Legislation is one of the most effective ways to protect and defend immunization from shifting political priorities. Many countries with whom the Sabin Vaccine Institute (Sabin) collaborates use legislation as a tool to improve uptake of country immunization services. 

Legislative Approaches to Immunization Across the European Region

Legislative Approaches to Immunization Across the European Region (PDF)

In the last five years, Europe has experienced outbreaks and increased incidence of vaccine-preventable diseases, notably measles, across the region. This represents a marked change, since the World Health Organization (WHO) European Region had reported an immunization coverage rate of almost 95 percent in the years 2012-2013. Since then, countries from in the region have made notable changes to frameworks for immunization legislation, which are examined in detail in Legislative Approaches to Immunization Across the European Region.

This study by Sabin is the first and only systematic review of immunization legislation that includes all 53 countries in the WHO European region and provides a comprehensive overview that can be used by countries as a point of reference when evaluating legislative frameworks for immunization laws. The research was conducted using qualitative methods, surveying the 53 countries in the European Region, and complementary desk research. Additional information was collected from authoritative secondary sources and from insights provided by national experts and members of the project steering committee. Sabin’s technical partner, the Georgetown University’s  O’Neill Institute for National and Global Health Law, supported the project with in-depth legal analysis, the development of categorization criteria and classification of current country approaches.

This study is part of Sabin’s strategic objective to provide evidence-based resources for policy makers to inform country decision making. Sabin serves as a broker by organizing parliamentary briefings and legislative workshops to build political will for immunization, sharing technical resources and supporting country ownership of immunization systems.

View the report (PDF)

Supporting Materials

European Immunization Policy Database
This comprehensive examination included legislation, supporting documents, national constitutions, public regulations, decrees and other relevant information on country immunization programs, which are now publicly available in Sabin’s European Immunization Policy Database.  

European Region Matrix: Immunization Legislation (PDF)
Because approaches to immunization legislation across the European Region are diverse, a Matrix: Immunization Legislation was developed to categorize country laws and policies and provide an overview of the degree of immunization oversight.

Likert Scale: Assessing Levels of Immunization Legislation (PDF)
The Likert Scale: Assessing Levels of Immunization Legislation was developed to further classify country immunization legislation with a scale from recommended to mandatory immunization with robust monitoring and follow-up, divided into five levels. Additionally, five national and regional case studies provide further comparison and analysis of legislative approaches to immunization.

Public Presentation (PDF)
This presentation provides an overview of the report in a digestible format, including information from the supporting case studies.

Webinar: European Immunization Legislation
In this webinar, Dr. Bruce Gellin, president of Global Immunization at the Sabin Vaccine Institute, and Katie Gottschalk, executive director of the O'Neill Institute for National and Global Health Law at Georgetown Law, walked through the report findings and participants had the opportunity to participate in a Q&A Session with our research team. View the webinar recording.

Case Studies

The Baltic States
A comparison of legislative approaches across three countries with similar historical, geographic and health contexts

Moving toward a more coercive approach to immunization

Reviewing a recommended approach with mandatory requirements for school attendance

The Nordic Countries of Denmark, Finland, Norway and Sweden
The recommended approach in practice

The Ukraine
Exploring factors that undermine a strong legislative framework for immunization

2017 European Legislation Case Studies

The 2017 case studies explore how Finland, Latvia, and the United Kingdom, countries with high immunization coverage levels, well-financed programs, and relevant legal frameworks, have tackled vaccine procurement, financial provisions, and provisions to increase vaccine uptake.

2017 case studies on immunization legislation in Europe

Other Country Laws & Regulations Related to Immunization

Sabin has gathered immunization-related laws and regulations from partner countries and other countries to serve as a tool for national policy makers interested in strengthening their immunization systems through legislation.

Immunization-related laws & regulations