Vaccine Uptake Research Articles

An integrated approach to enhance vaccine uptake in chronic patients – the VacciNetwork project

Abstract Issue/problem Individuals with chronic illnesses are at a higher risk of infections and their complications. Vaccinations are crucial in reducing this risk and their integration in chronic care pathways can enhance vaccine uptake, but it requires a collaborative approach and increased awareness in care personnel, caregivers and patients. Description of the problem The Local Health Authority of Rome 2 (ASL Roma 2, with approx. 1.3 million residents) initiated an active promotion plan for recommended vaccinations in chronic patients in January 2023, and a Clinical Vaccinology Workbook was produced to guide healthcare workers in promoting vaccinations across various care settings. The plan aims to establish collaborative agreements with hospitals and territorial structures that manage these patients, integrating vaccination plans with clinical and healthcare pathways for a more holistic approach to chronic disease management, a model that could benefit similar populations globally. Results Data was extracted from administrative databases regarding vaccinations performed in 2022 and 2023 on fragile subjects, i.e., those with a marked ‘risk condition’, aged ≥18 years. The results showed that vaccine uptake was more than doubled (6675 vs. 2041; +227%). Notably, vaccinations rose among those with oncological-hematological diseases (+212%), asplenia (+185%), chronic kidney failure or on dialysis (+190%) and those with an HIV infection (+160%). Increases were also significant in other immunocompromised conditions (+194%). Lessons The practice underlines the importance of targeted vaccination programs within chronic care management. Collaborative healthcare frameworks can significantly improve vaccination rates, reducing the burden of infectious diseases in high-risk populations. These results underscore the potential applicability of such a model in other regions and countries, highlighting the universal relevance of integrated healthcare solutions. Key messages • Collaborative, integrated frameworks between clinical and vaccination services can represent a model for increasing vaccine uptake in chronic disease patients. • Strategic partnerships and education in healthcare settings can improve vaccination rates and contribute to more holistic chronic disease management.

Cultural filters in processing information on COVID vaccines among minoritized groups in London, UK

Abstract Introduction Vaccination coverage among minoritized groups, including migrants, is low in the United Kingdom. Cultural factors are often cited as barriers, yet the broader impact of minoritization on vaccine acceptance remains understudied. We explored the intersection of culture with individual, familial, and systemic factors in shaping trust and perceptions of COVID-19 vaccines in East London, UK. Methods We conducted focus group discussions (n = 6) and interviews (n = 19) with individuals from minoritized backgrounds in East London to elicit their perceptions and experiences of COVID-19 and the vaccination programme. Thematic analysis was used to identify individual, social, and systemic factors influencing the processing of perceived value of information on COVID vaccines. Findings Culture was rarely cited as an explicit barrier to vaccine uptake. Instead, participants’ linked their perceived vulnerability and immunity to COVID-19 with age, sex and health status. Information about COVID vaccines was processed and acted upon in the context of gendered family dynamics and support. Community identity, gatekeepers and social networks further influenced the perceived legitimacy of information received. Some participants voiced how their minoritized status shaped trust/mistrust in the national health system’s and government’s delivery of the COVID-19 information and vaccination campaigns Conclusions Unpacking cultural filters is crucial for addressing vaccine-related information barriers in minoritized groups. Going beyond mere language translation, tailored communication materials should address social enablers and systemic barriers. Further, closer collaboration between community gatekeepers and healthcare professionals to facilitate optimal use of these materials is needed to improve vaccine uptake. Key messages • Culture should not be assumed to be the main factor contributing to non-adherence and non-uptake of public health vaccine. • Vaccine uptake can be improved by healthcare workers and key community gate-keepers working collaboratively with minoritized groups.

