Improving Childhood Vaccination Coverage Rates in Europe

Childhood vaccination plays a critical role in reducing mortality and morbidity worldwide, lowering disease incidence, and strengthening public health protection. In short, vaccination remains one of the most effective tools for preventing infectious diseases.

Over the past several decades, childhood vaccination coverage has improved across Europe, with several countries achieving the World Health Organization’s (WHO) 95% coverage target. While this progress is significant, vaccination coverage rates declined in many European Union (EU) countries between 2010 and 2021. As a result, Europe has experienced outbreaks of vaccine-preventable diseases (VPDs), including major measles outbreaks.

These trends highlight the urgent need to strengthen resilient immunization systems across the EU. Addressing barriers to vaccine uptake is essential to protecting populations from preventable illnesses, reducing deaths linked to VPDs, and improving preparedness for future public health crises.

Researchers from the World Federation of Public Health Associations (WFPHA) and its International Immunization Policy Taskforce examined changes in childhood vaccination coverage across the EU between 2010 and 2021. Their analysis focused on WHO vaccination indicators, including:

• Diphtheria, Tetanus, and Pertussis (DTP) 1st dose
• DTP 3rd dose
• Haemophilus influenzae type b (Hib3)
• Hepatitis B 3rd dose (HepB3)
• Measles 1st dose
• Measles 2nd dose
• Polio 3rd dose

The study identified major trends, barriers, and policy recommendations for improving childhood vaccination coverage rates in Europe.

Childhood Vaccination Coverage Rates in the EU (2010–2021)

The analysis revealed several important patterns across EU member states:

• Vaccination coverage rates fluctuated significantly across countries and vaccine types.
• Most vaccines had lower coverage rates in 2019 than in 2010.
• Lower-performing countries, including Austria and Romania, experienced more severe and frequent fluctuations.
• Higher-performing countries generally maintained stable vaccination coverage rates.

These findings suggest that vaccination systems across Europe remain vulnerable to disruptions and uneven public health capacity.

Why Fluctuations in Vaccination Coverage Matter

Variations in childhood vaccination coverage are a major public health concern. Fluctuating vaccine uptake rates reveal weaknesses within national immunization systems and increase the risk of outbreaks of vaccine-preventable diseases.

Lower vaccination coverage also weakens herd immunity, leaving vulnerable populations, including immunocompromised individuals and children unable to receive vaccines, at greater risk.

To improve long-term public health resilience, EU countries need stronger vaccination infrastructure, more reliable delivery systems, and crisis preparedness strategies.

Key Factors Causing Declining Childhood Vaccination Rates in Europe

The WFPHA article identified several major barriers contributing to declining childhood vaccination coverage rates in Europe.

Structural Barriers to Vaccine Access

Practical challenges continue to limit vaccine uptake for many families. Common structural barriers include:

• Difficulty taking time off work for vaccination appointments
• Limited access to healthcare facilities
• Delays in vaccine procurement and supply chains
• Inconvenient clinic hours

Evidence suggests that improving accessibility plays a major role in increasing vaccination rates.

Vaccine Hesitancy and Misinformation

Vaccine hesitancy remains one of the leading contributors to declining vaccination coverage across Europe. The spread of misinformation (particularly online) has negatively affected public confidence in vaccine safety and effectiveness.

Research highlighted declining vaccine confidence in several EU countries, including:

• Austria
• Bulgaria
• Romania
• Germany
• France
• The Netherlands
• Sweden

Public awareness campaigns, trusted healthcare communication, and evidence-based educational initiatives have proven effective in rebuilding confidence in vaccines.

Impact of COVID-19 on Routine Immunization

The COVID-19 pandemic significantly disrupted routine childhood vaccination services across Europe.

Key pandemic-related challenges included:

• Healthcare resource diversion
• Lockdowns and restricted movement
• Reduced healthcare visits
• Supply chain interruptions
• Delayed data collection and reporting

Many countries experienced additional declines in vaccination coverage between 2020 and 2021, increasing the risk of outbreaks of measles, polio, and other vaccine-preventable diseases.

The Ukraine Crisis and Regional Vaccination Gaps

The ongoing Ukraine crisis further intensified vaccination challenges across Europe. Countries already experiencing immunity gaps, including Poland and Romania, faced additional pressure due to population displacement and disruptions to vaccination services.

