The EU’s new cardiovascular health plan aims to improve vaccination against respiratory diseases. In a comprehensive interview, Prof Colin Russell makes the case for greater investment, better data and empowering health professionals.
Read: European heart health plan aims to boost vaccination rates
Prof Russell, a professor at the University of Amsterdam School of Medicine, co-chairs the Steering Group on Prevention of Respiratory Infections, founded in 2017 to strengthen immunisation uptake in Europe. Formerly known as the Steering Group on Influenza Vaccination, it has expanded its remit to reflect the growing potential of adult immunisation.
In 2025, the group changed the name of its annual #EUFluDay, relaunching it as #EURespiDay, reflecting its broader mission. It brings together 12 organisations representing healthcare professionals, scientists, civil society and industry, and its activities are supported by Vaccines Europe.
Vaccines Today: What are the main barriers to improving immunisation uptake, and how could the proposed Council Recommendation help address them?
Prof Colin Russell: Despite the high burden of respiratory infections in Europe, consistent low immunisation coverage across Member States continues to leave millions unprotected. Two major barriers are fragmented data reporting and chronic underinvestment in immunisation.
What’s the problem with data?
Reporting remains inconsistent and delayed. For example, only a handful of countries reported COVID-19 immunisation uptake among at-risk populations to the European Centre for Disease Prevention and Control (ECDC) for the 2023/24 season, while aged-based reporting was also inconsistent. This limits comparability with flu data and leaves decision-makers without a clear picture of current protection gaps, impacting the consistency and reliability of important data resources such as the European Respiratory Virus Surveillance Summary (ERVISS).
Why is investment an issue?
Immunisation remains chronically underfunded. Today, only 0.5% of national healthcare budgets is allocated to immunisation on average. That is a very small share for one of the most effective prevention tools we have. This lack of investment contributes to persistent gaps in uptake and slows the introduction of new vaccines into national immunisation schedules.
The Council Recommendation can help address these barriers by calling on Member States to strengthen monitoring and data collection by expanding existing flu surveillance systems to cover COVID-19, pneumococcal disease and RSV. It should also invite the European Commission to support the ECDC by establishing harmonised Member State guidelines for immunisation coverage reporting.
Finally, the Recommendation should strongly encourage investment in immunisation at both EU and Member State level. This includes through leveraging available fiscal flexibilities to support sustained EU country investment in immunisation, support for healthcare professional training, clearer guidance on prevention budgeting, and dedicated funding for immunisation in the next long term EU budget.
What does the evidence tell us about the connection between respiratory infections and cardiovascular diseases (CVDs)?
The evidence linking respiratory infections to CVDs is strong and growing. Respiratory infections can increase the risk of cardiovascular problems, especially for those with pre-existing cardiovascular disease. Even flu or pneumonia can trigger inflammation and blood clots, increasing the risk of heart attack, stroke or heart failure. In fact, the likelihood of a heart attack or stroke can increase up to six-fold in the days following a respiratory tract infection.
This makes immunisation against respiratory infections an important tool for cardiovascular prevention. Evidence shows that vaccination can reduce the likelihood of cardiovascular complications, including heart failure and premature cardiovascular death.
Recognition of this link is also growing. Last year, the European Society of Cardiology published a Clinical Consensus Statement calling for vaccination to be recognised as a core component of cardiovascular disease prevention. The priority now is to translate this recognition into meaningful policy change.
As the EU kicks off work on a Council Recommendation in this area, what are the merits of setting concrete targets for immunisation uptake?
As the Steering Group, we are calling for the Council Recommendation to include annual EU-wide coverage targets for flu, COVID-19, RSV and pneumococcal disease using the 75% uptake target for flu in at-risk populations as a benchmark to increase immunisation rates across the life course.
Concrete targets matter because they make progress measurable. A target is not a mandate, but a common goal that helps Member States understand the level of ambition needed to benefit from the full potential of immunisation, best protect the population and reduce the burden of vaccine preventable diseases, and gives all actors a clear landing zone to work towards.
Vaccination coverage rate targets should be guided by ECDC recommendations and aim for the highest possible level of protection within realistic timelines, tailored to the needs of specific populations and risk groups (including children, older adults, and people experiencing chronic illness or pregnancy).
For targets to be meaningful, they must be supported by practical measures that make immunisation easier to access. This includes reminder systems, using existing immunisation visits to deliver additional recommended immunisation, integrated delivery in alternative settings, ensuring immunisation tools are available and funded, and removing unnecessary prescription requirements.
