During European Immunisation Week 2024 (21st-27th April), the European Centre for Disease Prevention and Control (ECDC) released data that show an “increase in cases of vaccine-preventable diseases”. Diseases such as measles and pertussis are demonstrating a marked increase across the region. The greatest risk is to young children, with ECDC emphasising the importance of “community immunity”.
A “disheartening” trend
Dr Andrea Ammon is the Director of ECDC and is concerned by the data.
“It is disheartening to see that despite decades of a well-documented safety and effectiveness track record of vaccines, countries in the EU/EEA and globally still face outbreaks of several vaccine-preventable diseases.”
Dr Ammon suggested that the “key actions” against diseases will be “achieving and maintaining high vaccination uptake, disease surveillance, and prompt response actions”.
“Vaccines have protected many generations, and we should ensure that this continues to be the case.”
Measles
ECDC reports that the increase in measles cases began in 2023, and the trend has continued in “several” EU Member States. Between March 2023 and the end of February 2024, “at least” 5770 measles cases were reported. This includes “at least” 5 deaths. In February 2024, 29 countries shared measles data with the ECDC. A total of 623 cases were reported by 21 countries. While case numbers decreased in comparison with the previous month, ECDC implies that this could be attributed to “reporting delays”.
Countries that reported the highest case counts were Austria (190), Romania (152), Italy (92), Germany (59), and France (38). The highest risk is faced by infants below one year of age, who are too young to be vaccinated. They should “therefore be protected by community immunity”.
“Measles spreads very easily, therefore, high vaccination coverage, of at least 95% of the population vaccinated with two doses of measles-containing vaccine, is essential to interrupt transmission.”
Pertussis
Pertussis cases have also been observed in greater numbers since mid-2023, and ECDC suggests that a “more than 10-fold increase in cases” is emerging in preliminary data from 2023 and 2024 compared to 2022 and 2021. Again, newborn babies and infants, who are too young to be “fully vaccinated”, are at an increased risk of severe disease or death.
“To best protect them, it is essential to ensure that all recommended pertussis-containing vaccines are given on time.”
Furthermore, vaccination during pregnancy can protect infants.
Identifying immunity gaps
ECDC encourages countries to apply “continuous efforts” to the identification of immunity gaps in the population. Individuals should check with healthcare providers to ensure that they are up to date with recommended vaccines and timelines, which vary by country.
“Additional work is needed to ensure no one is left behind, especially amongst vulnerable and underserved populations such as refugees, migrants, asylum seekers, and other groups.”
European Immunisation Week
European Immunisation Week is recognised as a “key occasion” to “underscore the importance of vaccination” for health and wellness at all stages of life. It is also a change to celebrate “one of the most remarkable achievements in public health of the 20th century”: vaccines.
“ECDC remains committed to supporting and enhancing national vaccination programmes, prioritising the principles of vaccine quality, safety, and efficacy, and ensuring timely and fair access for all.”
From 21st to 27th April 2024 the European Region celebrates European Immunisation Awareness Week (EIW) with a range of events and initiatives to raise awareness of the importance of immunisation in public health. Additionally, this year’s EIW coincides with the 50th anniversary of the Expanded Programme on Immunisation (EPI). Therefore, the campaign will “celebrate the remarkable achievements of the EPI over the past 5 decades” as well as emphasising the “urgent need” to achieve “high and equitable” coverage in every community.
What is EPI?
The EPI was launched by WHO in 1974 as an initiative to ensure equitable access to life-saving vaccines for every child, regardless of geographic location or socioeconomic status.
“Over the past five decades, EPI has evolved and achieved remarkable milestones that reshaped the global health landscape.”
The launch of EPI used the momentum of the smallpox eradication effort to encourage universal access to vaccines for children. WHO comments that now, every country has a national immunisation programme, and vaccines are “universally recognised” as among the best public health interventions to prevent fatalities and enhance the quality of life.
