The invisible epidemic: why European health systems are missing two silent killers of older adults
1 September 2026
Every winter across Europe, emergency rooms fill with older adults suffering from severe, gasping respiratory infections. The immediate suspects are familiar: seasonal flu and SARS-CoV-2. Yet behind hospital walls, thousands of elderly patients are quietly battling two other viral threats that almost never make the public health headlines.
Respiratory Syncytial Virus (RSV) and Human Metapneumovirus (HMPV) are well-known to pediatricians, but their impact on older populations is a massive, unaddressed public health blind spot.
A new white paper published by EHMA exposes a critical breakdown in European disease surveillance: despite triggering massive waves of pneumonia, intensive care stays, and deaths among seniors, both viruses remain virtually invisible to routine clinical practice and national tracking systems.
High mortality, low visibility
The human and financial toll is immense. RSV alone is estimated to cause between 120,000 and 320,000 hospitalisations and 12,000 to 20,000 deaths annually among older adults in Europe. HMPV carries a burden that, in some evidence, runs even higher than RSV’s; both viruses send older adults to emergency departments at roughly twice the rate they end up admitted to hospital, often triggering life-threatening complications for those living with chronic heart failure or COPD. One study, in a population with 78% flu vaccination coverage, found combined HMPV and RSV hospital admissions running at nearly double those caused by influenza.
Yet, when we mapped surveillance arrangements across France, Germany, Italy, Spain, and the UK, a stark multi-country trend emerged: while systems for monitoring flu and COVID-19 are highly refined, RSV tracking remains incomplete, and HMPV is caught almost purely by accident.
Data from a survey of 52 European health experts highlights the lack of progress. Self-reported familiarity with adult HMPV monitoring sits at a low 2.9 out of 5. Across the past three years, perceived progress in tracking HMPV was rated at just 2.29 out of 5, indicating systemic stagnation. When asked how receptive their health system would be to adopting enhanced HMPV testing and surveillance measures, experts scored their own countries just 4.0 out of 10, well behind the 5.46 they gave RSV.
The primary care diagnostic vacuum
The root cause of this data blackout is structural.
When an elderly patient presents to a family doctor with acute respiratory symptoms, virological testing is rarely performed. Advanced nucleic acid amplification tests (NAATs) and multiplex PCR panels, which can detect RSV and HMPV simultaneously—are concentrated almost exclusively in hospital laboratories due to high costs, complex logistics, and restrictive outpatient reimbursement rules.
Because primary care practices are not equipped or incentivised to test, public health authorities receive almost no outpatient data. Without actionable numbers, policymakers underestimate the disease burden, creating a cycle of underfunding, lack of clinician training, and low political prioritization, all compounded by post-pandemic fatigue.
A blueprint for European action
Fixing this gap does not require building costly new surveillance infrastructure from scratch. The solution lies in integrating these pathogens into the systems Europe already relies on. In our white paper we outlined a pragmatic, phased roadmap for health managers and policymakers:
- Integrate pathogens into existing platforms: expand established influenza and COVID-19 sentinel networks to automatically include RSV and HMPV tracking, focusing specifically on age-stratified reporting for adults aged 60 and older.
- Harmonise European data flows: establish a compact minimum dataset—including age, comorbidities, care setting, and severity, and enforce routine reporting to European surveillance platforms like TESSy and ERVISS.
- Empower frontline doctors: distribute concise, accredited clinical decision tools for general practitioners, geriatricians, and emergency specialists to clarify when to test and how to report cases.
- Prepare for diagnostic expansion: invest in affordable multi-pathogen tests for outpatient settings, pilot sentinel multiplex testing in long-term care facilities, and adjust reimbursement models to match emerging vaccines and therapies.
Without accurate diagnostic data, health systems are effectively planning prevention strategies in the dark. As Europe’s population ages, bringing RSV and HMPV out of the shadows is no longer just a technical laboratory issue, it is an urgent public health imperative.
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What our Members say
I have been active in EHMA since the first years of the '90s and I have seen its evolution from a small association of members interested in sharing knowledge on health management practices to the current status of reference and advisory key player for EU, health systems and organisations, stakeholders associations, industry and universities. EHMA is now a unique knowledge hub, policy advisor, community of practice and network of best in class organisations involved in health policy and management. A place where health managers can build their competences, policy-makers and stakeholder associations envision how to implement and sustain change through health management, industry leaders understand how to engage more effectively with health organisations and systems. The right place to nurture and grow health management capabilities and capacity for every stakeholder of health systems.
Prof Federico Lega, University of Milan, Italy
Health management has a crucial function in shaping public health and health system challenges. The Medical University of Varna, Bulgaria had success in collaborating with EHMA on EU-funded projects that has resourced us to create new health management competencies for the future workforce. In addition to all classical definitions, health management is a science dealing with individuals, groups, and society at large. It is an art contributing to the beauty of our lives and an interactive communication process at all levels of institutions and human energy. I have also had the pleasure to chair the South Eastern European Special Interest Group which gives members a space to discuss and tools to address how health systems are managed in our regions.
Prof Todorka Kostadinova, Medical University of Varna, Bulgaria
I enjoy the high level of interaction and engagement in EHMA’s activities, in particular during the annual conference where the panel discussions are rich and well prepared. As a hospital manager and professor of health management, EHMA motivates and inspires me to be creative. You go back home feeling energised from seeing old friends and making new connections, as well as being convinced of serving as EHMA’s ambassador. It’s a strong feeling of interdisciplinary engagement, but it also feels like being part of family-like community.
Prof Sandra C. Buttigieg, MD, University of Malta, Malta
Health workforce has become more essential in operating, managing and maintaining health systems lately, particularly in crisis and emergency situations. European healthcare professions and the workforce need to be high on the agenda of managers and decision makers. The Health Services Management Training Centre, Semmelweis University in Hungary is a longstanding EHMA member, because it connects us with collaborators and experts, with whom we can have complex debates, from whom we can learn and at the end find solutions in various challenging fields of healthcare management.
Dr Eszter Kovács, Health Services Management Training Centre, Semmelweis University, Hungary
As a hospital administrator and health management professor, I see on a daily basis that the healthcare challenges require talented and skilled managers to transform it. the EHMA membership has been beneficial to bring healthcare management research and education to the demanding healthcare services world, promoting healthcare management competencies and knowledge creation.
Dr Alexandre Lourenco, APAH - Association of Portuguese Hospital Managers, Portugal
Many healthcare systems in Europe and beyond are facing similar challenges which require innovative and creative solutions. EHMA’s annual conference, webinars, Programme Directors’ group and other activities and resources provide incredible opportunities for networking, connecting and sharing experiences. A distinct feature of EHMA is the diversity of members with representation from many countries, sectors and different communities of practice – academic, policy-makers, practitioners, managers, leaders and students. The annual conference is a highlight in the calendar year, offering a friendly, fun and learningful environment for emerging and established members to engage, collaborate and meet up with old and new friends. I am proud to be a member of the EHMA Board.
Prof Ann Mahon, University of Manchester, UK
Society evolution, pandemics and ageing modify health needs. So, health policies and services are to change dramatically. EHMA, through webinars, workshops and annual conference provides an excellent insight to a professional changing world, favouring closeness to management innovation and the protagonists of these changes. As a primary care services’ manager, participating in EHMA activities is really worth it and allows to involve oneself in the innovation processes.
Antoni Peris-Grao, MD, Consorci Castelldefels Agents de Salut (CASAP), Spain