The role of sociodemographic factors on herpes zoster vaccine uptake among hard-to-reach populations

Abstract Background The anti-Herpes Zoster (HZ) vaccination program was expanded with the adjuvated recombinant vaccine (HZR) in the Lazio Region, Italy, in 2022, restricting its use only to certain categories at risk due to pathological conditions, such as dialysis patients or immunocompromised individuals. This study focuses on the role of clinical and socio-demographic factors on HZR vaccine uptake within the fragile resident population of the Local Health Authority Rome 2 (ASL RM2). Methods This population-based, retrospective cohort study leveraged data from various registries and databases. The study population comprised 835,779 individuals aged ≥18 years who were both RM2 residents and registered with an RM2 general practitioner (GP). Among these, 143,242 individuals with at least one chronic condition were assessed for vaccination uptake using a multivariate logistic model, exploring associations with gender, age, nationality, marital status, household size, and level of deprivation. Results At the conclusion of the study period, a small fraction (1.5%) of the fragile subjects had received at least one dose of the HZR vaccine, and a majority (78%) completed the vaccination course of two doses. The analysis indicated that vaccine adherence was significantly higher in males (OR = 1.15) and individuals aged 65 + (OR = 1.13) while lower among residents in areas of medium (OR = 0.61) and high deprivation (OR = 0.44) and with specific living arrangements - widowed people living alone (OR = 0.66) and families ≥ 6 people (OR = 0.63). Conclusions The ASL RM2 vaccination strategy for hard-to-reach individuals includes an integrated approach, with the engagement of local healthcare facilities and hospitals. Despite these efforts, lower adherence in socioeconomically disadvantaged fragile patients suggests a pressing need for targeted communication strategies and interventions to ensure equitable access to the HZ vaccine, as these groups are more vulnerable to developing chronic diseases. Key messages • Socio-demographic factors significantly influence Herpes Zoster vaccine uptake in hard-to-reach populations, with lower adherence in socially deprived groups. • Tailored, equity-driven approaches are essential for enhancing vaccine coverage among hard-to-reach fragile individuals, mitigating the higher disease risks in these communities.

Advancing data-driven decision-making for human papillomavirus (HPV)

Abstract Background HPV is among the most important infections associated with cancers in men and women, including cervical cancer which is the second most common cancer affecting women aged 15-44 years in the EU. Yet, data on vaccine uptake, HPV infection rates and incidence of related cancers is lacking across Europe, obstructing policymakers’ ability to build adequate prevention strategies towards the EU’s goal of eliminating HPV-related cancers. Methods Vaccines Europe analysed the landscape of data collection practices for HPV, highlighting discrepancies across Europe as well as successful initiatives. Results Our analysis reveals stark gaps in data collection across Europe. Some countries do not report disease levels and vaccination coverage for HPV. When reporting does occur, methods and timelines often differ between countries. Limited data availability exists for vaccination uptake in boys and young adults. This lack of standardisation hinders the comparability and reliability of collected data. It also impedes the integration and analysis of data within and across countries, hindering the development of effective elimination strategies. Concrete actions are needed at EU and national level to further develop and strengthen data collection, sharing and use in decision-making. Our research calls on strengthening ECDC’s role, promoting best practice sharing between countries, ensuring sustained resource allocation for data systems/surveillance, establishing electronic vaccination registries, an EU implementation roadmap to support countries in achieving the objectives of Europe’s Beating Cancer Plan, and translating data into policy recommendations. The Council Recommendation on vaccine-preventable cancers provides a framework for EU Member States to establish electronic vaccination registries and the ECDC to develop an HPV dashboard by the end of 2024. Key messages • Current data collection practices leave Europeans more vulnerable in the fight against cancer. • Robust data can guide policy and support elimination strategies for vaccine-preventable cancers.

Adult Immunization Board: A platform to provide guidelines for implementation of adult immunization

Abstract Background Several organizations, including governments, (inter)national public health organizations and vaccine manufactures are currently considering how adult immunization can be further improved to increase health impact and promote a lifelong approach to vaccination. Despite many organizations thinking about ways to improve adult immunization, there is currently no multidisciplinary discussion platform focusing on this topic at the European level. Therefore, a group of experts in the field of adult immunization established the Adult Immunization Board (AIB). Methods AIB is established with the aim of contributing to the reduction of the impact of vaccine-preventable infections and diseases in European adults. AIB works by organizing 2 meetings per year: 1) a technical meeting to discuss specific technical aspects on adult immunization with subject-matter experts, and 2) a country meeting to discuss country specific aspects of adult immunization together with local experts. Results In April 2023 and 2024 the AIB organized its first technical meetings on “Assessing the health burden of vaccine-preventable infections in European Adults (2023)” and “Strategies for introducing and implementing vaccines for adults into National Immunization Programs in Europe (2024)”. In December 2023, the AIB organized its first country meeting in Italy with local experts to learn out best practices in adult immunization and address aspects to improve. Conclusions AIB is a platform that brings together the different key European stakeholders in adult immunization to effectively contribute towards the implementation and optimization of adult immunization programs in Europe. Key messages • Continued efforts to promote research, implementation, awareness, accessibility, and vaccine uptake are crucial to mitigate the burden of (future) infectious diseases in the adult population. • The AIB represents a significant step towards bolstering adult immunization efforts in the EU.

