State of Vaccine Confidence in the EU: 2018

"Awareness about the public losing confidence in vaccination has increased, especially in Europe where a number of countries have faced important confidence crises in the past 20 years which partly resulted in the devastating measles outbreaks seen today."

Confidence in (and demand for) vaccines is influenced by a number of factors, including the importance, safety, and effectiveness of vaccines. Commissioned and financed by the European Commission, this report assesses the overall state of confidence in vaccines among the public in all 28 European Union (EU) member states and among general practitioners (GPs) in 10 EU member states. The Vaccine Confidence Project (VCP)™ in its 2015 global survey on vaccine confidence, found that the European region had the lowest level of confidence in the safety and effectiveness of vaccines (Larson, 2016). The survey across the 28 EU member states in this report builds on the previous survey to provide a more comprehensive picture of vaccine confidence across the EU and establishes spatial and temporal trends in confidence. The range of novel EU-wide and country-specific insights into vaccination behaviours may impact on public policy.

The VCP developed a 4-question core survey (the Vaccine Confidence Index™) to measure confidence in vaccines across 4 dimensions: the perceived importance, safety, and effectiveness of vaccines, and their compatibility with the subjects' religious beliefs. Overall, across the 28 EU member states, public perceptions towards vaccines are largely positive, with the majority of the EU public agreeing (strongly or tend to agree) that vaccines are important (90.0%), safe (82.8%), effective (87.8%), and compatible with religious beliefs (78.5%). The results of the survey suggest that a number of member states - including France, Greece, Italy, and Slovenia - have become more confident in the safety of vaccines since 2015; Czech Republic, Finland, Poland, and Sweden have become less confident over the same period.

As vaccine confidence varies by vaccine, confidence in this survey is assessed for vaccines in general as well as for the measles, mumps, and rubella (MMR) and seasonal influenza vaccines. Among the findings: Confidence in the safety and importance of the MMR vaccine exceeds confidence in the seasonal influenza vaccination in the majority of EU member states in the survey. However, in Sweden, Belgium, and Bulgaria, only 57.1%, 64.7%, and 74.6% of the public (respectively) agree that the MMR vaccine is safe. The survey revealed that confidence in the importance of the seasonal influenza vaccine is notably low in Austria, Czech Republic, and Denmark. Younger adults in the survey have less confidence in the safety and importance of both the MMR and seasonal influenza vaccines (and vaccines generally) than older age groups.

While GPs generally hold higher levels of vaccine confidence than the public, the survey found that 36% of GPs surveyed in Czech Republic and 25% in Slovakia do not agree that the MMR vaccine is safe, and 29% and 19% (respectively) do not believe that it is important. The majority of GPs surveyed in these countries report they are not likely to recommend the seasonal influenza vaccine, yet Czech Republic, Poland, and Slovakia all report to the World Health Organization (WHO) that they recommend the seasonal influenza vaccine to pregnant women (WHO, Immunization Schedule by Antigens, 2018).

Reflecting on the findings, the researchers indicate that, while the survey shows that a majority of citizens in the EU still believe in the importance, effectiveness, and safety of vaccines, there have been declines in confidence in certain countries since 2016, highlighting the need for continuous monitoring, preparedness, and response plans. The examples of Sweden and Poland illustrate how confidence can rapidly decline in any country, even those with optimal coverage rates and successful vaccination programmes. In a number of EU countries, anti-vaccine groups, bolstered by social and mainstream media, have started influencing politics and political elections.

The survey also confirmed that European countries are varied, with different historical and political contexts. Each area of confidence and each vaccine addressed in the survey triggered different results in different countries, showing how political and media discourse can shape a country's confidence in vaccines, including MMR and seasonal influenza. This finding highlights the need for targeted responses to rebuild trust.

Finally, if healthcare professionals are to remain an effective way of building and maintaining the general population's trust in vaccines, a continuous monitoring system should be established to detect any potential changes in their own beliefs and behaviours.