Global Public Health Policies: Public Health Associations’ Perspectives

Why Public Health Advocacy Matters

The definition of advocacy may vary slightly across disciplines. According to the World Health Organization (WHO), health advocacy is a combination of social actions aimed at securing political commitment, policy support, social acceptance, and systems support for a particular goal or program. Advocacy is identified as one of the core functions of public health and is a key tool for achieving the Sustainable Development Goals (SDGs).

In global public health, advocacy involves engaging diverse stakeholders in decision-making to improve population health. National public health associations and international non-governmental organizations (NGOs) play a vital role in advocating, advising decision-makers, guiding initiatives, and raising citizens’ awareness. Advocacy initiatives and campaigns, joint position statements, resolutions, and internal policies are recognized as the primary tools for influencing public health policy.

As countries continue to address challenges ranging from climate change and emerging infectious diseases to health inequities and workforce shortages, understanding the role of public health associations in shaping policy has become increasingly important. Their advocacy efforts help translate evidence into action and ensure that public health remains a priority within national and international decision-making processes.

Study Overview: Mapping Public Health Advocacy Across 12 Countries

In a recent study by researchers from the World Federation of Public Health Associations (WFPHA), public health advocacy activities conducted by national public health associations between 2018 and 2021 were examined to identify strengths, gaps, and opportunities to strengthen future policy development.

The study included 12 national public health associations representing:

• Ethiopia
• Cameroon
• South Africa
• Nigeria
• Canada
• United States
• Brazil
• Spain
• France
• United Kingdom
• Australia
• New Zealand

A total of 220 officially approved policy documents were analyzed, including position statements, internal policies, white papers, and official submissions to government bodies.

Key Findings on Global Public Health Policies

According to the study, the largest number of policy documents originated from high-income countries and focused primarily on environmental health and communicable diseases, including COVID-19. However, significant regional differences emerged.

Africa: Focus on Health System Strengthening

In the African region, public health advocacy focused primarily on strengthening health systems. This emphasis reflects the importance of building resilient health infrastructure, expanding access to services, and improving population health outcomes.

Women’s and child health also emerged as an important area of advocacy, particularly in Nigeria.

Europe and South America: Pandemic Preparedness and Communicable Diseases

Public health associations in Europe and South America devoted much of their advocacy work to communicable diseases and pandemic management.

The COVID-19 pandemic highlighted the importance of preparedness, surveillance systems, evidence-informed policymaking, and coordinated responses to public health emergencies.

North America and the Western Pacific: Climate and Environmental Health

In North America and the Western Pacific region, climate change and environmental health were dominant advocacy themes.

This reflects growing recognition that environmental determinants—including air quality, extreme weather events, biodiversity loss, and climate-related health risks—have profound implications for population health.

Major Public Health Advocacy Themes Identified

The analysis identified 11 major advocacy themes across all participating public health associations:

Communicable Diseases

Including COVID-19 preparedness, prevention, response, and vaccination policies.

Environmental Health

Including climate change, pollution, sustainability, and planetary health.

Health Equity

Advocating for fair access to health services and addressing social determinants of health.

Health System Strengthening

Supporting stronger healthcare systems, workforce development, financing, and service delivery.

Human Rights and Health

Promoting health as a human right and protecting vulnerable populations.

Mental Health and Substance Use

Addressing growing mental health challenges and substance-related harms.

Non-Communicable Diseases

Including cardiovascular disease, cancer, diabetes, and other chronic conditions.

Women and Child Health

Supporting maternal, newborn, and child health outcomes.

Nutrition

Advocating for healthier food systems and improved nutrition policies.

Injury Prevention and Violence Reduction

Addressing preventable injuries and violence-related health burdens.

International Health

Promoting cross-border collaboration and global health cooperation.

A Critical Gap: Limited Attention to International Health and Human Rights

One of the most important findings of the study was that relatively limited attention was paid to international health and health as a human right across all regions.

Given the interconnected nature of modern public health challenges—including pandemics, climate change, migration, and health inequities—there is a growing need for more internationally focused advocacy efforts.

The study suggests that future advocacy should be more strongly rooted in:

• Health as a human right
• Global solidarity
• International cooperation
• Intersectoral policymaking
• Sustainable Development Goals implementation

Strengthening Public Health Advocacy for the Future

The study revealed that public health associations are active advocates across a broad range of health issues. However, additional efforts are needed to strengthen the effectiveness of advocacy and policy impact.