The study emphasized the importance of coordinated crisis preparedness plans to prevent widening immunization gaps during humanitarian emergencies.

Strategies for Increasing Childhood Vaccination Coverage Rates

The article identified several evidence-based strategies that can improve childhood vaccination uptake across Europe.

Improve Access to Vaccination Services

Improving convenience and accessibility can significantly increase vaccine uptake. Recommended strategies include:

• Expanding the number of providers authorized to administer vaccines
• Offering vaccinations outside traditional healthcare settings
• Providing extended clinic hours
• Delivering outreach services and catch-up campaigns

Countries with accessible, community-based vaccination systems tend to achieve more stable vaccination coverage rates.

Strengthen Vaccine Communication and Education

Effective communication between healthcare professionals and families is essential for improving vaccine confidence.

Successful approaches include:

• Public awareness campaigns
• Reliable vaccine information materials
• School and community education programs
• Direct communication between patients and healthcare workers

Healthcare professionals remain one of the most trusted sources of vaccine information.

Expand the Use of Digital Technologies

Digital tools can help improve immunization tracking and reduce missed vaccinations.

Key recommendations include:

• Electronic immunization records
• Real-time surveillance systems
• Automated vaccine reminders
• Improved vaccination data collection

Countries using digital reminder systems have reported improved vaccination coverage and more accurate immunization records.

Policy Recommendations for Strengthening Childhood Vaccination Programs

Based on the WFPHA International Immunization Policy Taskforce recommendations, policymakers across the EU should focus on the following priorities.

Facilitate Easier Access to Vaccination

• Expand vaccine administration locations
• Increase provider flexibility
• Offer vaccinations outside standard working hours
• Reduce logistical barriers for families

Invest in Immunization Infrastructure

• Strengthen healthcare workforce capacity
• Improve vaccine supply systems
• Enhance outbreak preparedness plans

Improve Data Collection and Surveillance

• Develop real-time monitoring systems
• Expand electronic immunization records
• Use automated reminder technologies

Increase Public Awareness and Education

• Launch targeted vaccine education campaigns
• Combat misinformation with evidence-based communication
• Support healthcare worker engagement initiatives

The Importance of Resilient Immunization Systems in Europe

The findings demonstrate that childhood vaccination systems across Europe remain vulnerable to public health crises, misinformation, and structural barriers.

Evidence consistently shows that improving vaccine accessibility, strengthening communication, and investing in digital health infrastructure can increase vaccination coverage rates and reduce the risk of disease outbreaks.

As Europe continues to navigate the long-term effects of COVID-19 and the Ukraine crisis, resilient immunization systems will remain essential to protecting children and communities from vaccine-preventable diseases.

Maintaining strong childhood vaccination programs requires continuous investment, coordinated policy action, and sustained public trust in vaccination systems.

Life Course Immunization: Why Lifelong Vaccination is Essential for Public Health

Immunization is a lifelong shield that goes beyond childhood. While pediatric vaccination programs have seen tremendous success, adult and adolescent immunization remains a dangerously overlooked pillar of global health. This critical gap leaves populations vulnerable to preventable diseases, pandemics, and needless suffering at every stage of life.

For decades, vaccination has been rightly celebrated for its role in conquering infectious diseases. A powerful new consensus from the world’s top health organization is expanding its mission: vaccination is a cornerstone of preventing non-communicable diseases (NCDS) like heart attacks, strokes, and diabetic complications.

The urgency to close this gap has never been greater. This paradigm shift is the driving force behind a new global initiative.

The 2024 Geneva Accord: A New Strategy for a New Health Reality

In November 2024, a pivotal meeting in Geneva, convened by the world’s most influential health and community NGOs, aimed to address a silent crisis: the alarming decline in adult vaccination rates and its cascading impact on global health.

The result was a Call to Action: International Health and Community NGOs Advocate for Life-Course Vaccination. This document represents a consensus among organizations that collectively represent millions of health professionals and citizens worldwide. It moves the conversation from why life-course immunization is essential to how we must achieve it. Now, with a vital new concept, life-course vaccination is necessary for NCD prevention and healthy aging.

Supported by a Coalition of Global Health Leaders.

This call to action is endorsed by the following organizations, representing millions of doctors, nurses, pharmacists, public health experts, medical students, and aging advocates worldwide.