Interventions’ transferability assessment to strengthen Vaccination Uptake Among Migrants in Greece

Abstract Background Migrant children in Greece face significantly lower vaccination coverage rates for MMR and HPV compared to their counterparts. To address this disparity, our research focuses on selecting and adapting evidence-based interventions tailored to the specific needs of different migrant communities staying in Greece, guided by the PIET-T framework. Methods Using a stakeholder-engaged approach, we involved 26 key stakeholders to select evidence-based interventions relevant to the Greek context. These interventions underwent detailed analysis, considering their effectiveness, cultural appropriateness, and potential for transferability within the PIET-T framework. Key stakeholders provided input on intervention feasibility and country- and context-specific adaptation. Results Three interventions were identified as promising for MMR and HPV vaccination uptake: two health promoter interventions and a school-based vaccination one. The health promoter intervention was adapted so to involve health professionals and trusted community members delivering culturally sensitive education and navigation support, addressing barriers such as language and lack of information. The original school-based program implements education sessions and on-site vaccinations, leveraging the trusted environment of schools to reach parents and children. On-site vaccinations were omitted since they were not relevant to the Greek context due to legal barriers. Conclusions Our stakeholder-engaged approach, guided by the PIET-T framework, ensures interventions are tailored to the specific needs and contexts of different migrant communities in Greece. By prioritizing cultural sensitivity and community involvement, we aim to enhance MMR and HPV vaccination uptake and improve health outcomes among migrant populations.

Don’t pass me by: Tackling vaccine hesitancy among migrants via the RIVER-EU project

Abstract Literature research has suggested that vaccination hesitancy (VH) has been increasing in recent years across migrant populations. It poses various challenges, including risks of outbreaks, and re-emergence of diseases. Nevertheless, only few studies provide an insight of the interventions successful in tackling VH among these groups. This presentation will describe a multi-country research enterprise that aims to respond to these needs. The “RIVER-EU - Reducing Inequalities in Vaccine uptake in the European Region - Engaging Underserved communities” project (funding from EU’s Horizon 2020, Grant Agreement No. 964353) involves several underserved communities, such as Ukrainian migrants (UMs) in Poland, migrants and refugees in Greece, females with Turkish/Moroccan migration background in the Netherlands and the marginalized Roma communities in Slovakia. The project aims at improving child and adolescent HPV/MMR vaccination among these communities by implementing tailored interventions, suitable for each target country. The focus is on removing health system barriers to vaccination. The data regarding VH are an important by-product of the RIVER-EU project, and shows the connection between perceived access barriers and VH. A project-based approach to combat VH among UMs in Poland will serve as a case study to demonstrate the complex process of development of adequate interventions, that could be used to support this migrant group, with disturbingly low vaccination uptake. However, this presentation will go beyond this case study findings - a review of the existing evidence will help generalize our results. Overall, this presentation will show to how investigating various drivers of under-immunization helps to assess what approaches, strategies and interventions are effective to combat VH among marginalized migrant groups.