According to the researchers, several priorities could improve future advocacy efforts:

Better Use of Evidence

Evidence-based policymaking remains essential for designing effective health interventions and demonstrating impact.

Improved Access to Data

Making public health data more accessible to policymakers and decision-makers can support faster and more informed policy responses.

Sustainable Funding Mechanisms

Adequate resources are necessary to maintain advocacy efforts and implement long-term public health strategies.

Increased Public Awareness

Citizen engagement and awareness can help build support for public health policies and strengthen accountability.

Expanding the Public Health Advocacy Coalition

The study also recommends broadening advocacy efforts beyond traditional public health stakeholders.

Future advocacy initiatives could involve:

• Academics
• Journalists
• Media organizations
• Influencers
• Civil society organizations
• Public health professionals

Working together as a unified voice may help strengthen policy influence, increase public awareness, and support the adoption of evidence-informed health policies.

Why Public Health Associations Matter in Global Health Policy

Public health associations serve as a critical bridge between research, policy, and practice. By translating scientific evidence into policy recommendations, they help governments and institutions respond to evolving health challenges.

As the world continues to confront climate change, future pandemics, health inequities, and emerging global threats, strong advocacy from public health associations will remain essential to advancing health equity, strengthening health systems, and ensuring that health is considered across all sectors of society.

Conclusion

This study demonstrates that public health associations play a vital role in shaping global public health policies through advocacy, evidence-informed recommendations, and stakeholder engagement.

While advocacy efforts between 2018 and 2021 focused heavily on environmental health, communicable diseases, and health system strengthening, the findings also highlight opportunities for a more international and intersectoral approach grounded in the recognition of health as a human right and aligned with the Sustainable Development Goals.

Moving forward, stronger collaboration among public health associations, policymakers, researchers, journalists, and civil society will be essential to building healthier, more equitable, and more resilient societies worldwide.

Promoting Oral Health for Refugees: A Call to Action

Global forced displacement has reached unprecedented levels. As a result of persecution, armed conflict, generalized violence, natural disasters, famine, and economic instability, millions of people have been forced to leave their homes in search of safety and protection.

Among the many health challenges refugees face, access to oral health care remains an often-overlooked issue despite its importance to overall health, well-being, and quality of life.

This policy brief from the FDI World Dental Federation, the Framework Convention on Global Health Alliance, the Sustainable Health Equity Movement, and the World Federation of Public Health Associations (WFPHA) calls for urgent action to ensure that refugees can access essential oral health services as a matter of health equity and human rights.

Why Promoting Oral Health for Refugees Matters

The scale of global forced displacement continues to increase worldwide.

According to international estimates cited in this policy brief, more than 103 million people had been forcibly displaced worldwide by mid-2022, including over 32 million refugees, with more than two in five under the age of 18.

Refugees are among the most vulnerable and marginalized populations globally. They frequently encounter barriers to healthcare caused by:

• Population displacement
• Limited health infrastructure
• Workforce shortages
• Financial constraints
• Language barriers
• Reduced access to preventive services
• Disrupted continuity of care

While these challenges affect many aspects of health, oral health is often overlooked despite being an essential component of overall health and well-being.

Oral Health Is a Human Right

Like all people, refugees are entitled to access health care, including oral health care, as guaranteed by the International Covenant on Economic, Social and Cultural Rights.

This right is reinforced by the 1951 Refugee Convention and its 1967 Protocol, which require countries to provide healthcare without discrimination and on the same basis as nationals.

Access to oral health care should therefore not be viewed as an optional service. It is an important part of fulfilling the right to health and advancing health equity for displaced populations.

The Burden of Oral Disease Among Refugees

Evidence consistently shows that refugees experience higher rates of oral disease while facing greater barriers to care.

Studies referenced in the policy brief indicate that refugees often experience:

• Dental caries (tooth decay)
• Periodontal disease
• Oral soft tissue lesions
• Traumatic dental injuries

At the same time, refugees are less likely to access preventive oral health services and frequently seek care only when experiencing severe pain or emergencies.

Language barriers, limited mobility, financial challenges, unfamiliarity with health systems, and reduced service availability can all delay access to timely and affordable care.