The Growing Immunization Gap: How Vaccines Prevent Chronic Disease

The traditional benefits of vaccination, such as preventing outbreaks, reducing healthcare costs, and protecting the vulnerable, remain critically important. Yet, recent data reveal a concerning decline in vaccination rates, posing a threat to global health security.

Reports from the WHO, UNICEF, and other bodies show:

• Adult vaccination rates have stagnated or dropped since the pandemic, particularly among aging and at-risk populations.
• Measles outbreaks are resurging in countries where the disease was previously controlled.
• Low uptake of flu, COVID-19, and RSV vaccines in high-risk groups leads to preventable hospitalizations and deaths, straining healthcare systems.

This evidence underscores the urgent need for the coordinated strategy outlined in the new Call to Action.

What does this mean in practice?

• Influenza & COVID-19 increase heart attacks and strokes: These viral infections cause severe inflammation, which can destabilize arterial plaque, leading to cardiovascular events, risks that vaccinations can reduce.
• RSV & pneumonia can lead to respiratory decline: In older adults or those with COPD, a severe respiratory infection can result in permanent lung damage and a significant decline in functional health.
• HPV & cancer: The human papillomavirus (HPV) is a leading cause of cervical, oropharyngeal, and other cancers. HPV vaccination is, quite literally, a form of cancer prevention.
• Shingles & chronic pain: Reactivation of the varicella-zoster virus, the cause of chickenpox, can lead to debilitating, long-term nerve pain, drastically reducing quality of life.

By preventing the initial infection, vaccines directly prevent the chronic conditions that follow.

The 10-Point Plan: A Roadmap to Integrate Vaccination and NCD Prevention

The coalition’s document provides a clear roadmap. Here are the 10 critical actions it urges advocates and policymakers to implement:

1. Protect Health and Social Care Workers: Ensure they are prioritized to prevent the spread of disease to vulnerable patients.
2. Guarantee Equitable Access: Tailor vaccine access to every stage of life, removing financial and logistical barriers.
3. Mobilize the Health Workforce: Provide tools and resources for vaccine delivery across all care settings.
4. Establish Adult Vaccine Schedules: Develop clear, comprehensive, and equitable vaccination schedules for adults that complement existing pediatric programs.
5. Develop Robust Immunization Registries: Implement interoperable systems to track vaccine uptake in real-time.
6. Integrate Vaccination with NCD Prevention: Recognize the strategic role of vaccination in preventing complications from non-communicable diseases, such as heart disease and diabetes.
7. Expand and Simplify Vaccination Pathways: Make getting vaccinated easier through community-based and mobile clinics.
8. Raise Awareness and Build Confidence: Run public campaigns highlighting the value of vaccination throughout one’s life.
9. Embed Community Engagement: Involve communities in vaccine program design and development to ensure they meet real needs.
10. Leverage the Health Workforce: Empower health professionals, from students to retirees, to be champions for vaccination.

The Tangible Benefits of a Life-Course Immunization Approach

Adopting this framework offers profound advantages that strengthen societies:

• Prevents Deadly Outbreaks: High vaccination coverage across all ages creates a stronger herd immunity, protecting those who can’t be vaccinated.
• Dramatically Reduces Healthcare Costs: Preventing diseases such as shingles, pneumonia, and HPV-related cancers reduces hospitalizations, long-term care needs, and lost productivity.
• Protects Vulnerable Populations: A vaccinated community is a safer environment for older people, newborns, and individuals with weakened immune systems.
• Builds Resilient Health Systems: By preventing illness, health systems are less burdened and better able to handle other crises.
• Promotes Healthy Communities: Lifelong immunization supports well-being at every age and helps entire communities live healthier, more active lives.

From Call to Action to Reality: How We Can All Participate

Implementing this vision requires a commitment from all sectors. The Call to Action provides the blueprint, but we all have a role to play in its implementation.

• Policymakers: Must prioritize funding, establish national adult schedules, and remove regulatory barriers.
• Healthcare Providers: Can integrate vaccine discussions into every routine care visit, for every age group.
• Individuals & Communities: Should stay informed, advocate for access, and get recommended vaccines.
• Organizations: Can sign on to support the call to action and promote their messages internally and externally.

A Healthier Future for All Generations

Life-course immunization is a fundamental right and a shared societal responsibility. We can no longer silo infectious disease and chronic disease efforts. We must unite these two pillars of health.