A European Initiative
In April 2024 WHO European Region announced that it has “joined forces” with the European Union (EU) in a “groundbreaking” project worth €3 million. This project aims to achieve and sustain high and equitable immunisation coverage in both EU and non-EU countries associated with the EU4Health programme. It focuses on improving coverage among “vulnerable population groups, with special emphasis on Roma communities”. These communities are “often disproportionately affected” by vaccine-preventable diseases.
One aspect of the project involves supporting the ministries of health in countries with a large Roma population to “develop, strengthen, and scale up tailored immunisation service delivery”. Not only does this offer access to health protection from vaccines, but also strengthens regional health security.
The project will facilitate:
The collection of high-quality subnational vaccination data
The monitoring and analysis of the reasons behind suboptimal immunisation coverage with vaccines in the national immunisation schedule
The development of context-specific, impactful solutions
Furthermore, lessons taken from developing and implementing these tailored interventions in specific countries will be shared and contribute to increasing immunisation equity across the Region. This project will allow the development of an immunisation data dashboard in line with the monitoring and evaluation framework of the European Immunisation Agenda 2030 (EIA2030).
In March 2024 CEPI announced that an international consortium comprising experts in human challenge studies is beginning a project to develop advanced, virus-blocking coronavirus vaccines to prevent infection from SARS-CoV-2 and other coronaviruses. The project, worth $57 million, is led by Imperial College London and funded by the EU’s Horizon Europe Programme and CEPI. It involves “more than a dozen scientific teams and organisations” that will run trials to select viruses and identify the “best conditions under which to safely induce infection” in healthy volunteers.
Once a virus is selected the researchers will attempt to infect healthy volunteers who have received an experimental vaccine. However, these vaccines will be inhaled or sprayed into the nose, designed to induce mucosal immunity. Scientists hope that this could “be the key” to stopping onward transmission of coronaviruses.
Human challenge studies
Human challenge studies are “unique in their ability to investigate and understand” disease onset and development in a “safe and highly controlled environment”. Imperial College London emphasises that the study is “carefully managed” in a “safe way”.
“They allow researchers to tease out complicated interactions and point out potential targets for prevention, vaccines, or treatment that cannot be seen in patients who are infected naturally.”
The project is called Mucosal Immunity in human Coronavirus Challenge (MusiCC) and will last 5 years. Imperial College London’s researchers have acquired “years of experience” in using human challenge studies to “deepen scientific understand of a range of infectious diseases”. For example, in February 2021, Imperial ran the world’s first human challenge study for COVID-19. Imperial will collaborate with partners such as the University of Antwerp’s Vaccinopolis to establish human challenge models that can be applied across multiple trial sites.
The trials will test potential mucosal candidates against betacoronaviruses, the sub-family that includes the SARS-CoV-2 viruses and MERS coronavirus among others. With harmonised standard operating procedures, the trials will be implemented at several sites in the UK, Europe, the US, and Singapore, involving small groups of young, healthy volunteers.
The project is to ensure that any vaccines that are developed are made available “first and at an affordable price” to “the most vulnerable populations” in line with CEPI’s Equitable Access Policy. Data generated will be published with open access to benefit the international scientific community.
Blocking transmission
Dr Richard Hatchett, CEO of CEPI, states that “vaccines that can stop the transmission of a virus, rather than only reducing the severity of the disease it causes, are crucial to being able to end pandemic and epidemics swiftly”.
“If we could find a way to induce virus-blocking mucosal immunity with the next generation of COVID-19 vaccines, for example, we could then dramatically reduce the circulation of the SARS-CoV-2 virus and hence limit its ability to generate dangerous new variants.”
Professor Chris Chiu of Imperial College London, principal investigator for the project, reflected that “coronaviruses typically infect people through cells lining their nose, throat, and lungs”.