The burden of oral disease among refugee populations represents a significant but often neglected public health challenge that requires urgent attention.

Improving Maternal Oral Health Literacy Among Refugee Communities

Oral health promotion and disease prevention are especially important during pregnancy and early childhood.

Research cited in the policy brief demonstrates that a mother’s:

• Oral health status
• Oral health knowledge
• Oral health literacy
• Health behaviours
• Socioeconomic circumstances

can significantly influence her children’s oral health outcomes.

Why Maternal Oral Health Matters

Maternal oral health is closely linked to childhood oral health outcomes, including the risk of dental caries.

Studies have shown that refugee maternal oral health literacy is associated with children’s oral health outcomes. However, misconceptions about oral health during pregnancy remain common.

Creating supportive systems that empower mothers and caregivers with oral health knowledge can help establish:

• Healthy oral hygiene practices
• Preventive behaviours
• Healthy dietary habits
• Improved oral health outcomes across generations

Women also play a critical role in supporting the health of families and communities, including children, older adults, and medically vulnerable family members.

Investing in maternal oral health literacy is therefore an important strategy for improving community health more broadly.

Ensuring Access to Essential Oral Health Services for Refugees

Refugees are entitled to primary healthcare services, including oral healthcare.

The World Health Organization’s Global Oral Health Action Plan provides important guidance on what constitutes essential oral health care.

Essential Oral Health Care Includes

Urgent and Emergency Care

Services that address:

• Acute orofacial infections
• Severe dental pain
• Dental trauma
• Orofacial trauma
• Abscess management
• Necessary extractions

Preventive and Routine Oral Health Services

Services that support early detection and prevention, including:

• Oral health examinations
• Professional cleanings
• Diagnostic radiographs
• Oral cancer screening
• Preventive interventions
• Access to essential dental medicines

Rehabilitative Care

Comprehensive oral health systems should also consider:

• Permanent restorations
• Periodontal treatment
• Endodontic treatment
• Appropriate referral pathways

Access to these services should be integrated into primary healthcare systems and made available to refugees without discrimination.

Oral Health Equity and the Sustainable Development Goals

Promoting oral health for refugees is not solely a healthcare issue.

It is also a matter of:

• Human rights
• Health equity
• Social justice
• Sustainable development

Ensuring equitable access to oral healthcare supports the core commitment of the United Nations Sustainable Development Goals (SDGs) to “leave no one behind.”

Refugees cannot achieve their full health potential if oral health continues to be excluded from refugee health planning, service delivery, and policy development.

A Call to Action

The FDI World Dental Federation, Framework Convention on Global Health Alliance, Sustainable Health Equity Movement, and World Federation of Public Health Associations recognize that oral health is an integral part of overall health and well-being. Access to oral health care is a fundamental human right.

They urge policymakers, healthcare providers, and international and national organizations to:

1. Include Oral Health in Refugee Health Strategies

Include oral health as part of current and future refugee health priorities, particularly for:

• Pregnant women
• Mothers
• Infants
• Young children

2. Raise Awareness of Refugees’ Oral Health Rights

Promote understanding of oral health and refugee health rights among:

• Healthcare professionals
• Public health practitioners
• Social service providers
• Community organizations
• Non-healthcare staff who work with refugee populations

3. Ensure Equitable Access to Essential Oral Health Services

Ensure access to essential oral health services as an integral component of:

• Primary healthcare
• Maternal healthcare
• Antenatal care
• Community health programs

through partnerships with national and local dental and health organizations.

Advancing Refugee Health Through Oral Health

Refugees face significant barriers to achieving and maintaining good oral health despite clear international commitments to health equity and human rights.

Addressing oral health needs through prevention, education, maternal health initiatives, and equitable access to essential services can improve health outcomes across the life course while strengthening broader refugee health systems.

Promoting oral health for refugees is therefore not only a public health priority but also an essential step toward advancing dignity, equity, and the right to health for all.

View additional FAQs on promoting oral health for refugees below:

What oral health challenges do refugees face?

Refugees commonly experience higher rates of dental caries, periodontal disease, traumatic dental injuries, and barriers to accessing timely oral health services.

Why is oral health important for refugees?

Oral health is an essential part of overall health and well-being, affecting nutrition, communication, quality of life, and broader health outcomes.

Are refugees entitled to oral health care?

