Respiratory syncytial virus (RSV) is the leading cause of infant hospitalization in Europe. The UK launched a national maternal vaccination program in September 2024, generating the largest real-world dataset of its kind globally within a single season. This talk presents what year one looked like in practice.

• Program design: how the UK structured delivery through antenatal services, the timing window chosen (from 28 weeks), and how coverage was tracked across 90% of English births
• Effectiveness data: over 81% reduction in infant hospitalizations when vaccination occurred at least two weeks before birth, rising to nearly 85% at four weeks — including 69% protection for preterm infants
• The uptake picture: coverage reached 55–64% in year one — a meaningful start, but well below influenza vaccine uptake levels, raising immediate questions about which pregnant women were not reached and why
• The implementation lesson: what the UK's linked data infrastructure (NHS maternity records, immunization data, hospital surveillance) made possible that most European countries could not yet replicate

Human papillomavirus vaccination was introduced across Europe from around 2008. Fifteen years later, the evidence from countries that achieved and sustained high coverage is unambiguous: cervical cancer is becoming a preventable, and in some cohorts an already-prevented, disease. This talk examines what sustained success looks like at the population level.

• Coverage milestones: Iceland, Portugal, and Norway have reached 90% coverage in girls by age 15 — the EU Council target for 2024 — demonstrating that high and sustained uptake is achievable across different health system models
• Outcome data: Swedish studies show a 79% reduction in cervical cancer incidence in women vaccinated before age 17; studies from Scotland report zero cases of cervical cancer in cohorts vaccinated at 12–13 years
• What made the difference: school-based delivery, gender-neutral programs, sustained political commitment, and integration into routine adolescent health services — not a single intervention but a system
• The time-horizon lesson: what HPV teaches about the relationship between program fidelity today and population health outcomes a decade and a half from now — and what it means for newer programs still in their first years

In March 2026, a cluster of meningococcal B cases in Kent — two deaths and 23 confirmed cases, triggering emergency vaccination of university students — brought public and political attention to a gap that had existed for twelve years. A MenB vaccine had been available and proven effective since 2012. A 2014 JCVI cost-effectiveness ruling explicitly excluded adolescents from routine vaccination while infants became eligible from 2015 — meaning the university-age cohort affected in Kent had never been offered the vaccine as children. This talk examines what happens when program design decisions create invisible failure modes.

• The policy sequence: how the 2014 cost-effectiveness assessment was made, what it concluded, and what assumptions it embedded about acceptable risk in adolescents versus infants
• The outbreak: the Kent cluster as an epidemiological event — the age profile of those affected, why university students represented a high-exposure group, and the emergency response mounted
• The equity dimension: the JCVI's original decision is a case study in how explicit policy choices — not failures of access or uptake — can design inequitable outcomes into a program; the families of those who died are now calling publicly for wider vaccine availability
• Lessons for program design: how cost-effectiveness thresholds interact with age-group targeting decisions, and what the Kent cases suggest about how such thresholds should be reviewed as epidemiological conditions change

Pertussis is a vaccine-preventable disease that Europe had largely brought under control. Between 2023 and 2024, it came back with force: nearly 14,000 confirmed cases in England in the first nine months of 2024 alone, and the worst outbreaks in decades across multiple European countries. The disease had not changed. What had changed was the maintenance of immunity over the life course — and particularly the immunization of pregnant women. This talk examines pertussis as a model of what happens when lifecycle immunization thinking breaks down.

• The 2024 resurgence: the epidemiological pattern across the UK, Czech Republic, Netherlands, and wider Europe; why the COVID-19 pandemic suppressed pertussis transmission and created a population-level immunity debt
• The infant mortality picture: of 26 infant deaths from pertussis in England since the maternal program began in 2012, 21 were born to unvaccinated mothers — a figure that is both a measure of vaccine effectiveness and an indictment of program fidelity, with maternal uptake falling from over 74% in 2017 to under 59% by early 2024
• The lifecycle argument: pertussis is not a childhood disease — it circulates in adults, who transmit it to infants too young to be vaccinated; the adult booster schedule is the missing link, and most European countries do not have systematic adult pertussis catch-up programs
• A note from wastewater surveillance: by late 2024, circulating vaccine-derived poliovirus was detected in wastewater in Germany and other EU countries, prompting catch-up recommendations; pertussis and polio together illustrate a broader truth — sustained immunity across the life course cannot be assumed from high infant coverage alone

France was, for much of the 2010s, the most vaccine-hesitant country in Western Europe. Forty percent of French adults doubted vaccine safety — against 13.5% of Americans. The government's response was not a communication campaign but a structural one: a progressive expansion of the mandatory schedule, the deployment of school-based delivery for HPV, and a broadening of who is authorized to prescribe and administer vaccines. This talk examines France as a policy systems case study in intentional program change.

• The mandate strategy: in 2018, France expanded its mandatory childhood schedule from 3 to 11 vaccines — a politically bold decision that followed a citizen consultation process and produced measurable coverage gains; from January 2025, meningococcal B and ACWY vaccines were added to the mandatory schedule for infants, responding to a surge in invasive meningococcal disease that reached its highest level since 2010
• The school-based HPV program: launched in autumn 2023 for all 12-year-olds, the school-based HPV campaign achieved a 17 percentage-point increase in coverage in a single year — from below 30% to 48%; the target is 80% by 2030; coverage is rising for both girls and boys under the gender-neutral program
• Widening the delivery pathway: from 2026, nurses, pharmacists, and midwives can prescribe and administer vaccines to anyone aged 11 and older — reducing dependence on general practitioners who historically under-recommended vaccination in France
• What France teaches: the hesitancy framing was a dead end; the system change framing — making vaccination easier, more automatic, and less dependent on individual clinical encounters — is producing results; the question for other countries is which elements of the French approach are transferable and which are specific to France's political and cultural context

The meeting has so far examined programs that target infants, children, adolescents, and pregnant women. Adult immunization — beyond influenza — remains the least systematic component of European immunization policy. Shingles vaccination illustrates the problem clearly: a vaccine with demonstrated efficacy, approved across Europe, fully funded by national health systems in only 7 of 27 EU countries, with wide variation in age thresholds, patchy uptake even where funded, and marked disparities by socioeconomic status and ethnicity in who actually gets vaccinated. This talk takes adult immunization as a lens for the unfinished policy agenda.

• The fragmented landscape: shingles vaccination policy varies dramatically across the EU — different recommended ages, different funding models, different delivery channels; the recently expanded EU approval covers adults from age 50, and in at-risk groups from 18, but national implementation lags far behind regulatory possibility
• The uptake paradox: even in countries with funded programs, cumulative uptake remains low; the population reaching eligibility is not the same as the population being vaccinated; socioeconomic gradients and ethnic disparities in uptake persist across all adult vaccines studied
• The inverse care law in adult vaccination: age-based eligibility thresholds interact with socioeconomic gradients in life expectancy to systematically exclude the people most at risk — those in deprived populations who may not live to the eligibility age, or who disproportionately miss the booking systems through which vaccines are offered
• The agenda question: what would it take to bring adult immunization to the same level of systematic delivery that childhood immunization has achieved in high-performing European countries — and which of the lessons from Acts 1 and 2 apply directly?

The closing hour moves from case studies to principles. The facilitator will draw the five cases into a structured conversation organized around three questions, with input from all speakers and the audience.