After decades of steady progress, childhood vaccination rates in Europe have stopped rising, with coverage stalled or falling in many countries, information from a new study in The Lancet Regional Health-Europe. Most countries still report rates above 90%, but the shift is a clear warning for public health officials.
Researchers examined seven major vaccines across all 27 EU countries from 1980 to 2024. Since 2019, 16 countries have seen declines in coverage for more than half of these vaccines. The sharpest drops were for Haemophilus influenzae type b and polio, with 20 countries showing downward trends. Coverage for hepatitis B and the combined diphtheria, tetanus, and pertussis vaccines also fell in 18 and 17 countries, respectively. World Health Organization and UNICEF data show that only Cyprus, Hungary, Iceland, and Portugal reached the 95% coverage target for both doses of the measles vaccine in 2024. The EU/EEA average was 93.8% for the first dose and 87.8% for the second.
In 2024, Luxembourg and Portugal were the only EU countries to reach at least 95% coverage for all seven childhood vaccines analyzed.
Spain continues to report some of Europe’s highest vaccination rates, with 2024 figures ranging from 92% for polio to 97% for measles and rubella. Still, the study notes a recent slowdown or slight decline. For five of the seven vaccines tracked, Spain and Germany both showed downward trends, raising questions about how long herd immunity can hold. The European Centre for Disease Prevention and Control (ECDC) reported 2,339 measles cases in the EU/EEA last year; 73% of those infected were unvaccinated. The figures show the impact of falling coverage.
The study’s authors, Leonardo Villani and Luigi Russo, say the situation is not yet a crisis. They warn, but, that high coverage alone is not enough. Even small, steady declines can weaken community protection, especially if rates fall below the 90% or 85% needed to prevent outbreaks of diseases such as measles or polio. Recent reports from the ECDC and GPEI echo the warning, stressing that minor drops in vaccination rates can have serious public health consequences.
Trends vary across Europe. Hungary, Denmark, France, Portugal, and Italy have increased coverage for at least half of the vaccines studied. Bulgaria, Cyprus, and Czechia have seen declines across all immunizations. Romania’s coverage remains below 80% for every vaccine, while Bulgaria’s is around 94%.
Romania stands out, with coverage below 80% for all seven vaccines studied in 2024 and downward trends for every immunization. Sixteen EU countries showed declines in at least four vaccines, indicating that the trend affects a broad group of countries, not just isolated cases.
The reasons for these changes vary. The study points to disruptions in routine vaccination during the COVID-19 pandemic, especially from 2019 to 2022. Misinformation and the rise of populist movements have also fueled vaccine hesitancy in some areas. The authors say no single factor explains the declines: economic barriers, social inequality, and communication failures all play a part.
Spanish experts urge caution when interpreting the numbers. Jaime Jesús Pérez Martín, president of the Asociación Española de Vacunología, says changes in data collection or registration systems could affect the trends. He says the direction of the trend and absolute coverage need to be considered together.
Pediatrician Francisco Moraga-Llop says vaccination coverage has been slipping for a decade, while measles has made a global comeback since 2017. In Spain, coverage remains high but is not perfect. Earlier this year, the World Health Organization withdrew Spain’s measles-free status after renewed local transmission.
Other recent research has raised similar concerns. Last year, another study in The Lancet found that vaccination progress had stalled or reversed in many countries, including Spain. The biggest setbacks were in developing regions, but the trend is now visible in wealthier countries too.
Otavio Ranzani, an epidemiologist at the Sant Pau Research Institute, says the most worrying development is the reversal in countries that once led in vaccination. As vaccine-preventable diseases become rare, he says, people forget their dangers, which can weaken support for immunization programs.
Villani and Russo see the current trends as an early warning. They stress that the diseases targeted by these vaccines have not disappeared and that keeping coverage high is impressive to prevent their return. Vaccines save lives, but the progress of the past fifty years is not guaranteed.
Europe faces the challenge of addressing these vulnerabilities before they grow. Spain’s experience shows that even countries with strong immunization systems can face setbacks. Public health gains require ongoing effort, and a loss of trust or access can quickly undo years of work. For a look at how public health disruptions can affect daily life in Spain, see this recent case of regional closures due to severe weather.