Yes. International human rights instruments, including the International Covenant on Economic, Social and Cultural Rights and the 1951 Refugee Convention, support refugees’ right to healthcare without discrimination.

Why is maternal oral health important in refugee populations?

Maternal oral health knowledge and behaviors significantly influence children’s oral health outcomes and can help prevent oral disease across generations.

No Public Health Without Planetary Health

“Fighting climate change today is the best public health opportunity.” – Maria Neira, the World Health Organization

“We are all responsible for the health of the planet.” – Emma Te-Patu, World Federation of Public Health Associations

As the world continues to navigate the long-term impacts of COVID-19, conversations about global health security have expanded beyond pandemic preparedness alone. Public health leaders increasingly recognize that the health of people, communities, and health systems cannot be separated from the health of the planet.

This connection was the focus of the plenary session “No Public Health Without Planetary Health” at the 17th World Congress on Public Health in Rome. The message remains just as relevant today as the global public health community prepares for the 18th World Congress on Public Health in Cape Town, South Africa, under the theme “Health Without Borders: Equity, Inclusion and Sustainability.”

What Does “No Public Health Without Planetary Health” Mean?

The concept of planetary health recognizes that human health depends on thriving natural systems. Clean air, safe drinking water, nutritious food, stable ecosystems, and a safe climate form the foundation of population health.

In an increasingly interconnected world, environmental degradation, biodiversity loss, pollution, and climate change are no longer solely environmental concerns. They are public health concerns.

As Emma Te-Patu, WFPHA Immediate Past President and Māori public health leader, explains:

“There is no such thing as the health of only one country. We are all responsible for the health of the planet and understanding and drawing on the Indigenous people’s knowledge systems that have been in place from time immemorial and authentically engaging with this knowledge and using it to inform our global health needs collectively and from an understanding that health is a human right and is, therefore, a priority above all.”

Why Planetary Health Matters for Global Public Health

Promoting global health is a vital mission in an interconnected world. It requires cooperation among governments, public health organizations, healthcare professionals, educators, volunteers, advocates, and communities.

Ms. Te-Patu identifies five priorities that are essential to strengthening public health globally:

Decolonizing Public Health

Removing systemic barriers to equity and ensuring that diverse knowledge systems, including Indigenous perspectives, are meaningfully included in public health decision-making.

Proper Resourcing of Public Health

Sustainable investment is necessary to strengthen health systems and improve preparedness for future challenges.

Legislative Accountability

Countries need legislative mechanisms that ensure accountability for protecting and advancing public health.

Growing the Public Health Workforce

A resilient public health workforce is critical to responding to emerging health threats and improving population health outcomes.

Accessible and Relevant Public Health Education

Public health education must remain accessible, evidence-based, and responsive to contemporary challenges.

The Biggest Threats to Public Health

Ms. Te-Patu also highlights several major barriers to improving public health outcomes:

• Ego and the commercial financial imperative
• Reactionary responses rather than strategic responses
• Lack of proper resourcing

These challenges become even more significant when viewed through the lens of climate change and planetary health.

Why Climate Change Is a Public Health Threat

Global crises are increasingly interconnected. Climate change affects food systems, water security, air quality, disease patterns, displacement, and economic stability.

As a result, climate change is widely recognized as one of the defining public health challenges of the 21st century.

Maria Neira, Director of the Department of Environment, Climate Change and Health at the World Health Organization (WHO), emphasizes the breadth of its impact:

“Climate change is definitely touching all the pillars and supports of our health: access to food, to safe drinking water, and to clean air. It is changing the way we will protect our health and the way we need to prevent the worst impacts of climate change.”

She adds:

“People need to understand that climate change is not just something that will happen to the planet in the future, but it is affecting our health right now: it affects our lungs, and it causes diseases. We are already paying for it.”

Climate Change and Health: What the Evidence Shows

According to the World Health Organization:

• Between 2030 and 2050, climate change is expected to cause approximately 250,000 additional deaths each year from malnutrition, malaria, diarrhoeal disease, and heat stress.
• Direct health-related costs are estimated to reach USD 2–4 billion annually by 2030, excluding costs in sectors such as agriculture, water, and sanitation.

These impacts are not distributed equally.

Low-income countries and vulnerable populations are disproportionately affected by:

• Sea-level rise
• Extreme weather events
• Food insecurity
• Water scarcity
• Forced migration

The result is a growing challenge for public health systems worldwide.