Primary care utilization in Bulgaria: some effects of the COVID-19 pandemic

Abstract Background Disruptions to primary care provision during the pandemic set back prior advancements in screening and chronic disease management. Delays in routine vaccination added to preexisting hesitancy and sustained the downward trend in vaccination rates. The study examines the magnitude and duration of primary care disruptions in Bulgaria between 2020 and 2022. Methods The impact of the pandemic on primary care is assessed using administrative data from the National Health Insurance Fund covering the annual number of primary care services. To evaluate the effect on healthcare utilization, the average number of check-ups per person during the pandemic is compared to a pre-pandemic period (2017-2019). Results After the onset of the pandemic, all visits declined significantly on an annual basis. In 2020, overall prophylactic check-ups dropped by 6-13% and remained lower than the baseline until 2022. Initial figures for 2023 suggest some recovery, while specific services are likely to experience an ongoing decrease. During the pandemic, the average number of prophylactic examinations for children fell between 6.9 and 9.3%. In 2022, there was a modest resumption, although these services did not reach the preceding levels. Adult prophylactic visits declined by approximately 10-12% between 2020 and 2021, but following a U-shaped pattern, they rebounded in 2022. Visits associated with chronic diseases experienced a drop of 7.8% in 2020 and continued to decrease in the next two years. Child vaccination was affected for a shorter period. In 2022, the coverage for most vaccine-preventable diseases was close to the pre-pandemic levels. However, the uptake of MMR and pneumococcal vaccines failed to demonstrate a clear path to recovery. Conclusions During the pandemic, a considerable drop in primary care utilization has been recorded. Effective recovery requires sustained service delivery and a rapid post-lockdown rebound to mitigate the negative impact on health outcomes. Key messages • Primary care needs additional recovery measures to prevent long-term harmful impacts on health outcomes. • Investing in service delivery innovations can boost resilience during disruptive events.

The Scourge of measles

Abstract Once considered a disease of the past, the resurgence of measles in England has garnered significant attention in recent weeks and months. The uptake of routine childhood vaccines including the measles, mumps and rubella (MMR) vaccine is the lowest it has been in a decade and is well below the 95% uptake needed to protect the population and prevent outbreaks. This is giving this serious disease a chance to get a foothold in our communities. From having never seen a case of measles in their life time doctors in England are now notifying cases of measles based on clinical suspicion. Since October, we have seen a rapid increase in both measles cases and outbreaks of measles across England (the total number of cases confirmed since October 2023 to date is 1109) and it has been declared a national incident. The abstract highlights the consequences of vaccine hesitancy, illustrated by case studies of outbreaks of measles among susceptible populations such as schools and prisons and the steps being taken to control the spread. Social media misinformation, distrust in healthcare authorities, and concerns over vaccine safety are some of the factors shaping parental attitudes towards MMR vaccination. In response to these challenges, the abstract underscores the importance of targeted interventions aimed at addressing vaccine hesitancy, such as community engagement initiatives, tailored communication strategies, and healthcare provider training. By emphasizing the critical role of MMR vaccination in preventing measles resurgence, this abstract advocates for a collaborative approach involving healthcare stakeholders, policymakers, and the public to combat to combat this preventable yet persistent threat to public health.

Community Health Worker Service: addressing the needs of Gypsy/Travellers in Scotland

Abstract Background Members of the Gypsy/Traveller community in the United Kingdom face significant health inequalities compared to the general population, including lower life expectancy, higher rates of morbidity and suicide and poorer infant and child outcomes. This study evaluated the implementation of community-based lay workers in Scotland - the Gypsy/Traveller Community Health Worker (CHW) service. Methods This multi-method qualitative study (December 2021 to August 2023) included 16 individual interviews, five focus groups, one workshop, two informal discussions, and one site visit. Participants were stakeholders, CHWs, and members of the Gypsy/Traveller community. Additionally, 116 documents were analysed. The framework method, Proctor’s implementation outcomes and thematic analysis were used for data analysis. Results CHWs reached approximately 1,000 individuals across six National Health Services (NHS) Boards. The implementation outcomes showed that the intervention was accepted and feasible. A third-sector organization (Black and Minority Ethnic Carers of People Project - MECOPP), played a crucial role in successfully delivering the CHW service. This innovative intervention employed members of the Gypsy/Traveller community as lay healthcare workers to break down barriers to accessing healthcare and other services (e.g., uptake of cervical screening, vaccination, housing, and sanitation). The CHWs were trusted, ensured healthcare information was culturally appropriate and successfully addressed discriminatory behaviours in health and social care. Limited resources pose challenges to the sustainability of the service. Conclusions The Gypsy/Traveller CHW service enhanced prevention, acted as a bridge between communities and health systems and addressed the wider determinants of health. The Gypsy/Traveller community still faces discriminatory, racist, and stigmatising behaviours, which further impede the quality, delivery, and accessibility of care. Key messages • The Community Health Worker service was acceptable and feasible in the Gypsy/Traveller community, acting as a bridge between community and health systems and increasing access to services. • Community Health Worker Service is an important strategy for delivering healthcare support through their sector organizations to address historical discrimination against minority ethnic groups.