How important is digital infrastructure for helping EU countries track immunisation uptake, identify gaps among at-risk groups, and support delivery of the future Council Recommendation? What role can the EU play in supporting this?
Digital infrastructure can be an effective tool to help support increased vaccine coverage rates across the EU. Robust infrastructure and accurate data on disease levels and immunisation coverage can help identify gaps, reach vulnerable populations, evaluate programme effectiveness, and guide resource allocation.
Denmark is an interesting example of the effective use of digital infrastructure to support immunisation uptake. Its national Immunisation Information System includes a central electronic vaccination registry, as well as reminder and recall functionality and disaggregated data on coverage by region and risk group. Both patients and healthcare professionals have access to these records, supporting vaccine confidence and uptake. During the COVID-19 pandemic, this helped Denmark identify low-uptake areas in real time and deploy mobile immunisation teams, which helped contribute to a stronger outbreak response.
Healthcare professionals are a trusted source of vaccine information. What support do they need to communicate the importance of immunisation against respiratory infections, including for at-risk groups such as people with cardiovascular diseases?
This ties into the example of Denmark. We know that doctors, nurses and pharmacists are the most trusted source of health information and play an essential role in informing their communities about the benefits of immunisation. For example, studies show that patients are 14 times more likely to get immunised if recommended by one of these groups.
That is why they need the right tools, training and support to communicate the importance of immunisation against respiratory infections, particularly for at-risk groups such as people with CVDs. I’ve seen firsthand in my own hospital that healthcare professionals often lack the understanding of why immunisation against respiratory infections is so important for CVD prevention. We need to make sure that the scientific evidence is translated into clinical practice.
This can be done through stronger immunisation education in university curricula, practical guidance for healthcare professionals, and their meaningful involvement in immunisation policy and programme design.
As the Steering Group, we hope this is reflected in the Council Recommendation. The EU has an opportunity to support Member States by promoting the integration of immunisation education and outreach into medical training and daily practice.
Do you think public awareness is strong enough about the benefits of immunisation against respiratory infections?
Simply put, no. Public awareness of the benefits of immunisation against respiratory infections is not strong enough. Misconceptions remain common, for example that flu is “just a cold”, when in reality it can lead to pneumonia, respiratory failure and other serious complications.
There’s also a widespread belief that RSV and pneumococcal diseases are primarily children’s diseases, without recognising their impact on older adults, something that will become increasingly important as Europe’s population ages. And, as we all know, despite the great desire for COVID to simply “be over,” it still poses a significant burden. Yet the median COVID-19 vaccination coverage rate among people aged 60 years and above was only 8.7% in EU/EEA countries during the 2024/25 season.
What role should EU and national policymakers play in addressing misinformation and awareness gaps?
The public needs a clearer understanding of the benefits of immunisation across respiratory infections. These benefits go beyond preventing illness. They include reducing complications, protecting long-term lung health, lowering cardiovascular risk, easing pressure on healthcare systems and supporting healthier, more productive societies.
The Council Recommendation should call on Member States to strengthen vaccine confidence through transparent, evidence-based communication and targeted community engagement. The European Commission should also consider reinstating the State of Vaccine Confidence in the EU reports. This should go hand in hand with supporting healthcare professionals to act as trusted advocates for immunisation in their communities.
How relevant is the publication timeline of the Council Recommendation for EU countries as they develop or update their national cardiovascular health plans?
The publication timeline is highly relevant because it needs to align with the broader implementation of the EU Safe Hearts Plan.
Through the “EU cares for your heart” initiative, the Commission will support Member States to develop or strengthen their national cardiovascular health plans by 2027. If the Council Recommendation on immunisation against respiratory infections is published in time, it can provide clear EU-level guidance while these plans are still being shaped.
This matters because immunisation should be reflected as a core preventive measure in cardiovascular health planning. Without timely guidance, Member States may take different approaches, leading to further fragmentation and missed opportunities to strengthen prevention across Europe.
EU Safe Hearts to boost adult vaccination
Under a Flagship Initiative of the EU Safe Hearts Plan, the European Commission will prepare a ‘Council Recommendation’ on vaccination for people at risk of cardiovascular events. The Recommendation, which would require the backing of EU Member States, would support national governments in increasing vaccination against influenza, COVID-19, RSV, pneumococcal disease and herpes zoster (shingles). The aim will be to better identify at-risk individuals who would benefit most from vaccination, and for better monitoring of vaccine uptake in this group.