Healthy Environments Are Public Health Investments

Environmental risks continue to drive preventable illness and death.

As Maria Neira notes:

“We know that an unhealthy environment is responsible for 13 million deaths every year due to the lack of safe water or the lack of clean air.”

She further highlights that:

“The toxic air alone kills 7 million people annually.”

Creating healthier environments supports access to:

• Safe drinking water
• Safe food
• Clean air
• Healthier ecosystems

It also helps address emerging concerns such as plastic pollution and microplastics in the food chain.

Planetary Health, Pandemic Preparedness, and Global Health Security

The COVID-19 pandemic exposed vulnerabilities and inequities across health systems worldwide.

Strengthening global resilience requires investment not only in emergency response but also in prevention, surveillance, research, and environmental sustainability.

Ms. Te-Patu identifies several priorities for improving global health security:

A Strong Pandemic Treaty

An international instrument designed to prepare the world better for future pandemics.

Greater Civil Society Engagement

Public health decisions should include meaningful consultation with communities and civil society organizations.

Continued Decolonization of Public Health

Health systems are stronger when they reflect diverse experiences, perspectives, and knowledge systems.

Stronger Collaboration Across Public Health Communities

International, regional, national, and local actors must work together to address shared challenges.

Government Transparency

Clear and transparent communication is essential for building trust and improving public health outcomes.

Health Without Borders: Looking Ahead

The relationship between planetary health and public health remains one of the defining issues of our time.

As Maria Neira concludes:

“We are all citizens of the world now. Pandemics do not recognize borders, so a united international response is vital. The same approach is used when we deal with the environment. If, for example, we do the deforestation in the Amazonia, in one way or another, it will affect all of us.”

This message strongly resonates with the theme of the 18th World Congress on Public Health in Cape Town, South Africa: “Health Without Borders: Equity, Inclusion and Sustainability.”

Whether addressing climate change, environmental degradation, pandemic preparedness, or health inequities, the principle remains the same:

There Is No Public Health Without Planetary Health

Protecting population health requires protecting the systems that sustain life itself. Climate action, environmental stewardship, Indigenous knowledge, equitable health systems, and global cooperation are not separate agendas. They are fundamental components of a healthier, more sustainable future for all.

Public Health Impact of Uganda’s Anti-Homosexuality Act: WFPHA Stands with the Ugandan LGBT Community

The World Federation of Public Health Associations (WFPHA) stands in solidarity with the Ugandan LGBT community and denounces Uganda’s Anti-Homosexuality Act (2023). The legislation raises serious concerns for public health, human rights, and access to healthcare, while threatening decades of progress in HIV prevention and control.

The health of populations depends on inclusive societies, equitable access to services, and the protection of human rights. Laws that increase stigma, discrimination, and barriers to healthcare can have consequences that extend far beyond the individuals directly affected.

Uganda’s Anti-Homosexuality Act (2023)

On 21 March 2023, the Ugandan Parliament passed the Anti-Homosexuality Act (2023). By criminalizing same-sex conduct, the Act criminalizes lesbian, gay, bisexual, and transgender (LGBT) Ugandans, the provision of services to LGBT Ugandans, and the dissemination of information about LGBT communities.

The Act also requires Ugandans to report individuals suspected of being LGBT and prohibits the sheltering of LGBT persons. It further provides for the death penalty in cases defined as “aggravated homosexuality.”

At the time of the original WFPHA statement, President Yoweri Museveni indicated that he would assent to the Act following amendments related to what was described as “rehabilitation.”

Why the Act Is a Public Health Concern

Beyond its legal implications, the Act has significant consequences for public health.

By undermining access to healthcare services among already vulnerable populations, the legislation threatens Uganda’s longstanding achievements in HIV prevention and control. Public health evidence consistently demonstrates that stigma, discrimination, and criminalization create barriers to healthcare access, testing, treatment, prevention services, and health-seeking behavior.

The World Health Organization and other international health bodies have long recognized that discrimination can negatively affect population health outcomes and contribute to widening health inequities.

Evidence on the Health Effects of Anti-LGBT Legal Environments

LGBT persons have existed throughout human history and across cultures. Natural variations in sexual orientation and gender identity exist regardless of enacted laws and policies.

