I’ve spent years working on vaccination policy in Europe, and if there’s one thing we still underestimate, it’s this: the value of immunization does not begin and end with preventing acute infections in childhood.
That is yesterday’s framing.
In today’s Europe, immunization must be recognized not as a narrow public health tool, but as a strategic pillar of resilience.
Europe faces overlapping pressures: aging populations, chronic diseases, antimicrobial resistance (AMR), climate-sensitive health threats, workforce shortages and constrained public finances. In this context, immunization is not just about preventing illness, it’s about protecting resilience across health systems, economies and societies. The first policy shift is therefore conceptual but essential: immunization must be recognized and governed as a strategic investment in resilience.
At the centre of this is the recognition that infection is a cascade.
Infections weaken the immune system and increase vulnerability to further disease. Viral infections are often followed by bacterial ones, leading to antibiotic use and misuse, and contributing to AMR.
Some infections are directly linked to cancer. In 2024, the European Commission adopted a Council Recommendation on vaccine-preventable cancers, recognizing vaccination, particularly against HPV and hepatitis B, as a central pillar of cancer prevention and setting the ambition to eliminate cervical cancer in Europe.
The first policy shift is therefore conceptual but essential: immunization must be recognized and governed as a strategic investment in resilience.
Respiratory infections can trigger inflammatory responses that destabilize individuals, worsen underlying conditions or precipitate cardiovascular events. The European Commission now explicitly recognizes this link, with vaccination forming part of the response to reducing cardiovascular disease risk and evidence showing reductions of around one-third in major adverse cardiovascular events.
Emerging evidence also points to longer-term impacts on brain health and functional decline. Infections such as influenza, respiratory syncytial virus (RSV), pneumococcal disease and shingles are associated with a higher risk of cognitive decline, dementia and loss of autonomy. Preventing infection therefore also means protecting brain health, independence and quality of life.
The burden of infection is not just the initial illness. It’s everything that follows. Complications, hospitalizations, antibiotic use, long-term deterioration and sustained pressure on already stretched health systems, in addition to broader societal impacts, from transmission and caregiving burden to sick leave and productivity losses.
This calls for a policy shift: immunization should be embedded across disease prevention, healthy aging, cancer, cardiovascular, AMR and brain health strategies, not looked at in isolation.
By preventing infection in the first place, immunization addresses the root cause and contributes to tackling major health challenges while strengthening resilience across systems and societies. And its value is both long term and immediate.
Look at RSV. Europe now has the tools to prevent a large share of severe infections, and where they are implemented at scale, the impact is immediate. In Ireland’s first national immunization season, uptake exceeded 80 percent, with around 22,500 infants protected. Cases fell by 65 percent, hospitalizations by 76 percent and intensive care admissions by 65 percent.
This calls for a policy shift: immunization should be embedded across disease prevention, healthy aging, cancer, cardiovascular, AMR and brain health strategies, not looked at in isolation.
Within a single winter, this translated into hundreds of hospital beds freed, reduced ICU pressure and immediate relief for overstretched paediatric services.
Applied to other member states, this would translate into thousands of hospitalizations avoided and significant system capacity released within a single season.
When RSV is seen as a workforce and system issue, parents unable to work, productivity losses, pressure on families, overwhelmed emergency departments, and delayed care, the value of prevention becomes immediately visible.
This is what short-term return on investment looks like and how immunization can have a strong impact at scale. Even small increases in vaccination uptake translate into thousands of avoided hospitalizations, reduced antibiotic use and immediate relief for health systems.
The policy implication is clear: sustained high uptake across the life course must be treated as a strategic objective.
The return on investment is clear. Adult immunization programs can generate returns of up to 19 times their initial investment, through avoided hospitalizations, reduced treatment costs, lower antibiotic use and preserved productivity.
Conversely, underperforming programs aren’t neutral. They represent lost value, avoidable complications, unnecessary expenditure and sustained system pressure.
In a context of constrained public finances, efficiency must mean investing where returns are highest. Immunization is one of those interventions.
Few interventions combine this level of impact at scale. Higher uptake translates directly into fewer hospitalizations, lower system pressure and a more productive workforce, creating fiscal space by preventing avoidable expenditure.
The next policy shift is implementation: this recognition must now translate into member state action, through sustained investment, stronger programs, and higher uptake, including by leveraging the fiscal space and flexibilities of the EU’s New Economic Governance Framework.
Yet immunization remains significantly underinvested. In most EU member states, less than 0.5 percent of healthcare budgets are allocated to vaccination programmes, despite their substantial returns.
We must recognize value and invest accordingly.
European institutions are beginning to reflect this shift. The European Commission has recognized immunization as a pillar of health system preparedness and resilience, as well as its role in reducing cardiovascular risk, addressing AMR and preventing infection-related cancers.
The next policy shift is implementation: this recognition must now translate into member state action, through sustained investment, stronger programs, and higher uptake, including by leveraging the fiscal space and flexibilities of the EU’s New Economic Governance Framework.
Delivering on this ambition requires looking beyond uptake alone. Access across the life course depends on sustained investment, not only in programs, but also across the full value chain, from research and development to manufacturing.
Europe’s vaccine ecosystem is a strategic asset, but underinvestment risks weakening innovation, reducing supply resilience and limiting access.
Investing in immunization for every generation requires sustained and predictable investment across both programs and the broader vaccine ecosystem. This is a public health imperative and a matter of competitiveness and strategic autonomy.
In a poly-crisis era, immunization is one of the rare policy choices that protects health, supports productivity, strengthens resilience and reinforces competitiveness. These benefits are often achieved rapidly, sometimes within a single season.
That is not a marginal benefit. It is a strategic asset.
Europe has everything it needs to lead. The science is there. The industrial capacity is there. The policy direction is clear. What is needed now is the decision to act.
Investing in immunization is a choice to protect, to strengthen and to grow. And Europe can lead the way, by investing in immunization for every generation.
Disclaimer
POLITICAL ADVERTISEMENT
- The sponsor is European Federation of Pharmaceutical Industries and Associations (EFPIA).
- The entity ultimately controlling the sponsor is European Federation of Pharmaceutical Industries and Associations (EFPIA).
- The political advertisement is linked to EU vaccines policy.
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