“Mucosal immunity generated at these surfaces is highly specialised and very different to immune responses in the circulation. Since it directly acts in the place that viruses enter and exit the body, it could be the key to developing vaccines that can block viruses from being able to spread from one person to another.”
Professor Chiu is excited to “bring together world class expertise in human challenge studies”.
“With our partners, we will build on the fundamental groundwork we’ve already carried out at Imperial, and through our leading expertise and experience in human challenge studies for a range of pathogens, help to develop the next generation of transmission-blocking vaccines.”
The European Commission’s Laurent Muschel, Head of HERA, and Marc Lemaître, Director-General for Research and Innovation, commented on the importance of research and innovation as “an essential part of the jigsaw” of “health emergency and pandemic preparedness”.
“Supported through up to €35 million by the European Union’s Horizon Europe programme, MusiCC is an exciting and potential game-changing project, opening up the possibility to target and block viruses, stopping their transmission. Investing in research for health emergency preparedness and response remains a priority for the European Commission to protect the health of our citizens and public health beyond Europe.”
Professor Hugh Brady, President of Imperial College London, is “delighted” that Professor Chris Chiu is leading the consortium.
“Working with our global partners, we will be able to use human challenge studies to help develop future vaccines that will benefit humanity. This work is a fantastic example of Imperial’s ability to bring people and organisations together to create real-world impact.”
We will hear more about human challenge models and their applications in respiratory virus research from Dr Catchpole at the Congress in Washington this April; do get your tickets to join us there and don’t forget to subscribe for more vaccine partnership insights.
In January 2024 the European Commission announced that it is putting forward a “Recommendation to support Member States in their efforts to prevent cancer through vaccination”. This has a focus on “boosting the uptake” of two vaccinations that are critical in preventing viral infections that can lead to cancer. These are the vaccines against human papillomaviruses (HPV) and Hepatitis B (HBV). Furthermore, the EC is encouraging improved monitoring of coverage rates.
Europe’s Beating Cancer Plan
The latest recommendation is part of Europe’s Beating Cancer Plan, which is a “political commitment to turn the tide against cancer” and a “stepping stone towards a strong European Health Union”. The European Commission reports that in 2020, 2.7 million people in the region were diagnosed with cancer. A further 1.3 million people died from cancer, with cancer cases “set to increase by 24% by 2035”, making it the leading cause of death in the EU. The Plan will have €4 billion in funding.
Unfortunately, many Member States are “well below” 50% HPV vaccination coverage for girls, and there are limited data available for boys and young adults. Furthermore, there is a “significant lack of data” on HBV vaccination rates.
Measures for Member States
The recommendation includes a “series of measures” that could improve the uptake of the lifesaving vaccines, including:
Providing vaccinations free of charge and/or fully reimbursed
Ensuring that vaccination is easily accessible, particularly to target groups and vulnerable or high-risk populations
Integrating vaccine-preventable cancer immunisation into national cancer plans
Strengthening communication efforts, particularly by highlighting the benefits of vaccination to parents, young people, and target groups and addressing mis- and disinformation
Improving monitoring and reporting of vaccination coverage, to identify where gaps might need to be addressed
Setting a concrete target for HPV vaccination for boys
Strengthen national efforts to reach WHO’s 2030 targets for HBV:
95% vaccination coverage (3rd dose) of childhood HBV vaccination
95% of pregnant women screened for hepatitis B
95% of newborns who received timely (within 24 hours of birth) HBV birth-dose vaccination, including by strengthening systems for the monitoring of progress towards those targets and by making use of available support from ECDC if needed
Putting strong electronic vaccination registries in place
Exchanging best practices with other Member States to improve national efforts
The EC intends to support Member States as they implement the recommendation. For example, it will provide a model for communication campaigns, adaptable to “national needs” and considering “national specificities”, to raise awareness of the importance of the vaccinations. The Commission will support improvements to monitoring across the EU, and the European Centre for Disease Prevention and Control (ECDC) will develop a dashboard of vaccination rates by the end of 2024.
