On 19 May, the European Economic and Social Committee in Brussels became the meeting point for a community five years in the making: researchers, civil society organisations, national public health authorities, representatives from major international agencies (e.g., World Health Organization, UNICEF, and the European Centre for Disease Prevention and Control (ECDC)), healthcare professional representatives, and people working directly with communities – among them, a Roma health mediator, a Dutch medical student with a Moroccan background, a Polish primary care health promoter, and a school principal from Athens.
The RIVER-EU final conference “Making Vaccine Equity Work: Community-led Solutions for a Healthier and More Resilient Europe” put on display the project’s field experience, implementation learning, a newly launched guideline and action framework, and closed with a pragmatic conversation about what happens next.
The conference was hosted by Alain Coheur, Director of European and International Affairs of the National Union of Socialist Mutuality Societies (UNMS) and Member of the European Economic and Social Committee, who opened with a framing that set the tone for the day. Health systems cannot be resilient if they are not equitable, he argued and vaccine equity is a strategic imperative, a matter of health security, social cohesion and economic investment. Drawing on his background in the mutual insurance sector, he made a point that is easy to overlook: mutual benefits are not only reimbursement bodies. They are trusted social health actors rooted in communities, running vaccination campaigns, supporting hesitant families, and framing vaccination as an act of collective solidarity. They are, he argued, exactly the kind of civil society infrastructure that makes community-led health work possible, and they belong in this conversation.
The results, front and centre
RIVER-EU worked with five communities across four countries: Ukrainian migrants and war refugees in Poland, marginalised Roma communities in Slovakia, migrants and refugees in Greece, and Turkish and Moroccan background communities in the Netherlands. In every context, the intervention included a trained health promoter model in which community members delivered tailored vaccination education to people who looked and sounded like them.
The results showed increases in vaccination literacy and in intention to vaccinate across all sites. But the more important result was trust built where it had not existed before; conversations happening that would not have happened otherwise; communities that felt heard rather than targeted.
Voices from the field
The session that will stay with most people was the one that included community members and those closest to the interventions.
Mufida Nazri, coordinator of Medical Center Medyk in Warsaw, described opening a clinic for Ukrainian refugees within a week of the full-scale invasion, staffed with doctors who spoke Ukrainian, Polish and English. The work was not primarily about vaccination. It was about earning the right to bring it up: “First speaking about them. How to protect and help them and after, say that there is a vaccine.”
František Turták, a coordinator of Roma health mediators in Slovakia, described what it takes to talk to people you know about something as sensitive as HPV. The mediator’s role, he reflected, is not to know everything, it is to know how to guide people toward the right source.
Salima Ouali, a medical student and health promoter from the Netherlands, captured what it meant to sit with Turkish and Moroccan mothers as someone from within their community: not to speak at them, but with them.
Daphne Gavrili, principal of the Intercultural School of Athens, said it simply: “The project is not only about vaccines. It is about respect and dignity.”
You can watch the recording of this session here.
From community to implementation: how it was actually done
After the community voices, a session with the project’s researchers and implementing partners asked a question practitioners rarely get to answer honestly: what did you assume going in that turned out not to be true?
Tamara Schloemer from Maastricht University introduced the transferability framework that underpinned the work; a participatory process that asked not “what should we implement?” but “what has worked elsewhere, and what would need to change for it to work here?” Community members and stakeholders were part of that assessment from the start, not consulted after the fact.
What followed was a series of honest accounts of adaptation of an intervention which was originally used along the US-Mexico border. In Slovakia, interventions that looked promising on paper were rejected by the community. For example, field vaccination triggered strongly negative associations: for some community members, it recalled the practice of vaccinating dogs, a comparison that carried real stigma. Mothers wanted their children vaccinated by their own trusted paediatrician. In Greece, combining elements from different interventions and reframing HPV as cancer prevention rather than sexual health made the difference. In Poland, the project started with one population and had to rebuild entirely for another when the full-scale invasion of Ukraine transformed who was arriving and what they needed. In the Netherlands, the national vaccination guideline changed during the intervention. The target group expanded from only girls to both girls and boys. RIVER-EU team reflected this change in the educational sessions which made the intervention feel more relevant and increased interest, as HPV vaccination was no longer seen as something only for girls.
The session closed with the question: what happens now?
In Slovakia, Roma health mediators from Healthy Regions incorporated the training around HPV and HPV vaccination into their ongoing community outreach, and will continue to offer this engagement as a part of their overall work.
In Greece, the emphasis was on using what was created: the tools, the synergies, the settings that were found to work and on being clear about the distinction between what is within a practitioner’s control and what requires advocacy.
In Poland, the goal is cross-border continuation: applying RIVER-EU’s findings to new target groups and maintaining cooperation with Ukraine.
In the Netherlands, the infrastructure built in the field: trained health promoters, community relationships, co-created materials, is already being extended to other underserved communities, and an accredited e-learning course was co-developed with the Dutch National Institute for Public Health and Environment.