Whole of prison approach to vaccination: co-development of information materials for people living in prison

Abstract Enhancing vaccination literacy is pivotal in addressing hesitancy, especially among incarcerated populations who may lack regular access to health information, thus ensuring health equity. Supported by the European Union, the RISE-Vac project endeavours to bolster vaccine literacy, accessibility, and uptake within European prisons. To discern vaccination knowledge gaps and preferences for information dissemination, consultations were conducted with incarcerated individuals in the United Kingdom (via the Prisoner Policy Network), France, and Moldova. A total of 344 responses were garnered: 224 from the UK, 70 from France, and 50 from Moldova. In addition a focus group was conducted in the UK. The key themes that emerged were common across the 3 participating countries: views of vaccination, prior knowledge about vaccines, areas of appetite for learning, availability of reliable information, and preferred mechanism for information sharing. Participants were particularly interested in learning about the effectiveness, side effects, and manufacturing of vaccines. Their invaluable input informed the creation of educational materials, notably a brochure slated for pilot testing in European prisons and a video clip. Notably, individuals with lived prison experience were actively engaged at every phase of this initiative, ensuring its relevance and efficacy.

Advancing immunisation information systems: a proposal for the “unvaccinated registry”

Abstract Through a systematic review of 253 studies, we identified significant advancements in IIS functionalities including real-time data access, interoperability, and life-course vaccination records, crucial for robust public health responses. Our review reveals that vaccinations are vital for public health and societal welfare; however, vaccine hesitancy is a significant barrier, driven by complex factors. Most IIS implementations predominantly utilise web-based platforms focused on children’s vaccinations with features that enhance data interoperability and public health surveillance. Despite these advancements, gaps in vaccine coverage and hesitancy mapping persist due to suboptimal data integration and system interoperability. Parallelly, we propose a comprehensive registry that includes unvaccinated individuals, aiming to address vaccine hesitancy by integrating demographic and socio-economic data. This initiative promises to enhance health equity by providing actionable insights into vaccination gaps and facilitating targeted interventions. Ethical considerations, particularly data privacy, are paramount, as well as adhering to regulations such as GDPR to ensure the protection of personal health information. The integration of IIS with a registry that includes unvaccinated populations represents a transformative approach to public health, potentially increasing vaccine coverage and effectively informing policy decisions. This dual strategy leverages not only technological advancements but also incorporates essential behavioural insights, offering a path forward in the ongoing battle against vaccine-preventable diseases. This model aligns with the Italian National Vaccination Prevention Plan and underscores proactive, evidence-based strategies to enhance vaccination uptake, serving as a cornerstone for broader application in other national contexts.

Transferability of vaccination interventions from a community perspective: One size does not fit all

Abstract Background Removing health system barriers to childhood vaccination is an urgent matter in the migrant community in Greece, the Turkish and Moroccan communities in the Netherlands, the Ukrainian minority in Poland, and the marginalized Roma community in Slovakia. The objective of this study was to select and adapt potentially transferable evidence-based interventions for HPV and MMR vaccine uptake in partnership with the underserved communities. Methods Using a participatory approach, we assessed transferability of six pre-selected interventions with the Population, Intervention, Environment and Transfer (PIET-T) models: All countries investigated two interventions with trained community members to support vaccination as health promoters. Greece and the Netherlands included a school-based vaccination program. The Netherlands added two interventions addressing providers’ HPV vaccine communication, and Slovakia a multilevel intervention. Results We identified barriers and facilitators for successful intervention transfer in each of the target contexts. The transferability analysis showed that an intervention with health promoters is potentially transferable with adaptations in all countries. Principles of trust in the educator, tailored and trustworthy information, help in navigating the health system for vaccination and easy access at no cost are transferable key elements in all contexts. Adaptations refer to the intervention elements that need to be tailored to specific contextual needs. School-based vaccination was nowhere transferable. Health provider training needs to be culturally sensitive and adapted to the Dutch system. The multilevel intervention in Slovakia is not fully transferable. Conclusions Participatory transferability analysis was essential for decision-making and intervention adaptation. All countries independently selected a health promoter intervention as having potential to remove the identified health system barriers in the respective context.

