The impact of European vaccination policies on seasonal influenza vaccination coverage rates in the elderly.

Despite strong recommendations, seasonal influenza vaccination coverage rates (VCRs) remain limited in Europe, even in high-priority groups. There is a need for understanding the impact of vaccination-related policy elements and barriers toward vaccination. We aimed at assessing essential elements of vaccination policies and the influence of policy-related driving factors on VCRs among elderly. Sixteen European National Vaccine Industry Groups (NVIGs) were included in a survey to make an inventory of vaccination policies implemented at national level (2009). The questionnaire was structured around four topics: management of vaccination programs; influence of health care workers (HCWs); role of information/ communication campaigns; and access to vaccine. The information retrieved was put in relation to current VCRs among the elderly (≥ 65 y). Correlation coefficients between policy elements and vaccination rates were calculated. Several policy elements may be suitable to increase influenza vaccination uptake in the elderly, but only few countries make use of all alternatives. Countries with good monitoring systems regarding vaccine uptake rates (Spearman's rho = 0.639, p = 0.010) or sending personal letters offering free vaccination (Sp = 0.728, p = 0.002) showed on average higher coverage among the elderly than countries with less developed vaccine management systems. The presence of additional policy elements (setting national objectives, HCW incentives, vaccination reimbursement systems, awareness campaigns and clear VCR objectives) led to numerically increased VCRs. The presence of several elements of vaccination policies at national level, including broad information and reminding systems, strong official recommendations and good access to the vaccine may help to achieve improved influenza vaccine coverage rates among elderly.