Are vaccine shortages a relevant public health issue in Europe? A survey amongst countries participating in the EU-Joint Action on Vaccination, 2019

Background: National immunisation programmes depend on an adequate supply of vaccines but shortages have become more frequent globally in recent years. Vaccine shortages can lead to missed opportunities for vaccination and a greater risk of occurrence of vaccine-preventable diseases (VPD). Prevention of shortages is therefore a top priority worldwide. Methods and materials: The EU-Joint Action on Vaccination (JAV) is a European Commission-funded project 1EU-JAV has received co-funding from the European Union's Health Programme under Grant Agreement no. 801495.1EU-JAV has received co-funding from the European Union's Health Programme under Grant Agreement no. 801495. which aims to strengthen cooperation between European countries to fight VPDs, including improvement of vaccine supply and preparedness. In this context, from February to May 2019, we conducted a survey amongst persons in charge of national immunisation programmes or of vaccine supply/procurement in EU/EEA, to collect information on vaccine shortages in the previous three years. Stakeholder opinions on the main causes of shortages and possible solutions were also collected. Results: Twenty-one of 28 invited countries responded, of which 19 reported at least one shortage, for a total of 115 shortage events. The median number of shortages reported by each country was 5 (range 0–15). At the time of survey completion, there were ongoing shortages in six countries. DT/dt-containing combination vaccines, hepatitis A, hepatitis B and BCG vaccines were the most frequently involved vaccines. Supply and production issues were the most frequent causes but global shortage also played a major role. Median duration of shortages was five months (range <1 month to 39 months); 34% caused a disruption in immunization services. Procurement and purchase methods varied by country. Only half of countries have recommendations or procedures in place to address shortages. Conclusion: Vaccine shortages are a serious public health issue in the EU. Causes are complex and multifaceted and more research is needed to understand the economic and market-related causes. Improved communication between public health authorities, manufacturers and regulatory agencies is essential. Procurement and tender mechanisms should be improved and take into consideration, among others, multisource suppliers, other factors besides price, and the length of contracts. In case of vaccine shortages, all countries should have procedures or recommendation in place regarding the use of alternative vaccines or vaccination schedules.