Life-course immunization is the powerful and practical link that ties it all together. The 2024 Geneva Call to Action provides the definitive framework for achieving this goal. By embracing this strategy, we aren’t just preventing the flu or shingles; we are preventing heart failure, debilitating pain, and cancer. We aim to promote health throughout a person’s lifetime, rather than just treating a specific illness or condition.

By uniting behind this powerful consensus from the world’s leading health authorities, we can build healthier, more equitable, and more resilient communities for generations to come.

If your organization would like to endorse our Call to Action and join us in this effort, please get in touch with us at secretariat@wfpha.org

Click here to read the full, official Call to Action document supported by international NGOs

Global One Health Index Report, One Health for All

Geneva Principles for One Health Implementation

Adopted on the occasion of the World Health Assembly Side Event “One Health for All to Improve Global Public Health” on May 19, 2026, Geneva, Switzerland.

Preamble

We, the participants of the 79th World Health Assembly side event convened by the World Federation of Public Health Associations (WFPHA) and the Chinese Preventive Medicine Association (CPMA), reaffirm that human, animal, and environmental health are inextricably linked, forming a single, indivisible system.

Recognizing the persistent gaps between One Health policies and their effective implementation, and acknowledging the urgent need for coordinated action against emerging infectious diseases, antimicrobial resistance, climate-sensitive health threats, zoonotic pandemics, biodiversity loss, and food insecurity, as well as recognizing the essential role of civil society, faith communities, and Indigenous peoples as partners in One Health delivery, we hereby adopt and commit to the following Geneva Principles for One Health Implementation.

Principle 1: Shared Responsibility and Inclusive Governance

One Health implementation requires mandatory, institutionalized collaboration across health, agriculture, environment, water, food systems, and infant sectors at local, national, and global levels. Decision-making must include representatives of human, animal, and ecosystem health, civil society organizations, Indigenous peoples, and faith communities throughout design, implementation, and evaluation.

Principle 2: Bridging Policy-Practice Gaps

All One Health commitments shall be accompanied by gender-responsive, actionable roadmaps, clear budgetary allocations, and time-bound milestones. Policies must be co-designed with field implementers, community health workers, civil society organizations, Indigenous knowledge holders, and veterinary and wildlife services.

Principle 3: Monitoring, Evaluation, and Accountability

Each signatory institution commits to establishing measurable One Health performance indicators, including joint outbreak-response metrics, zoonotic disease transmission rates, antimicrobial-use surveillance, and ecosystem health outcomes. Regular independent peer review and public reporting on implementation progress shall be conducted, with findings made publicly accessible through open platforms.

Principle 4: Science-Based and Locally Informed Decision-Making

While global indices can serve as valuable tools, implementation decisions must be guided by local epidemiological, ecological, and social data, as well as traditional and Indigenous knowledge systems. We encourage the systematic adoption of integrated One Health assessment frameworks, including city-level One Health assessments, to identify capacity gaps and track improvements.

Principle 5: Capacity Building and Equitable Access

Sustainable One Health requires investment in cross-sectoral workforce training, laboratory networks, and digital surveillance systems, with priority given to low- and middle-income countries, small island developing states, and vulnerable communities. Knowledge exchange, open science, technology transfer, and expanded joint financing mechanisms should be prioritized.

Principle 6: Emergency Preparedness and Adaptive Management

One Health implementation must function as a dynamic, real-time system for early warning and rapid response. Mechanisms for adaptive management, including regular simulation exercises, community-based surveillance networks, and after-action reviews, shall be integrated into national and global health security and planetary resilience architectures.

Advancing One Health Through Global Cooperation

The COVID-19 pandemic highlighted the deep connections between health, animals, ecosystems, food systems, and the environment. A One Health approach is critical not only to prevent outbreaks of zoonotic diseases but also to address antimicrobial resistance, food safety, biodiversity loss, and climate-related health threats.

One Health is an integrated, unifying approach that aims to sustainably balance and optimize the health of people, animals, and ecosystems. It recognizes that the health of humans, domestic and wild animals, plants, and the wider environment is closely linked and interdependent. Through collaboration across sectors, disciplines, and communities, the approach supports prevention, preparedness, detection, and response to current and emerging global health challenges.

International cooperation has become central to advancing One Health implementation. The collaborative work of the World Health Organization, the Food and Agriculture Organization of the United Nations, the World Organization for Animal Health, and the United Nations Environment Program has strengthened global recognition of the need for coordinated action at the human-animal-environment interface. Their continued efforts support countries in improving prevention, prediction, detection, and response to global health threats while contributing to sustainable development.

