As we celebrate this year’s European Immunization Week under the hopeful banner of “Humanly Possible”, we are reminded of the immense progress public health has achieved through vaccination. In little more than half a century, at least 154 million lives have been saved by essential vaccines, 94 million thanks to measles vaccination alone. Yet, today, a disease once close to elimination, is making a troubling comeback.
The situation
According to WHO Europe and UNICEF, the European Region recorded 127,350 measles cases in 2024; double the number reported in 2023 and the highest since 1997. More than 40% of these cases were reported in children under five, and over half required hospitalisation. 38 precious lives were lost. The European Region now accounts for a third of all measles cases globally.
“Measles is back, and it’s a wake-up call…The measles virus never rests – and neither can we.”
-Dr Hans Henri P. Kluge, WHO Regional Director for Europe
The European Centre for Disease Prevention and Control (ECDC) also highlights this resurgence within the EU/EEA. From February 2024 to January 2025, 32,265 people were diagnosed. Romania alone reported 27,568 cases and 18 of the region’s 19 deaths. Notably, 86% of these cases were in unvaccinated individuals.
Today, less than 95% of the population in most EU/EEA countries receives both MMR doses—the threshold needed for herd immunity. Only four countries (Hungary, Malta, Portugal, and Slovakia) meet the recommended target.
And no country is immune to backsliding; even those with long-standing, high-coverage immunisation programmes. For example, Finland reports that just 91% of children born in 2017 received the second MMR dose, below the 95% benchmark for the second year running, with particularly low coverage in some counties.
The problem is not confined to Europe. In the United States, only three measles deaths occurred in the first 24 years of this century. Yet in just over three months of 2025, that number has already been matched.
What’s behind the numbers?
The record-high measles case count in Europe is a not only a warning about vaccination gaps; it is a signal of eroding public trust.
The Global Listening Project, recently interviewed people in 70 countries and found that since the COVID-19 pandemic:
- Vaccine confidence has decreased in 9 out of 10 countries.
- Young people and women report significantly lower trust.
- In Europe, Hungary, Romania, Greece and Finland saw sharp declines in perceived vaccine safety.
Research from the Vaccine Confidence Project shows that while trust in health professionals remains relatively strong, healthcare systems and governments face growing scepticism. During the COVID-19 pandemic, many people felt left out of decisions, confused by shifting guidance, or spoken down to. This left emotional scars that now undermine public cooperation with routine vaccination efforts.
“Vaccine uptake is closely intertwined with public trust in government. The state approves them, regulates them, recommends them, and sometimes even requires them. A lot of this is not about vaccines; it’s not really about what’s in the syringe ‒ it’s about wider issues.”
The decline in vaccine confidence is relational, not rational. People are not missing facts, but connection. They are asking to be heard, seen, and included. When vaccine campaigns fail to engage people as partners, mistrust grows. This is particularly true in communities with a history of exclusion or marginalisation.
When systems fail to explain and empathise, to recognise historical trauma or systemic neglect, medical decisions are shaped by experience, not just information. And “hesitancy” becomes a rational response.
Trust in action: RIVER-EU’s Participatory Action Research reaches the unreached
This is where RIVER-EU comes in.
RIVER-EU recognises that low vaccination rates often reflect systemic barriers rather than individual hesitancy. That is why it focuses on identifying and dismantling these barriers to ensure equity, build trust and increase vaccine coverage for underserved communities.
These barriers include lack of culturally and linguistically appropriate information and services, insufficient training for healthcare workforce, stigma and discrimination, amongst many others. RIVER-EU implements tailored interventions that resonate with the unique needs of each community and build trust from the ground up.
Central to RIVER-EU’s methodology is Participatory Action Research, which involves collaborating directly with community members to co-create solutions. This approach ensures that interventions are culturally sensitive, contextually relevant, and more likely to be effective. By engaging stakeholders throughout the process, RIVER-EU creates a sense of ownership and trust within communities.
Building upon its participatory framework, RIVER-EU employs a Participatory Transferability Analysis to adapt successful interventions across different contexts. This collaborative approach involves joint decision-making with community stakeholders to select and tailor interventions that address specific local barriers to vaccine uptake. By combining evidence-based strategies with community insights, RIVER-EU ensures that solutions are both effective and contextually appropriate.
Regarding vaccination against measles, RIVER-EU has employed this approach in Poland and Greece:
- In Poland, we worked with Ukrainian mothers, physicians, and other stakeholders to identify barriers and co-design outreach strategies. Read more about our implementation work in Poland.
- In Greece, we collaborated with adolescents, mothers, and professionals to offer culturally relevant interventions, like in-school vaccinations. Read more about our implementation work in Greece.
A call to action
How do we make immunisation #HumanlyPossible?
For health and care providers
You are often the first point of trust. Invest in your communication and listening skills. Consult reliable tools such as:
- UNICEF: Strengthening Confidence in Vaccines, Demand for Immunization and Addressing Vaccine hesitancy
- WHO’s Vaccines Explained Series: How To Talk About Vaccines
- PAHO: Communicating about Vaccine Safety: Guidelines to help health workers communicate with parents, caregivers, and patients
- Or local/national-level training from public health institutes or medical associations.
For researchers and public health professionals
Make science inclusive. Let evidence reflect the realities of those it aims to serve.
- Apply participatory action research (PAR) and integrate community insights into intervention design as a foundation to produce evidence that works.
- Build vaccine communication capacity within the health workforce (e.g. IMMUNION project materials: University of Antwerp’s Train the Trainers session, Vaccine Confidence and Communication for the The Standing Committee of European Doctors (CPME)) and within institutes (ECDC’s Technical report: Communication on immunisation – Building trust)
For policy and decision makers
Prevention success can make infectious disease risks seem distant; but that is an illusion.
- Keep measles and immunisation high on the political agenda.
- Recognise that trust in vaccination = trust in institutions.
- Fund community-based outreach, health literacy programmes, and workforce capacity to restore confidence.
For everyone
Everyone has a role. Protecting yourself helps protect your community.
- Check your vaccination status. If unsure, contact your healthcare provider.
- Encourage others to do the same, especially parents and caregivers.
- Consult reliable sources: