Improving vaccination coverage rates in adult populations: A handbook for health managers and policymakers

12 March 2026

Improving adult vaccination coverage has become an urgent priority for European health systems. Older adults continue to face high risks from vaccine preventable diseases, yet coverage rates for influenza, pneumococcal disease and other respiratory infections remain suboptimal in many Member States. To support health managers and policymakers working to close these gaps, EHMA has developed the Handbook: Strategies for improving vaccination coverage rates in adult populations. 

The Handbook brings together evidence and real-world insights from European countries that have successfully improved adult vaccination uptake. The 2026 edition includes four detailed case studies on pharmacy-based vaccination in France, national reimbursement reform in Austria, digital reminder systems in Denmark and EHMA’s Call to Action for a European pneumococcal target. Each case provides practical lessons and adaptable approaches that can help strengthen national or regional immunisation programmes. 

France: expanding access through pharmacy-based vaccination 

France offers a strong example of how expanding vaccination delivery beyond clinical settings can increase uptake. What began as a pilot for influenza vaccination in 2017 grew into a permanent system by 2023 that allows trained pharmacists to prescribe and administer all adult vaccines. 

This change has improved access for older adults and people with chronic conditions, especially in rural areas. France’s experience highlights the value of simple vaccination schedules, clear operating procedures and shared records between pharmacies and GPs. A phased implementation approach also helped maintain quality and build confidence across the system. 

Austria: strengthening national programmes through reimbursement 

Austria’s journey shows how policy change can unlock progress in adult vaccination. Although pneumococcal vaccination had been recommended for adults aged 60 and older since 2018, lack of reimbursement kept coverage low. Persistent advocacy from scientific societies, patient organisations and regional health leaders helped push the issue forward. 

In 2025, Austria approved funding for free pneumococcal and herpes zoster vaccination for adults aged 60 and above, as well as defined risk groups. This decision aligns Austria with Europe’s leading adult immunisation programmes and demonstrates how evidence, partnerships and well-timed advocacy can influence national policy. It also shows how digital tools such as the e-Impfpass registry can support accountability and transparent monitoring. 

Denmark: using digital reminders to support timely vaccination 

Denmark has built one of the most effective digital reminder systems in Europe by linking the national immunisation registry with the secure e-Boks/DK Post digital mailbox. Starting in 2018, adults began receiving personalised electronic reminders based on their age and vaccination history. 

Large-scale randomised controlled trials demonstrated that these reminders increase influenza vaccination coverage, especially for high-risk adults with chronic conditions. Clear messaging, simple calls to action and alternative channels for digitally exempt citizens played a key role. During 2020–2023, pneumococcal vaccination coverage in adults aged 65+ rose from almost zero to around 75%, with the digital reminder programme likely contributing to this progress. 

EHMA’s Call to Action: setting shared European goals 

To complement national efforts, EHMA launched a Call to Action in 2025 urging the EU to adopt a 75% pneumococcal vaccination target for adults aged 65 and older. The Call draws on the precedent of the 2009 EU influenza target and aligns with European commitments on healthy ageing. It provides a shared benchmark for Member States and supports advocacy efforts aimed at improving access and harmonising strategies. 

A call to action for Europe’s health systems 

Improving adult vaccination requires coordinated action across primary care, public health, digital services and policy. The EHMA Handbook offers practical tools that can help health managers design effective strategies, learn from successful models and strengthen national immunisation programmes. 

EHMA invites policymakers, managers and health professionals to use the Handbook, share it within their networks and apply its lessons to support healthier ageing across Europe. 

download the handbook

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