Childhood vaccination rates lag in Europe – fueling further resurgence of measles and whooping cough

Vaccine complacency across Europe and Central Asia is threatening child health, reveals new data from UNICEF and WHO

Childhood vaccinations against measles, whooping cough and other diseases in the WHO European Region - comprising 53 countries in Europe and Central Asia - remained below pre-pandemic levels in 2024, adding to the number of children left vulnerable to disease and increasing the risk of outbreaks, according to the latest WHO/UNICEF coverage estimates released today.

Globally in 2024, however, 89% of infants worldwide received at least one dose of the diphtheria/tetanus/pertussis (DTP) vaccine, and 85% completed all 3 doses. That's 171 000 more children receiving at least one vaccine and one million more children fully vaccinated in 2024 compared to 2023 - modest progress amid growing global challenges.

Alarming declines

On average, the coverage of childhood vaccines in Europe and Central Asia remained the same or declined by 1% in 2024 compared to 2023, revealing stagnated recovery to pre-pandemic levels. Between 2019 and 2024, coverage declined from:

• 92% to 91% with the second dose of measles/mumps/rubella (MMR) vaccine
• 95% to 93% with the third dose of DTP vaccine
• 95% to 93% with the third dose of polio vaccine
• 92% to 91% with the third dose of hepatitis B vaccine.
  

Coverage ranged widely among countries in the Region in 2024, with decreasing coverage rates of the first dose of the MMR vaccine and the third dose of the DTP vaccine overall, with some countries reporting a coverage rate of as low as 23% for MMR1 and 51% for DTP3. To achieve herd immunity and prevent outbreaks of many vaccine-preventable diseases, 95% coverage is needed every year in every community. In 2024, more than half of the countries in the Region did not meet the herd immunity target for MMR and/or DTP, and almost a third reported coverage below 90%.

"Last year alone, nearly 300 000 people got whooping cough in our Region - more than a 3-fold increase on the previous year. Meanwhile, over 125 000 caught measles in 2024 - twice as many as 2023. These are not just numbers - it's hundreds of thousands of families in anguish because their children are sick, and it could have been prevented," said Dr Hans Henri P. Kluge, WHO Regional Director for Europe.

"Vaccines save lives, and when coverage drops, disease spreads. That's why countries must invest in strong local health systems, ensure vaccines are available and accessible in every neighborhood and fight misinformation. Health workers need support to reach every family - especially in hard-to-reach areas. And communities must be empowered with trusted information, so parents can confidently vaccinate their children," continued Dr Kluge.

"In many ways, vaccination has been a victim of its own success across Europe and Central Asia," said Regina De Dominicis, UNICEF Regional Director for Europe and Central Asia. "Today's generation has not witnessed the devastating impact of vaccine-preventable diseases - leading to complacency and making it easier for misinformation to take hold. Last year's surge in measles cases - the highest reported in nearly 3 decades - is a reminder that, unless governments invest in strong community health systems and address inequities in access to health care and information, more children will face preventable illness, lifelong complications or even death."

Promising gains

Despite this stagnation, the uptake of newer vaccines, including against human papillomavirus (HPV), showed continued improvement, the data found. The increase is the result of a number of countries introducing these vaccines and the increased maturity of immunization systems to administer them. Steady increases in coverage in the period 2019 to 2024 were noted, from:

• 37% to 40% for girls and 8% to 26% for boys with the first dose of HPV vaccine
• 24% to 42% with the last dose of rotavirus vaccine
• 81% to 93% with the third dose of Haemophilus influenzae type b vaccine
• 81% to 86% with the last dose of pneumococcal conjugate vaccine.
  

Increasing the coverage of these vaccines has a clear impact in reducing rates of HPV infections and related cervical cancer, hospitalizations of children due to rotavirus-induced diarrhoea and suffering from pneumonia and invasive bacterial diseases.

Renewed efforts

"As we plan the next phase of our work across Europe and Central Asia, one thing is clear: vaccines must stay at the top of the agenda. The work is not yet finished. We need urgent, united action to close the gaps in coverage and stop preventable diseases from making a comeback. Every country has a role to play, even those with high vaccination coverage," concluded Dr Kluge.

UNICEF and WHO work together with health authorities across the Region to identify, understand and address inequities in immunization coverage at the local level. Ongoing projects, supported in part by the European Union, include the triangulation of data sources to identify who is not being reached with routine vaccinations and behavioural insights research to identify barriers to high uptake, which can include a lack of active screening, reminders or information to address common misconceptions, as well as other factors.

Countries that do not currently have measles cases or outbreaks must be proactive in planning and preparing to prevent the virus from spreading within and beyond the country. Countries currently experiencing outbreaks must continue their efforts to vaccinate all susceptible individuals, intensify case finding and contact tracing and use epidemiological data to identify gaps in vaccination coverage, so that immunization programmes can ensure affected communities are protected and future outbreaks can be prevented.