OBJECTIVES

: Epidemic influenza causes tens of thousands of deaths across Europe each year. Despite widespread population mixing, epidemiology data shows timing and severity of outbreaks differ considerably by country. Whilst a range of vaccines are available in Europe, national vaccination schedules vary due to differences in vaccination policy decision-making criteria. Here we use influenza data to assess the impact of variations in decision-making criteria and schedules on patient outcomes across European countries.

METHODS

: Epidemic influenza data (from ECDC/WHO Influenza website) and excess mortality data (from EUROMOMO) was gathered for European countries for the 2016/2017 and 2017/2018 flu seasons. Assessment methods for selected European countries were reviewed to identify the key decision-making criteria used to develop influenza vaccination policy. Influenza vaccination schedules were also identified. The epidemic and mortality data was correlated with the number and types of decision-making criteria, and characteristics of the vaccination schedules, to evaluate their relationship to patient outcomes.

RESULTS

: Data was gathered for Belgium, France, Germany, Hungary, Italy, the Netherlands, Spain, Switzerland and the UK. Countries using more decision-making criteria were associated with lower reported incidence of influenza-like-illness (ILI), and countries with the broadest vaccination schedules were found to have lower reported rates of ILI and excess mortality. Comparing incidence in countries that used a criterion against those that didn’t showed that some were associated with higher incidence. These were: feasibility of program implementation, clinical trial results and equity in access to vaccine. Decision-making criteria associated with lower incidence were: disease burden, efficacy and effectiveness, safety, and cost-effectiveness evaluation.

CONCLUSIONS

: Lower burdens of disease were found in countries using a wider range of decision-making criteria to develop vaccination policy compared to countries employing fewer criteria. This supports the use of a broader range of decision-making criteria when developing vaccination policy.