Research cited in the original statement demonstrates that structural anti-LGBT legal environments are associated with:

Increased Hostility and Violence

Studies have shown that anti-LGBT legal climates can contribute to increased hostility, harassment, and violence directed toward LGBT individuals.

Poorer Mental Health Outcomes

Research has linked discriminatory legal environments to:

• Higher levels of psychological distress
• Reduced life satisfaction and well-being
• Increased risk of psychiatric disorders
• Greater risk of suicidal ideation

These impacts are not limited to those directly targeted by legislation. Family members, friends, and broader communities can also experience psychological harm resulting from hostile public discourse and discrimination.

Human Rights Obligations and International Law

In 1995, Uganda acceded to the United Nations International Covenant on Civil and Political Rights (ICCPR).

For decades, international human rights mechanisms have interpreted the Covenant as providing protections against discrimination based on sexual orientation, gender identity or expression, and sex characteristics.

The original WFPHA statement noted that United Nations legal experts stated that imposing the death penalty under the Act would constitute an arbitrary deprivation of life and would be incompatible with Article 6 of the ICCPR.

The statement further emphasized that obligations under international law are not superseded by domestic legislation or constitutional interpretations.

Developments Since the Original 2023 Statement

Since the publication of the WFPHA statement, Uganda’s Anti-Homosexuality Act has remained the subject of legal and international scrutiny.

In April 2024, Uganda’s Constitutional Court upheld most provisions of the Anti-Homosexuality Act while striking down several sections, including provisions related to mandatory reporting and certain restrictions that were found to conflict with constitutional protections. However, the Court left the core provisions of the legislation in place, including criminal penalties for same-sex conduct.

Human rights organizations and public health advocates have continued to express concern that the law contributes to discrimination, barriers to healthcare access, and increased vulnerability among LGBT individuals. Reports published since the law came into force have documented ongoing concerns regarding harassment, evictions, loss of employment, denial of healthcare, and other forms of discrimination.

As of 2026, the Act remains in force and continues to generate concern among international public health and human rights organizations. Recent reports indicate that arrests and legal actions under the legislation continue to raise concerns about the health, safety, and well-being of LGBT individuals in Uganda.

The WFPHA’s Call for an Inclusive and Healthy Society

The WFPHA calls on the Ugandan President, Parliament, and Government to foster an inclusive and safe environment for all citizens while safeguarding the human rights of every individual, irrespective of sexual orientation or gender identity.

Protecting public health requires protecting human dignity. Policies that promote inclusion, reduce stigma, and ensure equitable access to healthcare are fundamental to improving population health and advancing health equity.

Co-Signer

The World Federation of Public Health Associations gratefully acknowledges the support of:

• European Public Health Association

Healthcare Worker Vaccine Hesitancy: What Drives COVID-19 Vaccine Acceptance?

Healthcare workers were among the first groups prioritized for COVID-19 vaccination during the pandemic. As trusted sources of health information and frontline responders, their attitudes toward vaccination play a critical role in public confidence and immunization uptake.

While vaccines remain one of the most effective public health interventions, research has shown that healthcare workers are not immune to vaccine hesitancy. Understanding what drives vaccine acceptance—and what creates barriers—is essential for strengthening future vaccination campaigns and building trust in public health systems.

A recent review conducted by researchers from the World Federation of Public Health Associations (WFPHA) and its International Immunization Policy Taskforce examined the factors influencing COVID-19 vaccine acceptance among healthcare workers across multiple countries and regions.

Why Vaccine Acceptance Among Healthcare Workers Matters

Healthcare workers face a higher risk of exposure to infectious diseases and play a central role in advising patients about vaccination. Their confidence in vaccines can influence both workplace vaccination rates and public perceptions of immunization.

The review analyzed 56 studies from around the world to better understand the demographic, behavioral, and social factors associated with COVID-19 vaccine acceptance.

The findings revealed significant variation between countries and regions, highlighting the complexity of vaccine decision-making among health professionals.

COVID-19 Vaccine Acceptance Rates Varied Widely

One of the most striking findings was the variation in vaccine acceptance among healthcare workers.

The highest reported uptake was found in Italy, where acceptance reached 98.9%, while one study from Cyprus reported acceptance rates as low as 30%.

