Last January, 28th 2020, the second term (2019-2024) of the MEPs Interest Group on “European Patients' Rights & Cross-Border Healthcare” was launched at the EU Parliament. Promoted by Cittadinanzattiva-Active Citizenship Network, with the endorsement of almost 100 associations across Europe, the Interest Group renews its commitment to be an opportunity for the development of the policy making process on healthcare at the EU level: civic participation in healthcare policies should be considered not only as a praiseworthy civic act, but also as a strategic source to safeguard the public healthcare system. A principle theorized forty years ago by the World Health Organization in the Declaration of Alma-Ata,¹ and then repeatedly affirmed internationally over the years.²

The fact that the first initiative³ promoted in the framework of the above mentioned Interest Group was linked to vaccination policies, is proof of the attention that this Interest Group wants to guarantee to this topic and more generally to the topic of prevention. The message underlined was that vaccination must be at the top of the EU Health agenda and priorities. The political goal to sensitize and ensure that the newly elected members of the European Parliament carry forward the commitment on the topic for this legislature period, follows the political goal got last year with the EU Commission. In fact, in order to commit to deliver accurate information to the public, fight myths and exchange best practices, we have achieved that the Coalition for Vaccination, one of the 20 concrete actions included in the “Proposal for a Council Recommendation on Strengthened Cooperation against Vaccine Preventable Diseases⁴” has been extended also to all the civil society’s representatives engaged on the topic, instead of being opened only to the European associations of healthcare workers and relevant students' associations in the field, as written in the Council Recommendation of 7 December 2018.⁵

These two examples testify the role of the active citizens that in Europe advocate for vaccination, and we hope this role could be officially recognized by the EU Institutions in the follow up of the “European Vaccine Action Plan 2015-2020”. Passing on the message that today European citizens only raise doubting or skeptical voices about vaccination is misleading for those who are instead daily committed to increase confidence, knowledge and consequently vaccination coverage. The genuine questions and doubts surrounding vaccination, expressed by citizens throughout Europe, signal the urgent need for Member States and for the health community to recognize them and respond accordingly. Knowing the vaccination calendar, who to deal with in case of doubts, what is the vaccine-vigilance, what each of us can do, when a vaccination is free and when it is paid, what to do when the time to access the vaccination is too long etc. are just few examples of topics on which people can learn more and consequently acquire information on how to protect themselves. Giving answers to doubts and countering vaccination hesitancy is more than right, but doing so without considering that there may be allies within the society would be a serious mistake.

The topic of vaccines affects the sustainability of healthcare systems, as the lack of vaccination and the degree of vaccination coverage have a strong impact on public health expenditures. The protection of citizens' rights, not only patients, cannot be guaranteed without proper information, especially on the subject of vaccines where it is essential to distinguish reliable sources of information from fake news.

In our country, Italy, a well-known and widely used popular saying states "we are all adults and vaccinated", meaning that we are all able to speak openly about "taboo" subjects, but also that we do not get easily deceived into believing what’s not true. Being adults and being vaccinated, according to this old popular way of saying, were synonymous of being safe and protected. Instead, people currently run the risk of being misled by the running fake news on vaccination, and this is a paradox no longer acceptable.

We strongly believe that there is a clear added-value to strengthening cooperation among all relevant actors at the EU level, including health authorities, the vaccine industry, research and innovation, the healthcare sector and others. However, we first need to guarantee the involvement of the civil society. A well-informed citizen who is aware of his rights is a resource for the society. For this reason, we need to invest in the empowerment of citizens and support every option and tool - starting from the ones produced with public resources - aiming at increasing citizens’ awareness of vaccines’ risks and benefits. The fight for vaccination can only be effective if the message reaches citizens, if the tools are available for all of us, and the information reaches all of Europe. In a concrete way, for a better development of the European Vaccination Information Portal, as well for the main output produced by the European Joint Action on Vaccination (EU-JAV), we need to ask ourselves how to better integrate civil society in this vaccination-related initiatives in order to make sure that the hard work and progress reaches a more general audience.

There are a lot of challenges facing vaccination across Europe: vaccine hesitancy, rising antimicrobial resistance (AMR), shifting epidemiology caused by migration, and of course budget pressures on health care systems. Indeed, we believe that a widespread vaccination culture is necessary, particularly to overcome the idea that we only get vaccinated when we are young and to, instead, shift towards a life-course vaccination approach⁷ which prevents a series of diseases even during adulthood.

We encourage the new European Institutions to open the doors in order to better listen and meet citizens face to face, rather than only on the web & social media. It will help all of us to increase mutual trust and to reduce the distance between EU Institutions and EU citizens. For instance, before the EU elections⁸ Active Citizenship Network (ACN) promoted at the EU Parliament in Brussels a debate on citizens' expectations with a selection of MEP candidates and, then, published a Position paper on prevention, innovation and a new health governance for the new EU Institutions, drafted by ACN with the endorsement of 18 associations. The first request send to the new EU Institutions was linked with the need to increase resources for health prevention, in both directions: the key role of screening and the promotion of a life-course vaccination approach. Since we think about advancing policies on vaccination, we need to be mindful regarding how we can help address these challenges. Prevention only represents 3% of all health care investment and vaccination represents the 10% of this 3%. In addition, vaccination has been demonstrated to be one of the most cost-effective public health strategies. When talking about priorities on the political agenda, what weight do we want to give to prevention? The answer to this question will help us to understand how much importance will be given to vaccination plans. Hopefully to receive good news in the upcoming Coalition for Vaccination Annual Meeting, next 9th March 2020 in Brussels.

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Conflicts of interest have not been reported by any of the authors.

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1. Cfr.International Conference on Primary Health Care, Alma-Ata, USSR, 6-12 September 1978.
2. Cfr. Consultazione sulla partecipazione civica in sanità. 2019.
3. Joined for vaccination: addressing vaccine hesitancy and increasing uptake in EU. A multi-stakeholder perspective. 2020.
4. The EU Commission on 26.4.2018 and included in the Council Recommendation. 2018.
5. Council Recommendation of 7 December 2018 on strengthened cooperation against vaccine-preventable diseases. Official Journal of the European Union. 2018.
6. Andrea Grignolio. Who's afraid of vaccines? p. 188.
7. The European Commission proposed a Council Recommendation on Strengthened Cooperation against Vaccine-Preventable Diseases. The EU executive notes that vaccination programmes need to adopt a life-course approach beyond childhood years. This approach aims to ensure a lifelong adequate protection and contributes to healthy living and healthy ageing as well as the sustainability of healthcare systems. the Commission has emphasized, 2018.
8. XIII European Patients’ Rights Day. 2019.