The Geneva Principles for One Health Implementation reinforce the importance of measurable action, inclusive governance, and accountability. By bridging knowledge and implementation, these principles aim to support stronger national and global systems that protect public health, strengthen resilience, and promote equitable and sustainable futures for all.

Bridging knowledge and action through measurement done by the Global One Health Index Research Team

A Vision for Our Federation: Two Years, Four Priorities, One Purpose

It is a thought I carry with me as I begin this presidency. We live in a turbulent world. Conflicts, climate crises, emerging pandemics, and deepening inequalities do not wait politely for our strategic plans to catch up. Events will challenge our priorities. They will test our resolve and demand our flexibility.

But what events cannot change — what I am determined they will not change — is the DNA of this Federation. The reason each of us gives so much of our time, energy, and passion to this agenda is a shared and unshakeable belief: that global public health matters, that the health of our societies and our planet is a collective responsibility, and that our greatest obligation is to those who are most vulnerable. That conviction is our compass, however turbulent the waters.

With that compass firmly in hand, I want to set out four work streams that will shape my two-year mandate.

First: strengthening our member organizations. WFPHA is only as strong as the national public health associations that make up its family. I am committed to ensuring the center serves the membership by sharing regular updates, a bi-monthly newsletter that keeps every association informed of major events and opportunities, and by introducing travel grants to enable young public health professionals to attend key international gatherings. The next generation of leaders must have a seat at the table.

Second: supporting our World Congresses on Public Health. These congresses are among the most important convening spaces in global public health. I want to ensure they are exceptionally well planned, properly resourced, and financially sustainable — events that our members are proud to attend and that leave a lasting legacy in their host cities.

Third: the creation of a WFPHA academic journal. Knowledge must be a public good. I envision an open-access journal available free of charge to all our members, and one in which up to 20 percent of published articles incur no publication costs for authors from the Global South. If we are serious about equity, we must begin with how we share knowledge.

Fourth: building a true Global Public Health Alliance. We are not alone. The Global Network of Academic Schools of Public Health and the International Network of Institutes of Public Health share our values and our ambitions. Working more closely together — creating something genuinely greater than the sum of our parts — is both a strategic opportunity and a moral imperative.

None of this will be achieved alone. It will take all of us, working in the same direction, with generosity and determination. I am fortunate to have the support of our outstanding CEO, Professor Bettina Borisch, and COO, Dr. Marta Lomazzi. With a team of this caliber — and a membership of this commitment — I am confident we can deliver.

The journey begins now. I am honored to take it with you.

Advancing Adult HPV Vaccination: From Evidence to Action

Human papillomavirus (HPV) is one of the most prevalent infections in the world, affecting up to 80% of individuals at some point in their lives. While the immune system clears most infections naturally, persistent high-risk HPV oncogenic genotypes can lead to serious health outcomes, including cervical, anal, vaginal, vulvar, penile, and oropharyngeal cancers. 

Even with highly effective vaccines authorized for adults and available in sufficient supply, vaccination rates among adults remain far too low. Expanding adult HPV vaccination offers a vital opportunity to reduce disease burden, strengthen long-term health outcomes, and accelerate progress toward broader cancer prevention goals.

Why Universal Vaccination Matters for Long-Term Cancer Prevention

Although early HPV prevention initiatives largely prioritized younger age groups, there is now broad recognition that universal HPV vaccination across adulthood is a crucial component of comprehensive disease prevention. Adults continue to face new exposure risks throughout their lives, and vaccination can protect them against HPV types they have not yet encountered. 

Importantly, natural immunity from previous infections does not offer complete protection against other high-risk genotypes, meaning adults with prior HPV exposure still gain meaningful benefit from vaccination. Emerging evidence also highlights positive outcomes when vaccination is delivered before or after cervical conization, reinforcing its value across different stages of adult care.

Barriers Limiting Adult Vaccine Uptake and Why They Must Be Overcome

Although clinical and economic advantages are well-established, adult vaccine uptake remains low due to:

• Lack of awareness and misconceptions about vaccine efficacy
• Limited access and insufficient provider recommendations
• Policy and funding gaps within national immunization programs

Many adults were not vaccinated during adolescence due to eligibility criteria, vaccine availability, or limitations in the healthcare system. Expanding eligibility can close this gap. 

