Trends in childhood vaccination coverage in the European Union, 1980–2024: an ecological time-series study

Background Vaccination is among the most effective public health interventions, yet vaccine hesitancy in the European Union (EU) has driven declining coverage and resurgences of vaccine-preventable diseases. Trend assessments are essential for informing strategies to maintain high coverage levels. Methods We analyzed WHO/UNICEF Estimates of National Immunization Coverage data (as of September 2025) for 27 EU countries from 1980 to 2024. Coverage for seven first-year antigens (DTP-3, HEPB-3, HIB-3, POL-3, PCV-3, MCV-1, RCV-1) was evaluated using Joinpoint regression for Average Annual Percent Change (AAPC) overall and recent Annual Percent Change (APC) shifts. Findings Of 183 country–vaccine time series, 128 showed positive AAPCs and 55 negative AAPCs, indicating substantial long-term gains but heterogeneous trajectories. In the most recent segment, APCs revealed predominantly declining trends, with 119 decreasing and only 64 increasing trends; 16 countries had four or more decreasing trends across antigens. In 2024, 71 country–antigen combinations reached at least 95% coverage and 62 were between 90% and 94%; in that year, Luxembourg and Portugal achieved at least 95% for all seven antigens, while Romania reported less than 80% for all. The most marked recent declines were observed for HIB-3 and POL-3, with 20 countries each showing decreasing trends, followed by HEPB-3 (18) and DTP-3 (17) whereas measles- and rubella-containing vaccines showed relatively more favorable recent trajectories. Most of these declining segments started between 2019 and 2022, coinciding with the COVID-19 pandemic and its immediate aftermath, and may reflect pandemic-related disruptions to routine childhood vaccination services. Interpretation Despite long-term gains, recent EU-wide coverage declines signal increasing risks to herd and individual immunity. International, national and community actions are needed to reverse trends. Funding Università Cattolica del Sacro Cuore contributed to the funding of this research project and its publication, Linea D3.1 2025 and Linea D3.1 2026.