Vaccine-preventable diseases are back in Europe. Vaccination rates are down, trust in institutions has fallen, and concern about misinformation is rising. Public health advocates, including patients and citizens groups, say some politicians are too shy about defending immunisation.
In the United States, there are growing concerns about access to vaccination. European experts are wondering aloud what would happen if political antipathy towards vaccination spread like a pandemic virus. They are supported by a handful of committed MEPs who have formed a Parliamentary Interest Group on Life-Course Immunisation.
‘Vaccination is probably the most successful and effective public health policy we have,’ says Tomislav Sokol, an MEP from Croatia. ‘We cannot take health for granted. People think [vaccine-preventable] diseases are gone, but they can reappear.’
One solution to luke-warm support for immunisation would be to strengthen people’s rights to preventive healthcare. This was the topic of a webinar hosted by the MEP Interest Group in September. The discussion explored whether European citizens’ rights to health could be interpreted to include a firm right to access vaccination. And, if so, what would this mean in practice?
Reading your rights
- The European Charter of Fundamental Rights features the right to benefit from healthcare – including preventative measures – in line with national law.
- The EU’s cross-border healthcare directive entitles citizens to seek certain treatments in other European countries, if their home country agrees.
- The European Charter of Patients’ Rights, drawn up by organisations from 15 countries, lists ‘preventative measures’ as the first of 14 (non-binding) rights.
However, translating aspiration into action is far from straightforward. Health is a so-called ‘second generation’ human right, according to MEP Sokol. Unlike first generation rights, such as the right to life or freedom of expression (sometimes called ‘negative rights’ which must be protected), healthcare is not an absolute right.
Authorities are expected to provide for good health, but they can also prioritise other things when resources are limited. And, Sokol explained, the EU has limited influence over national governments when it comes to setting health policy.
‘Health remains a national competence [responsibility]. The EU can provide financial support and, for example, share best practices on HPV vaccination in the context of cancer prevention, [but] we cannot do anything that is counter to national law; we cannot impose solutions that Member States don’t want.’
Preventative health, he said, can be considered a human right, but it is limited. Even the EU cross-border healthcare directive – which has been used by patients seeking, for example, organ transplants or specialists treatments for rare diseases in neighbouring countries, requires prior approval from national authorities who would cover the costs of care.
Setting Europe-wide immunisation policies or establishing an enforceable right to vaccination appears unlikely in the near future. However, the role of the EU in coordinating access to information and education, including in combatting misinformation, is seen as a key priority in protecting vaccination uptake. Experts argue that European politicians should put pressure on social media platforms to stop the spread of false rumours and disinformation designed to sow mistrust.
Professor Walter Ricciardi, Mission Board on Vaccination in Europe (MBVE), said addressing misinformation must go beyond fact checking. ‘It’s about addressing how algorithms are shaping trust in science and sowing decision paralysis. We can see what’s happening in the US and, if we are not prepared, it will happen in Europe too,’ he said. ‘The world is rapidly changing and we are still addressing new issues in a very old-fashioned way. It’s time for new ideas.’
Prof Ricciardi also called on the European Parliament to issue a ‘moral mandate’ urging governments to provide preventative healthcare, including vaccination and health screening, to all citizens.
Professor Catherine Weil-Olivier, Coalition for Life course Immunisation (CLCI) warned that artificial intelligence could make it even more challenging to combat misinformation. Declining trust risks exacerbating equity and access issues in immunisation. ‘AI is becoming more powerful,’ she said. ‘We need to be careful about how it shapes [social media] algorithms’.
To improve communication around vaccination, Prof Weil Olivier said experts should ‘meet people where they are’ and adapt their language to suit the target audience – whether that is the public, the media, politicians or healthcare professionals. ‘But first, we should listen,’ she added, ‘rather than trying to educate in a top-down way.’
Daniela Quaggia, Active Citizenship Network (ACN), said the right to preventative health is only meaningful if it is guaranteed in practice. ‘This requires clear policies, adequate resources and informed citizens,’ she said. ‘When it comes to vaccination, we still see worrying gaps in coverage and persistent inequalities in Europe.’
Dr Jane Barratt, Global Advisor on Ageing, Health and Social Policy, called for the right to prevention to be applied equally. ‘Preventative health in older age is not a luxury,’ she said. ‘Vaccination does more than reduce infection; it prevents frailty, reduces hospitalisation, and helps manage chronic diseases.’
In particular, she argued, rights to some services, including health screening, are ‘cut off’ in later life. She said rights matter only when they are backed by firm policies and financing, and called on the EU to take the lead by ensuring older adults are included in all immunisation programmes. ‘Is [prevention] a human right? We must answer with clarity: ‘yes’ and it must be across the life-course. Anything less codifies ageism into the system.’
On misinformation, Dr Barrett said social media platforms are aggravating misinformation and cannot be ignored. ‘We need to engage people with accurate, compelling and human centred stories,’ she said. ‘And at the same time, healthcare professionals need to be up to date with the most accurate information.’
Rodrigo Scotini, Infectious Disease Alliance (IDA), called for European authorities to do more on tracking vaccine hesitancy and urged social media platforms to increase content moderation. ‘Europe needs to engage trusted messengers and help them to share pro-vaccine messages,’ he said. ‘A third of health professionals don’t feel empowered to play this role. They need training and support in how to spot misinformation and how to change the narrative on vaccines to make it relevant to individuals.’
Right to be concerned
Whether a European citizen could take a case to assert their right to protection from a vaccine-preventable infectious disease remains unclear. However, as diseases continue to spread, there is a growing consensus that European authorities must do more to counter misinformation.
For their part, advocates of preventative health will need to engage with the public – and with trusted health professionals who face questions from the public.
We know how to prevent outbreaks of measles, pertussis and diphtheria. Perhaps what’s needed is inoculation against misinformation.
UK’s National Health Service Constitution: Rights and Responsibilities
In the United Kingdom, the NHS Constitution guarantees the right to recommended vaccinations. It also urges the public to take responsibility for their own health by participating in public health programmes, suchs as vaccination – but it stops short on making this a requirement.
‘You have the right to receive the vaccinations that the Joint Committee on Vaccination & Immunisation recommends that you should receive under an NHS-provided national immunisation programme.’
The Constitution implies that patients can expect access to free vaccines through their local health services.