Policymakers are key to establishing sustainable vaccination programs by embedding HPV vaccination for medically or socially vulnerable adults into routine healthcare and ensuring adequate funding and equitable access. Adult programs should not compromise coverage in younger populations. Cultural and linguistic sensitivity must also be part of these strategies to support trust and acceptance.

Accelerating Progress Toward WHO Elimination Goals

WHO has set ambitious goals for cervical cancer elimination, prioritizing adolescent girls as the primary target group, but extending vaccination to boys and adults whenever feasible. National programs should move forward using emerging evidence and practical implementation models. 

Strengthened vaccination systems can help reduce HPV-related cancers, improve health equity, and support progress toward global elimination.

Strengthening Policy and Practice for Adult HPV Vaccination

This call to action emphasizes the value of adult HPV vaccination from public health and economic perspectives. It highlights the global burden of HPV-related diseases and successful policy models from multiple countries. 

Key recommendations include integrating adult vaccination into routine care, expanding national immunization guidelines, strengthening awareness efforts, and adopting universal and inclusive approaches that span ages, genders, and geographies.

Risk Stratification Isn’t Enough, Adults Still Need Protection

Risk-based approaches are limited due to the widespread nature of HPV and varied exposure patterns. Several key considerations support universal adult vaccination:

Adults Remain at Ongoing Risk

Individuals continue to face new exposure risk throughout adulthood.

Men Are Disproportionately Underserved

Without access to established screening programs and often acquiring infections later, adult males represent a highly vulnerable group.

Ending Transmission Requires Addressing the Viral Reservoir

To eliminate HPV-related cancers, transmission must be stopped at its source, requiring immunization of both women and men.

Vaccination Works Even After Exposure

Adults previously exposed to certain HPV types still benefit from protection against other genotypes.

Public Health Outcomes Are Significant

Adult vaccination provides direct protection while reducing transmission and decreasing overall disease burden.

Current Age-Restricted Funding Leaves People Behind

Many national funding systems exclude adults who are still at risk.

Vaccination Must Be Easy to Access

Success depends on convenience, such as pharmacies, workplaces, and community hubs serving as vaccination sites.

A Consensus on Adult Vaccination Is Needed

Clear and unified policy guidance is essential to strengthen recommendations and drive adoption.

Low- and Middle-Income Countries Must Help Shape Global Policy

These regions carry the highest disease burden and must be active contributors to ensure global equity.

Faster Elimination Is Achievable

Countries like Sweden demonstrate that vaccinating adults can accelerate the elimination of HPV-related cancers.

Clear, Inclusive Communication Matters

Language such as “universal vaccination” promotes gender equity and reduces stigma.

A Global Call to Action for Policymakers and Health Leaders

Governments, global health organizations, and national public health associations are urged to expand HPV vaccination programs, particularly for adults and males, mobilize resources, and embed evidence-based strategies into national immunization plans. 

By committing to these priorities today, countries can accelerate cancer prevention and move closer to eliminating HPV-related disease.

Moving Forward Toward Global Health Equity

Expanding HPV vaccination to adults is a critical, evidence-based strategy to reduce HPV-related disease and advance global cancer prevention. Universal adult vaccination delivers individual and population-level benefits, especially in regions with limited access to screening and care. Progress requires collaboration among policymakers and health leaders to address gaps in access, awareness, and coverage. 

Integration into routine healthcare, stigma-free and inclusive communication, and a focus on vulnerable populations, such as individuals living with conditions like HIV, are essential. Taking timely action will drive progress toward eliminating HPV-related cancers and building a more equitable global health future.

Read our original call to action here.

Watch our video on this HPV call to action here.

Leer la llamada en español.

Public Health Citizenship in a Wounded World

The World Federation of Public Health Associations (WFPHA) convenes Global Public Health Week (GPHW) to mark the entry into force of the WHO Constitution, one of the UN Treaty Collection treaties, on April 7th, 1948. This year, GPHW could hardly have come at a more urgent moment, as war, displacement, climate breakdown, and political intimidation, once again demonstrate how fragile the systems on which global public health is built.