Factors associated with the intention to vaccinate children: a Finnish population survey on influenza

Abstract Background Influenza vaccination for children aged 6 months to 6 years is included in the national vaccination programme in Finland. Although all vaccines in the programme are free of charge, national coverage of influenza vaccination among children under 3 years and 3-6 years during 2020/21 was 43% and 35% respectively, with regional differences. Our aim was to assess factors underlying parental vaccination intention in order to increase influenza vaccine uptake among children in Finland. Methods We conducted a survey among parents (n = 17,844) of eligible children (aged 6 months-6 years), selected randomly from five Finnish municipalities. Children and their parents were selected from high and low coverage areas, and the study was conducted in February-March 2022. Logistic regressions were used to determine associations between vaccination intention and e.g., sociodemographic factors, attitudes and knowledge. Linkage to the national vaccination register was used to confirm realisation of vaccination intention after the study. Results Participation rate was 13% (n = 2,322 parents). Influenza knowledge, trust in official information, responding parent’s education level, adherence to the vaccination programme, number of children and changes in attitudes towards vaccination since COVID-19 were all associated with intention to vaccinate. Vaccination intention for children was 64% and realised vaccination 51%. Conclusions Despite the low participation rate, both vaccinated and unvaccinated children were represented. Influenza vaccine uptake is not dependent on a single factor. Our results identified the need for open dialogue between parents and healthcare professionals, as the lack of vaccine being offered by healthcare professionals was the most reported reason for not vaccinating. Key messages • Parental vaccine decision-making in settings where the vaccination is given free of charge is complex, and not always driven by intention to vaccinate. • Most parents had the intention to vaccinate, but some children still ended up not receiving their influenza vaccine.

Implementation evaluation of a school-based intervention on HPV vaccination (the PrevHPV study)

Abstract Background HPV vaccine coverage (VC) remains lower than expected in many countries, particularly France. We developed and evaluated the PrevHPV multicomponent intervention to improve HPV VC among French adolescents. We evaluated the implementation of the school-based components of the intervention. Methods We carried out a mixed-method study embedded in a cluster randomized controlled trial (July 2021-April 2022; 14/25 French school districts). The cluster was the municipality (n = 91). The school-based components of the intervention were ‘education and motivation’ and ‘at-school vaccination’. Quantitative data were collected through standardized activity reports and self-administered questionnaires; the implementation outcomes were fidelity, dose, reach, acceptability and sustainability. Qualitative data were collected through semistructured group interviews with school staff and analyzed using the Consolidated Framework for Implementation Research. Results We found high rates for: fidelity (e.g., 69% of the targeted classes had two educational sessions and 89% of schools invited all pupils for at-school vaccination, as planned); acceptability (e.g., pupils’ participation satisfying in 90% of the sessions, 96% of vaccinated pupils and 78% of school staff satisfied with at-school vaccination); and sustainability (e.g., respectively 91% and 76% of schools considered conducting sessions and vaccination days during the following year). However, the withdrawal of 1/3 of schools before the trial started and difficulties in mobilizing parents negatively impacted dose and reach. Several facilitators and barriers influenced the implementation of the components; they were related to the components’ design, the characteristics of both the external and internal environment of the school, the numerous stakeholders and individuals involved, and the implementation strategies used. Conclusions These results can guide policy making on school-based HPV vaccine promotion in France and Europe. Key messages • The PrevHPV study is supported by the French health authorities and conducted by a multidisciplinary consortium to tackle a long-lasting public health concern in France. • These findings have practical implications for implementing effective and acceptable school-based interventions in real life to improve HPV vaccine uptake and reduce HPV-associated burdens.