You can watch the recording of this session here.
The key message: do not make assumptions without first analysing the specific situation. And do not let the work disappear when the funding ends: the infrastructure, the relationships and the tools are the assets.
You can read more about RIVER-EU’s lessons learnt here.
A guideline built from the ground up
For the first time, the RIVER-EU Guideline was presented publicly. The development was led by Colin Campbell at the UK Health Security Agency, with support from Tamara Schloemer at Maastricht University. It addresses a gap practitioners know well: evidence on what works in vaccination interventions is plentiful, but practical guidance on how to transfer those interventions into a new community or context is scarce.
The guideline does not tell you which intervention to implement. It tells you how to decide through a cyclical process of contextual assessment, transferability analysis, community co-design, and adaptive implementation. Its central claim, which the whole day reinforced: low vaccination uptake in underserved communities is a health system failure, not a community failure.
Brett Craig, technical officer for immunization equity at WHO/Europe and Andrea Würz, Expert Behaviour Change and Risk Communication at Vaccine-Preventable Diseases and Immunisation Section at the European Centre for Disease Prevention and Control (ECDC) joined Colin to position the guideline within the broader landscape of tools. WHO’s TIP (Tailoring immunization Programmes) and THP (Tailoring health programmes) approach and ECDC’s social and behavioural science operational guide, which help identify barriers to vaccination, understand who is being missed, and explore why. The RIVER-EU Guideline builds on that by focusing on the next step: how to find, adapt, and implement interventions that have worked in other contexts. Together, they cover the journey from understanding to action.
You can watch the recording of this session here.
Opening the policy conversation
The afternoon asked the harder question: how does any of this actually enter policy?
Dr Katarzyna Lewtak from Poland’s National Institute of Public Health shared preliminary findings on the 2024–2025 measles resurgence: the driver was not nationality or refugee status, it was vaccination status. The accumulated immunity gap across all populations is the problem. Blaming specific communities is not only wrong; it distracts from the system failures that created the gap. Understanding what drives potential outbreaks offers key lessons both for policy and for public communication.
Marijn Stok, programme leader of the SocioVax research programme at the Dutch National Institute for Public Health and the Environment (RIVM), described what it takes to move evidence into policy: the problem, the solution, and political will must align. Evidence alone is not enough. Strategic framing, presenting vaccination equity as a systemic and structural priority, not an individual behaviour problem, is what opens the policy window.
Brett Craig from WHO/Europe named the institutional context directly. In the first European Programme of Work, equity was explicit, a named pillar with its own identity. In the second EPW, covering 2026 to 2030, equity has become horizontal: it runs across all five priorities rather than standing alone. Brett was careful to distinguish this not only as a threat but also an opportunity; vaccine equity sits alongside other inequities, which keeps it connected to the broader social determinants agenda. But it is less visible, and that matters. He noted the opportunity in the health security framing: linking immunisation equity to outbreak prevention and preparedness may be the most politically resonant route into decision-maker attention in the current climate. He also noted that it opened the pathway for more creative collaboration across different health sectors all aiming to achieve better and more equitable health outcomes.
Looking beyond 2030, Brett confirmed that the future of the European Immunisation Agenda after 2030 will be decided by member states by the end of 2026. His message for that process: the response to immunisation inequity must be data driven. Better data on underserved communities, more resources for research, and a clearer picture of what is driving immunity gaps, hesitancy, structural access, programme design failure and to what degree are the foundations without which no successor framework can be effective.
Fatima Cengic, Health Specialist with UNICEF’s Center of Excellence in the Global Programme Division, built the economic case. UNICEF’s new report on the costs of inaction to reach undervaccinated children in Europe and Central Asia shows returns of up to 76 dollars per dollar spent when coverage reaches 95%. Reaching hard-to-reach children costs two to three times more per dose but the returns are disproportionately large. She pointed to two concrete policy levers already within reach. First, the EU Child and Adolescent Health Strategy, a joint strategy between WHO/Europe and UNICEF to which all member states have committed, includes an immunisation dimension and also provides an existing accountability framework that practitioners and advocates can use to hold governments to their commitments. Second, UNICEF is developing a new immunisation equity toolkit for the EU in partnership with DG SANTE, the European Commission’s health department, including a cost-of-inaction analysis tool set to launch this summer.
You can watch the recording of this session here.
What the day left behind
- Trust is not built through campaigns; it is built through listening and building relationships, over time, by people who are part of the community.
- Adaptation is not a compromise; it is the work.
- Time matters: the five-year timeframe of RIVER-EU was itself a condition of success. Standard project funding cycles work against the slow, relationship-based work that produces durable results.
- And there is no need to start from scratch. Relevant guidelines, training tools, and frameworks exist. The gap is not knowledge. It is investment in translating knowledge into standard practice.