Making a difference
Margaritis Schinas, Vice-President for Promoting our European Way of Life, identifies in the Beating Cancer Plan a “strong political commitment to improve the lives of all our fellow citizens touched by this disease”.
“With today’s proposal, the EU is delivering support to Member States to increase cancer prevention, with a particular focus on protecting children, young people, and vulnerable populations. Prevention will always be the better way to fight cancer, and with 40% of cases being attributed to preventable causes, there is scope to make a difference.”
Stella Kyriakides, Commissioner for Health and Food Safety, agreed that “prevention is always better than cure”. She commented that the EU loses “almost 14,000” lives to cervical cancer each year, and 16,000 new Hepatitis B infections are reported yearly.
“With safe and effective vaccines, we have a historic opportunity to eliminate cervical cancer and other cancers caused by these viruses.”
Kyriakides emphasised that the EC “stands ready to support Member States in every way possible”.
A WHO Europe study issued as a preprint in January 2024 reveals the life-saving extent of COVID-19 vaccines in the region. The paper states that, by March 2023, 54 countries, areas, and territories (CAT) reported over 2.2 million COVID-19 deaths to the WHO Regional Office for Europe. The researchers estimate the number of lives that were “directly saved” by adult vaccinations in the region, between December 2020 and March 2023.
The study
The paper was intended to further previous work by “estimating the number of lives saved by COVID-19 vaccination in adults” aged 25 and over in the European Region. Using weekly COVID-19 mortality and COVID-19 vaccine uptake data from 34 CAT as well as vaccine effectiveness data from literature, the researchers were able to calculate the percentage reduction in number of expected and reported deaths.
“We found that over nearly 2 ½ years of the pandemic, COVID-19 vaccination programmes across 34 CAT of the WHO European Region reduced COVID-19 mortality by an estimated 57%, saving approximately 1.4 million lives.”
In the 34 CAT, the number of lives saved varied from 450 to 396,532. These findings are consistent with other study findings and highlight that “even during the Omicron period”, COVID-19 vaccines still “dramatically reduced mortality”. Indeed, “most lives were saved (67%) during the Omicron period”.
The greatest effect of the vaccine was observed in adults aged 60 or over, with 96% of all COVID-19 deaths averted by vaccine in the reporting countries occurring in this age group. The analysis indicates that older age-group booster doses “played an important role” in saving lives. The report also shows that for people aged 25-49, a second dose provided a “48% reduction in mortality”, despite the meagre 5% uptake of second and third boosters.
The countries that implemented “early” vaccination programmes covering “large parts of the population”, like Belgium, Denmark, Iceland, Israel, Malta, the Netherlands, and the UK, saw the “greatest benefit”.
Irrefutable evidence
Dr Hans Henri P. Kluge, WHO Regional Director for Europe, is glad that the study “documents the result of countries implementing” the advice on COVID-19 vaccines.
“The evidence is irrefutable.”
Dr Kluge highlighted that there are “more than 1.4 million people” in the region, most of whom are elderly, who are now “enjoying life with their loved ones because they took the vital decision to be vaccinated against COVID-19″.
“This is the power of vaccines.”
COVID-19 hasn’t gone away
The WHO Europe statement emphasises that, as “winter intensifies in the northern hemisphere”, COVID-19 cases are “once again on the rise” in parallel with other respiratory illnesses. Dr Kluge was clear that, although “much of society has acquired some level of immunity”, the risk is still there.
“COVID-19 hasn’t gone away. We have merely learned to live with it.”
He suggests that “most of us” can assess our own risk level, encouraging people who “get sick with signs of COVID-19 or flu” to “stay at home and away from others”.
This report clearly presents the significance of COVID-19 vaccines in the region, but how will it be received, and what can we do to turn it into action? For more on lessons from COVID-19 and preparing for future respiratory threats, do join us at the Congress in April. If you are unable to make it, why not subscribe here?