Developing an infodemic management toolkit for immunization: An iterative consultation process

Abstract Issue An infodemic is an overwhelming amount of information, accurate and otherwise, that accompanies health emergencies such as outbreaks and other health crises. Infodemic management work is done by people from different positions and professions, with differing resources at their disposal, and applied to a range of health issues. An infodemic insights report can help identify questions, concerns, information voids and circulating mis- disinformation to help inform an emergency response. Health issue specific guidance can be useful for those who may have infodemic management as part of their regular work but want to identify infodemic insights and contextualize these insights in relation to other programme data. Description The WHO and UNICEF ‘how to build an infodemic insights report in 6 steps’ document provides general guidance. A more immunization specific document, with practical and specific tools in standalone short focus areas was developed to guide infodemic managers or those working on vaccine demand and acceptance, and by vaccination field workers. The toolkit is intended for vaccines across the life course, including for children, adolescents, pregnant people, adults, and people with pre-existing conditions or have other vulnerabilities. Results Rounds of iteration with experts both internal and external to WHO provided useful feedback, review and suggestions. The toolkit provides information targeted at different resource and capacity levels. Lessons The consultative process resulted in a toolkit informed by experts and those who are likely end-users of the document. The consultations sought to align the toolkit with immunization programme processes and with other tools and interventions for improving vaccine uptake. Having health issue specific guidance is a useful addition to the infodemic manager toolbox and tools such as these can be an important component of community resilience and health security initiatives. Key messages • For immunization, infodemic management can support programme activities to build vaccine confidence and improve uptake, and manage vaccine-related events. • Expert informed guidance on health topic specific areas can be a useful addition to the infodemic manager toolbox.

Boosting influenza vaccination rates through policy gamification: the ‘Let’s Control Flu’ project

Abstract Background Influenza remains a public health challenge globally, leading to substantial morbidity and mortality, particularly among vulnerable groups. Despite the benefits of vaccination, achieving the desired vaccination coverage rates (VCR) proves challenging across Europe. The ‘Let’s Control Flu’ (LCF) tool emerges as a new contribution, merging gamification with epidemiological data and public health policies to help increase influenza VCR. Methods The LCF tool, developed from an extensive literature review and validated by a National Advisory Board, initially showcased its capabilities in Sweden. Offering an interactive simulation, it allows stakeholders to explore the outcomes of implementing 13 targeted public health policies (PHP) on influenza VCR and health outcomes such as infection rates, hospitalizations, and mortality. This approach simplifies epidemiological complexities, paving the way for informed decision-making. Results Following its success in Sweden, the LCF tool was extended to Germany and Czechia, underlining the value of gamified tools in public health decision-making. The application across these new countries not only resulted in paths to improve VCR but also provided insights into the tool’s scalability and adaptability different landscapes. Conclusions The LCF project underscores the efficacy of integrating gamification into health policy decision-making, offering a replicable model for enhancing influenza vaccination uptake across Europe. With the tool now successfully applied in multiple countries, its potential for broader European and global application is evident. This initiative aligns with WHO’s objectives, spotlighting gamification as a relevant component in improving vaccination strategies and readiness for influenza and other preventable diseases, thereby reinforcing the importance of innovative approaches in public health policy development. Key messages • The LCF tool integrates gamification with public health strategies to help effectively raise influenza vaccination coverage. • By merging gamification and epidemiological insights, the LCF tool also serves as a scalable model for Europe, supporting WHO’s goals to improve vaccine strategies and preparedness.

Educational and communication strategies to promote HPV vaccination: A Systematic Review

Abstract Background Despite the evidence supporting the value of vaccination, Cervical Cancer (CC) and HPV-related diseases still represents a public health challenge, requiring international efforts to address all barriers that can reduce vaccine acceptance and equitable uptake. In this context, implementing interventions aimed at enhancing knowledge levels within target populations emerges as a crucial approach to improve vaccination coverage. Thus, this study conducted within the PERCH project (PartnERship to Contrast HPV), aimed to explore all educational interventions/communication strategies adopted at the international level to improve HPV vaccine uptake. Methods A systematic literature review was conducted by querying three databases from July 1, 2006 (the time of the first HPV vaccine licensure) to January 30, 2024. It included studies focused on educational interventions/communication strategies adopted by healthcare providers (HCPs) targeting the World Health Organization (WHO)-recommended population for HPV vaccination, as well as parents, caregivers, teachers, and other influential individuals involved in vaccination decision-making. Results Overall, 16 studies were considered, with 68.7% (11/16) focusing on educational initiatives and 50% (8/16) on communication strategies. Regarding the target population, 19% (3/16) involved parents/caregivers, 25% (4/16) included both parents and adolescents, and the remaining 56% (9/16) targeted adolescents/young adults. Videos were the most commonly used channel for both types of interventions (54%), followed by informative materials (31%), person-to-person solicitation (17%), social media (15%) and slide presentations (23%). Conclusions Understanding the strengths and weaknesses in HPV knowledge and communication is crucial for developing effective, tailored strategies to disseminate reliable information and promote evidence-based knowledge, thereby implementing high-value healthcare. Key messages • Effective communication of vaccination’s value to stakeholders is essential for informing health policies, guiding best practices, and countering misinformation. • Further research is needed to develop interventions that effectively increase HPV vaccine acceptance, aligning with the WHO’s goals to eliminate CC and HPV-related diseases.

