Let me start by restating the obvious: vaccines save lives. We all know that. And we also know that knowing something does not always translate into trusting it, let alone acting on it.
At the European Public Health Alliance (EPHA) – we see vaccine hesitancy not as a fringe phenomenon, nor as a failure of science. We see it as a signal. A signal of eroded trust, growing inequities, and a disconnect between institutions and the people they serve.
We must confront this head-on.
A growing challenge with real-world consequences
The grim consequences of decreasing vaccine coverage include rising numbers of measles outbreaks: an estimated 10 million cases worldwide, of which 107,000 unfortunately died in 2023. This problem is not specific to geography or to a social class. Just this past year, Europe recorded over 127,000 cases of measles – the highest in more than two decades. That is a loud alarm bell.
Across Europe, vaccine hesitancy is no longer a theoretical risk. It is shaping public health outcomes – and not for the better.
Confidence in vaccines among health providers is also in decline. In the UK, flu vaccination rates among frontline NHS staff dropped to just 37.5%. That is a systemic failure – not just in logistics, but in trust, communication, and leadership. Recent surveys show that between 14% and 35% of European parents express hesitancy towards childhood vaccines. And in underserved communities – Roma, migrant, undocumented – barriers are systemic: no access, no tailored information, no trust.
Let me be clear: vaccine hesitancy does not occur in a vacuum. It is fuelled by inequality, disinformation, and broken social contracts. Just as EPHA insists on creating health-promoting food environments to address the obesity epidemic, we advocate for just and trustworthy systems when it comes to vaccination – environments where access is easy, equitable, and built on confidence.
So what have we done about it?
At EPHA, we’ve made tackling vaccine hesitancy one of our strategic priorities – not just during COVID-19, but well before and beyond. In our 2019 position paper, we called for:
- Community-led messaging
- Culturally competent approaches
- And embedding trust-building in long-term policy
That same year, we published 5 Recommendations to the EU. One of them was to work closely with civil society to amplify trusted voices in local settings.
Then came COVID-19. And with it, the inequities became stark.
In 2021, we launched a dedicated campaign to promote vaccine equity across Europe. We called for non-digital access to appointments, information in minority languages, and outreach designed with communities, not just for them.
We also led a civil society coalition that wrote to the European Centre for Disease Prevention and Control (ECDC), urging better monitoring of vaccine uptake among vulnerable populations – especially where trust gaps and access gaps intersect.
EPHA will continue to work in partnership with European and international agencies, notably WHO/Europe, to address all aspects of trust in vaccination.
From words to impact: building public dialogue
We know that policies alone won’t shift behaviour. People trust people, not policies.
That’s why we’ve invested in building dialogue. In April 2021, we hosted a webinar on vaccine hesitancy, with input from Professor Heidi Larson of the Vaccine Confidence Project. Among the key messages from that discussion were:
- People respond to consistency, not volume
- Trust is personal, not institutional
- Community engagement isn’t a “nice to have” – it is essential
Looking ahead
The challenge of vaccination uptake is not a communications or knowledge problem. It is not a problem of individual responsibility. It is a trust problem – trust in science, trust in health systems, trust in the motives of pharma companies, and at the end of the day, trust in governments and public institutions.
And trust is infrastructure. It must be built, maintained, and resourced. Here, we see an expanded role for WHO/Europe, and for civil society organisations such as EPHA.
At EPHA, we believe the way forward is grounded in three Es:
- Equity – to make vaccines practically accessible to all
- Empathy – to treat hesitancy as a consequence, not a defect
- Evidence – to invest in behavioural insight, not just biomedical tools
Vaccines are not just about immunity – they are about solidarity. They are about believing that what protects me must protect you too. That our health is interdependent – whether we like it or not.
Let us not waste the lessons of these past years. Let us rebuild that trust together.
Dr Milka Sokolović is Director General of the European Public Health Alliance (EPHA). This guest post was adapted from a speech by Dr Sokolović at a meeting in the European Parliament organised by the Infectious Diseases Alliance (IDA) and hosted by Nicolas Gonzalez-Casares MEP.