These differences suggest that vaccine confidence is influenced not only by individual factors but also by local contexts, health systems, communication strategies, and levels of trust in institutions.

Key Factors Associated with Higher Vaccine Acceptance

The review identified several characteristics that were consistently associated with greater willingness to receive a COVID-19 vaccine.

Older Age

Healthcare workers aged 30 years and older were generally more likely to accept vaccination than their younger colleagues. Greater clinical experience and increased awareness of personal risk may contribute to this trend.

Male Gender

Many studies have found that male healthcare workers report higher vaccine acceptance than female healthcare workers, although findings have not been consistent across all countries.

Physician Occupation

Physicians consistently demonstrated higher vaccine acceptance rates than other healthcare professionals. In contrast, vaccine hesitancy was often more common among nursing professionals.

Higher Levels of Education

Healthcare workers with university, master’s, or doctoral-level education were generally more likely to accept vaccination, suggesting that health literacy and understanding of vaccine science may influence decision-making.

Presence of Comorbidities

Individuals with chronic health conditions were more likely to be vaccinated, likely due to greater awareness of the risks associated with COVID-19 infection.

Influenza Vaccination History Was the Strongest Predictor

Across the studies reviewed, previous influenza vaccination emerged as one of the strongest predictors of COVID-19 vaccine acceptance.

More than 65% of the included studies found that healthcare workers who regularly received seasonal influenza vaccines were significantly more likely to accept COVID-19 vaccination.

This finding suggests that vaccine acceptance may reflect broader health-seeking behaviors and existing confidence in immunization programs.

What Drives Vaccine Confidence?

The review identified several factors that increased the likelihood of vaccine acceptance.

Knowledge and Health Literacy

Healthcare workers with greater knowledge of COVID-19 vaccines, including their effectiveness and safety, were more likely to be vaccinated.

Trust in Health Authorities

Confidence in governments, public health agencies, scientists, and healthcare institutions played an important role in vaccine acceptance.

Perceived Risk and Vulnerability

Healthcare workers who believed they were at greater risk of infection or severe disease were more likely to accept vaccination.

Protecting Others

Many healthcare workers cited protecting patients, family members, and colleagues as a key motivation for receiving a vaccine.

Common Barriers to COVID-19 Vaccine Acceptance

Despite the overall success of vaccination campaigns, several barriers contributed to hesitancy among healthcare workers.

Concerns About Side Effects

Fear of short-term and long-term adverse effects was the most frequently reported barrier across the studies.

Questions About Vaccine Effectiveness

Concerns regarding efficacy, particularly during the early stages of vaccine rollout, reduced confidence among some healthcare workers.

Lack of Information

Limited access to clear, transparent, and evidence-based information was another common factor associated with hesitancy.

Distrust in Institutions

Distrust of governments, pharmaceutical companies, or public health authorities negatively affected vaccine confidence in several settings.

An Important Research Gap: Public Health Professionals

While the review identified extensive research on healthcare workers, it revealed a notable gap in the literature.

No studies specifically focused on the vaccination sentiments of public health professionals.

Given their role in shaping public health policy, promoting immunization, and communicating evidence to communities, understanding their perspectives remains an important area for future research.

What Can Improve Vaccine Acceptance?

The review concluded that vaccination campaigns alone are unlikely to achieve optimal uptake.

Effective strategies should include:

• Educational initiatives that improve vaccine knowledge
• Transparent communication about safety and effectiveness
• Targeted interventions for groups with lower acceptance rates
• Efforts to build trust in health institutions
• Approaches that address misinformation and disinformation

A combination of evidence-based communication, tailored outreach, and community engagement is more likely to strengthen vaccine confidence than relying solely on vaccine availability.

Looking Ahead

The findings reinforce that healthcare worker vaccine hesitancy is influenced by a complex mix of personal, professional, and societal factors.

Older age, physician status, higher education, existing health conditions, and previous influenza vaccination were consistently associated with greater COVID-19 vaccine acceptance. At the same time, concerns about safety, effectiveness, information quality, and trust continue to shape vaccine decision-making.

As public health systems prepare for future outbreaks and vaccination campaigns, understanding these determinants will remain essential for building confidence, improving uptake, and protecting both healthcare workers and the communities they serve.

Read the original review here: Determinants of Acceptance of COVID-19 Vaccination in Healthcare and Public Health Professionals

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.