Vaccination is a cornerstone of primary prevention, aiming to prevent disease and reduce severity when illness occurs. It is especially critical for older adults, who are more vulnerable to severe complications from vaccine‑preventable illnesses. Ensuring high vaccination coverage among older populations is thus vital for reducing illness and alleviating pressure on healthcare systems.
The COVID‑19 pandemic has served as a stark real-world, large‑scale demonstration of the life‑saving efficacy of vaccines, with countries that achieved higher vaccination rates experiencing markedly lower excess mortality (OECD, 2023[1]). Vaccination was especially crucial for people over 60, who accounted for 93% of all COVID‑19 deaths in the EU in 2020‑21. By the end of 2021, nearly 90% of people aged 60 and above in the EU had completed their primary vaccination course, with all countries except three reaching at least 75% coverage. Denmark, Belgium and Ireland achieved 100% coverage in this age group. As evidence emerged on the waning effectiveness of vaccines (Menni et al., 2022[2]), European countries began administering booster doses in October 2021.
By mid‑2022, 83% of individuals aged 60 and above in the EU had received a booster shot. Booster uptake showed greater variation across countries compared to the primary vaccination course. All countries except Italy experienced lower booster uptake rates levels, with countries that had higher primary course coverage generally experiencing smaller declines in booster uptake. Declines were particularly significant in Croatia, Bulgaria, Latvia and Romania, where fewer than 50% of people aged 60 and over received a COVID‑19 booster dose. With the emergence of new COVID‑19 variants, all EU countries began administering a second set of bivalent booster vaccines in September 2022. However, uptake dropped significantly compared to the first booster, with less than 30% of people aged 60 and over receiving it by the end of 2022. Denmark, Ireland, Portugal, Sweden, Belgium and the Netherlands achieved the highest coverage rates of over 70%, while in Central and Eastern European countries less than 25% of the population aged 60 and above received a second vaccine booster dose (Figure 8.7).
Similar to their approach to COVID‑19 vaccination, all European countries have national recommendations to promote influenza vaccination among older people. During the 2019/20 flu season (pre‑pandemic), 44% of EU residents aged 65 and older received the flu vaccine. However, vaccination rates varied significantly across regions. Western and Southern European countries saw higher uptake, with Greece, the Netherlands and Malta achieving over 66% coverage. In contrast, Central and Eastern European countries such as Czechia, Hungary, Romania and Lithuania had rates below 25%.
The start of the pandemic spurred public health efforts to prevent simultaneous outbreaks of influenza and COVID‑19, leading to a 16% increase in flu vaccination rates in the EU. The 2020/21 season saw average uptake reach 51%, with Denmark meeting the WHO’s 75% coverage target while Spain, Romania, Ireland, Estonia and Italy increased their rates by over 10 percentage points year-on-year. In 2021/22, as influenza virus activity in the EU resumed following the relaxation of COVID‑19 measures, average vaccination uptake slightly decreased to 48% but remained over 4 percentage points above the pre‑pandemic level (Figure 8.7). Denmark, Portugal, Ireland and the United Kingdom attained over 75% coverage, while Latvia, Estonia and Ireland maintained significant increases from their respective 2019/20 rates. Conversely, nine EU countries experienced declines below pre‑pandemic levels, with Croatia, Slovenia, Malta and the Slovak Republic seeing particularly sharp declines exceeding 25%.
To varying degrees in different EU countries, vaccine hesitancy remains an obstacle to achieving high vaccination rates among at-risk populations. Pre‑pandemic confidence in vaccines was relatively high in the EU, with nearly 82% of the population considering vaccines to be safe in 2018 and only five countries with less than 75% of their citizens agreeing on the safety of vaccines. The onset of the pandemic did not substantially alter overall EU perceptions of vaccine safety by 2022. However, variation across countries increased, with Poland and France seeing increases of over 10% in the proportion of their populations agreeing on the safety of vaccines, while the Netherlands, Slovenia and the Slovak Republic witnessed declines exceeding 15% (Figure 8.8). Public perception of vaccine safety strongly correlated with both influenza and COVID‑19 vaccine uptake among older adults, with the latter showing an even stronger association. This highlights the importance of transparent communication by health authorities to build public trust and address misconceptions about vaccine safety and efficacy.