Vaccination campaign implementation in Madagascar: a Dynamic Sustainability Framework approach

Abstract Background The COVID-19 pandemic has highlighted the need for equitable and timely access to vaccination. Limited evidence is available on how to implement vaccination campaigns (VCs) that are sustainable and responsive to changes in real-world health policy and practice contexts. We present lessons learned from the implementation of a COVID-19 VC in the Boeny region of Madagascar. Methods Informed by the Dynamic Sustainability Framework, VC implementation was continuously reviewed during multisectoral stakeholder feedback rounds, key informant interviews, and problem-solving meetings to identify and put key adaptations throughout the campaign process into practice. Outcome indicators include pre- and post-VC vaccine hesitancy and trends in vaccine doses deployed were analyzed using generalized linear models. Results Key adaptations of the implementation strategy included community-led awareness-raising and outreach activities also in remote areas, strengthening VC through the training of 340 staff, and addressing gaps identified in the cold chain, waste management, vaccine transportation, and IT equipment. Overall, 24888 COVID-19 vaccines were administered in six months. Changes in campaign strategy increased the number of doses administered by 8% (RR = 1.08; CI 95%: 1.01; 1.15) per week. No changes in vaccine hesitancy post-VC were observed in an unvaccinated population(Δ = 0.02, CI 95%: -0.04; 0.08). Conclusions Collaborative and dynamic multi-sectoral VC strategies that combine healthcare-based approaches with pro-active outreach and community-led awareness-raising activities are essential in increasing vaccine uptake in limited-resource settings. Our findings show that despite boosting vaccination coverage, such initiatives may not have an impact on COVID-19 vaccine hesitancy at the community level Key messages • Multisectoral stakeholder collaboration and engagement are key to successful vaccination campaign implementation. • A Dynamic Sustainability Framework approach can be effective in ensuring a continuous fit between campaign and its setting.

5.I. Scientific session: Epidemiological insights into vaccine hesitancy in Europe: building bridges and overcoming barriers

Abstract Vaccine hesitancy remains a pivotal challenge in public health, undermining immunization efforts and the containment of infectious diseases across Europe. This scientific session aims to dissect the complex nature of vaccine hesitancy, uncovering epidemiological trends and barriers to vaccine acceptance, particularly in diverse demographic contexts. The objective is to facilitate a comprehensive understanding among public health stakeholders and to foster actionable strategies through enriched dialogue and interaction. This session will delve into recent studies and projects that highlight the variability of vaccine hesitancy within Europe. First, an exploration of COVID-19 vaccine acceptance will reveal how sociodemographic factors influence vaccine-related behaviors across 20 European nations. This will be complemented by an analysis of targeted interventions designed to enhance vaccine uptake among migrant populations, drawing lessons from the RIVER-EU project. Additionally, a focus on national efforts to combat measles vaccine hesitancy will provide a case study on the challenges and successes in altering public health narratives. Based on the feedback received on last year’s session, the format is intended not only to provide a platform to present empirical evidence and insights but also to encourage a participatory environment where attendees can exchange ideas and propose innovative solutions. For this reason, the session will engage the audience through an interactive discussion period at the end of each of the three presentations, stimulating thought-provoking dialogues that could lead to effective and innovative public health practices. Fostering international and interdisciplinary collaboration in the field of vaccine hesitancy is key for continued monitoring and reporting on the vaccine hesitancy phenomenon and inspiring actionable solutions. Key messages • Sociodemographic factors are associated with vaccine hesitancy across Europe indicating the potential for targeted strategies. • A platform to share insights and inspire actionable public health solutions to combat vaccine hesitancy amomg European public health professionals is needed.