global measles incidence increased in 2023, largely attributed to decreased vaccination coverage during the COVID‑19 pandemic. Among the 18 449 measles cases reported between September 2023 and August 2024, 87% were among unvaccinated people. In this period, measles outbreaks were reported by several countries in Europe, including Romania (accounting for 77.8% of all cases in Europe), Italy (4.9%), Belgium (3.3%), Austria (2.9%) and Germany (2.8%) (ECDC, 2024[1]). The high burden of measles in Romania, associated with low vaccination levels, led the Ministry of Health to declare a national measles epidemic.
Vaccination coverage against measles reflects care continuity and access to primary care. In 2023, 88% of children in the EU received two doses of the measles vaccine (Figure 6.3). Only Hungary and Portugal reached the recommended 95% coverage for population-level protection against outbreaks, while the Slovak Republic, Norway and Türkiye were just a percentage point below the recommendation. Vaccination coverage was the lowest (below 80%) in Romania, Bosnia and Herzegovina and Estonia. Compared to 2019, vaccination rates dropped by more than 10 percentage points in several EU countries, including Estonia, Malta and Romania.
The hepatitis B virus is transmitted through contact with blood or bodily fluids. Chronic infections can lead to cancer and liver cirrhosis, and children are at high risk of adverse outcomes. Vaccination against hepatitis B is included in childhood vaccination programmes in most EU countries, except for Denmark and Finland, although it is provided to at-risk groups (OECD, 2024[2]).
Most countries did not reach the recommended 95% coverage with three doses of the hepatitis B vaccine. On average, 92% of one‑year-old children were fully vaccinated in 2023 across those EU countries where it is included in the immunisation programme. Rates ranged from less than 80% in Estonia and Romania to over 95% in Portugal, Malta, Latvia, Belgium, the Slovak Republic, Luxembourg, Greece, France and Cyprus (Figure 6.3). Among non-EU countries, only Türkiye, Albania and Norway reached the recommended coverage.
HPV is highly contagious, as most of the sexually active population contracts the virus in their lifetime. In rare cases, a persistent infection with a cancer-causing strain can lead to a variety of cancers in both men and women, notably cervical cancer. Vaccination is the key to prevention, with the nine‑strain vaccine estimated to prevent up to 89% of all cervical cancer cases (OECD, 2024[2]).
Nearly all EU countries, along with Norway and Iceland, offer HPV vaccinations to both girls and boys in their teens. The last country to not include boys, Bulgaria, plans to start vaccinating them in 2025. The number of doses recommended in the schedule can vary. Some countries provide vaccinations in schools, while others in healthcare facilities (OECD, 2024[2]). In 2023, on average 64% of girls in the EU received all recommended doses of the HPV vaccine by age 15, ranging from 91% in Portugal to 7% in Bulgaria (Figure 6.4). In all countries except for Portugal, Iceland and Norway, coverage fell short of the WHO 2030 target to fully vaccinate 90% of girls by 15 years. Vaccination coverage among boys is generally lower than among girls, reflecting their more recent inclusion in the programmes. However, some countries have increased coverage in recent years, with seven countries achieving vaccination rates in boys less than 10 percentage points of girls’ rates. Eight countries (Norway, Portugal, Denmark, Ireland, Finland, Belgium, Hungary and the United Kingdom) vaccinated more than 60% of boys with all doses of the HPV vaccine in 2023.