Beyond “Polycrisis”: Interlocking Global Threats to Public Health

Although referred to in the WFPHA–GNAPH GPHW seminar on “Geopolitics and Public Health” as polycrises, more accurately, these are not a series of crises (which are, by definition, limited to events) but are much more complex than that. Conflict, forced migration, environmental catastrophe, economic instability, and disinformation are not separate emergencies but interlocking assaults on life, dignity, knowledge, and the systems that they protect.

The Public Health Impact of War and Displacement

For us, the public health implications are both immediate and long-term. War kills and maims far beyond the battlefield, destroying civic infrastructure, including water systems, transport and communication systems, safe housing, supply chains, and access to basic necessities such as food, health services, education, housing, imposing a massive toll on psychological health and wellbeing. 

War overwhelms and displaces civilians, most of whom are not sheltered by wealthy countries and wealthy people but are left internally displaced in camps, border zones, and fragile transit settings. War turns infectious diseases into epidemics, chronic diseases into crises, and trauma into a generational inheritance. War especially affects the health of women and children, who are usually absent from negotiation tables and routinely ignored. We can see that massive efforts are expended on war, but little thought is given to winning peace.

Public Health Ethics, Truth, and the Role of Journalism

To address these problems, public health work in the spheres of humanitarian aid and crisis response must remain fact- and evidence-based and impartial. But impartial does not mean passive. Truthfully reporting current events is essential in wartime as in every other time. Good journalism is itself a public health good, because when truth is weakened, violence becomes easier to justify and harder to stop. Neutrality is not the same as silence.

Global Threats to Public Health Systems and Institutions

Today’s battles are worldwide assaults on the public’s health, some driven by armed conflict but others by climate disaster, information catastrophe, oligarchic power, and the corrosion of global institutions. Public health cannot remain reactive, timid, and fragmented, but needs solid risk preparedness, stronger international bodies, alongside a renewed ethic of service and equality. Very few of our political leaders are even vaguely prepared for polycrisis, and a lack of planning for prevention and preparation for response to limit the inevitable impact of disasters increases risk to people and environments. 

Science is distorted and distrusted; experts are disdained. Influencers’ opinions receive more public attention than those of public health practitioners, despite the latter’s extended education and training. Public health institutions and professionals face an existential threat (see current government activities in the USA, for example) because the instant voices of modern populism are ranged against considered ideas of public service, vocation, and professionalism.

Public Health Ethics Matter in Times of Crisis

Public health ethics matter because public health is not only about disease prevention. It is also about conflict prevention. It is also about the conditions in which people can live with security in dignity, whether families can stay safe, whether children can thrive, whether truth can still be spoken, and whether vulnerability is protected by institutions. It is about refusing to accept that cruelty, corruption, and authoritarianism are simply the way the world now works.

Public Health Citizenship: Responsibility in a Time of Crisis

The lesson of these frightening days is not to despair but to take on responsibility. Public health applies to everyone, so all citizens have a role to play in resisting all the forces that make populations sick and societies cruel. We need stronger systems thinking, the courage to voice the truth plainly and with evidence, better training on the health consequences of war, public health approaches in peacebuilding, and broader inclusion at decision-making tables. Public health education and training must include political literacy, strategic communication, systems thinking, and ethical negotiation, key competencies recognized by WHO. 

This is a time for collective solidarity, not isolation; for courage, not resignation; for moral clarity, not detachment. Public health is often treated as a technical field. Yes, it is. But it is also a political one: health, especially public health, is a political choice. The public health community must say, and mean, that there is no health without peace, no peace without justice, and no justice without the courage to resist tyranny.

A Collective Civic Task for the Future of Public Health

We generate evidence for health. So, collectively, this is our space and our civic task. The need for preparedness is a public health issue that we must address. To repeatedly tell truth to power, choose solidarity over surrender, and refuse to be silenced, with courage.

Acknowledgements

We gratefully acknowledge the contribution of ideas from our seminar speakers and moderator: Bettina Borisch, Mary Codd, Chuck Johnson, Duha Shellah, Melissa Sweet, and Michael Moore.

Bibliography

• Borisch B, Lomazzi M. Should we still talk about the crisis? Journal of Public Health Policy, Federation’s Pages. Published online 16 March 2023. 
• National workforce capacity for essential public health functions: a Roadmap. WHO, 2024. 
• Middleton J. GNAPH president’s blog, The war on the public’s health. GNAPH, March 10th 2026.
• The link between geopolitics and public health: a WFPHA / GNAPH webinar.