This document summarizes immunization data from the WHO European Region in 2017-2018. It finds that while DTP3 and MCV1 coverage remains over 90% on average, coverage has declined in some countries. Over 500,000 children remain unvaccinated or under-vaccinated with DTP-containing vaccines and over 800,000 children remain unvaccinated for MCV1. MCV2 coverage is lower, with 18 countries reporting less than 90% coverage. National immunization systems have room for improvement as well, as not all countries meet WHO criteria for factors like having a national immunization technical advisory group.

1. www.euro.who.int
Routine immunization summary—
WHO European Region, 2018
Vaccine-preventable Diseases and Immunization programme
Division of Health Emergencies and Communicable Diseases
Data as of 10 December 2019

2. Immunization system characteristics—WHO European Region,
2017–2018
2
Characteristic
2017
N(%)
2018
N(%)
Countries with ≥95% DTP3 coverage1
32 (60) 30 (57)
Countries with ≥95% MCV1 coverage1
29 (55) 29 (55)
Countries with ≥95% MCV2 coverage1
18 (34) 22 (42)
Countries with sustained DTP3 coverage ≥95% in last 3 years1
26 (49) 25 (47)
Countries with sustained access to WHO accredited polio, measles, and rubella
laboratories2 53 (100) 53 (100)
Countries with NITAG in place that meets the six* WHO criteria3
36 (68) 35 (66)
Countries with national system to monitor AEFI3
50 (94) 51 (96)
Countries with communication plan to respond to vaccine safety-related events3
29 (55) 30 (57)
Countries with vaccine hesitancy assessment performed within last 5 years3
29 (55) 32 (60)
Countries with child’s vaccination status routinely checked at the time of
enrollment to or during childcare or school3 41 (77)
AEFI: Adverse event following immunization
DTP3: diphtheria-tetanus-pertussis-containing vaccine, third dose
MCV1: measles-containing vaccine, first dose
MCV2: measles-containing vaccine, second dose
NITAG: National Immunization Technical Advisory Group
*The six WHO NITAG criteria are 1. legislative or administrative basis for the advisory group; 2. formal written
terms of reference; 3. at least five different areas of expertise represented among core members; 4. at least one
meeting per year; 5. circulation of the agenda and background documents at least one week prior to meetings; 6.
mandatory disclosure of any conflict of interest
Data source: 1 WHO/UNICEF Estimates of National Immunization Coverage (WUENIC) as of 15 July 2019; 2Polio Laboratory Network: www.euro.who.int/poliolabnetwork & personal communication based on annual accreditation
process of the European MR Laboratory Network; 3 WHO/UNICEF Joint Reporting Form on immunization (JRF) as of 10 December 2019
N (total # of countries in the Region) = 53

3. Regional immunization coverage estimates—WHO European
Region, 2014–2018
3Data source: WHO/UNICEF Estimates of National Immunization Coverage (WUENIC) as of 15 July 2019
Vaccine 2014 2015 2016 2017 2018
DTP1 96 96 96 97 97
DTP3 93 93 92 94 94
HepB3 81 82 82 83 84
Hib3 77 76 76 76 76
PCV3 46 48 62 73 78
Pol3 94 94 94 93 93
MCV1 94 94 93 95 95
MCV2 89 89 88 90 91
DTP1: diphtheria-tetanus-pertussis-containing vaccine, first dose
DTP3: diphtheria-tetanus-pertussis-containing vaccine, third dose
HepB3: hepatitis B vaccine, third dose
Hib3: Haemophilus influenzae type b vaccine, third dose
PCV3: pneumococcal conjugate vaccine, third dose
Pol3: polio-containing vaccine, third dose
MCV1: measles-containing vaccine, first dose
MCV2: measles-containing vaccine, second dose

4. Summary of third dose diphtheria-tetanus-
pertussis-containing vaccine (DTP3)
4

5. Number of countries categorized by national DTP3 coverage
estimate—WHO European Region, 2014–2018
5Data source: WHO/UNICEF Estimates of National Immunization Coverage (WUENIC) as of 15 July 2019
DTP3: diphtheria-tetanus-pertussis-containing vaccine, third dose
N (total # of countries in the Region) = 53
35
34
30
32
30
14
13
15
13
18
4
6
8
8
5
0 10 20 30 40 50
2014
2015
2016
2017
2018
Number of countries
Year
≥95% 90–94% <90%

6. Countries categorized by national DTP3 coverage estimate—
WHO European Region, 2018
6Data source: WHO/UNICEF Estimates of National Immunization Coverage (WUENIC) as of 15 July 2019
Countries with <90%
DTP3 coverage estimate
Country % coverage
Montenegro 87
Romania 86
Austria 85
Bosnia and Herzegovina 73
Ukraine 50
DTP3: diphtheria-tetanus-pertussis-containing vaccine, third dose
N (total # of countries in the Region) = 53
Disclaimer: The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or
area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. © WHO 2020. All rights reserved.

7. Number of countries with ≥90% DTP3 reported coverage in
≥90% of districts—WHO European Region, 2014–2018
7Data source: WHO/UNICEF Joint Reporting Form on immunization (JRF) as of 10 December 2019
DTP3: diphtheria-tetanus-pertussis-containing vaccine, third dose
N (total # of countries in the Region) = 53
N (total # of countries in the Region with more than one administrative level) = 49
25 26 25 23
18
0
10
20
30
40
50
2014 2015 2016 2017 2018
Numberofcountries
Year
≥ 90% districts with ≥ 90% DTP3 reported coverage

8. Number of children unvaccinated and under-vaccinated with
DTP-containing vaccine—WHO European Region, 2014–2018
8Population source: United Nations, Department of Economic and Social Affairs, Population Division. World Population Prospects: The 2019 Revision.
Data source: WHO/UNICEF Estimates of National Immunization Coverage (WUENIC) as of 15 July 2019
DTP: diphtheria-tetanus-pertussis-containing vaccine
Number of surviving infants ranged from 11.05 million in 2018 to 11.32 million in 2014
0
100
200
300
400
500
600
700
800
900
2014 2015 2016 2017 2018
Numberofchildren(inthousands)
Year
Unvaccinated (0 dose) Under-vaccinated (1 or 2 doses only)

9. Summary of first dose measles-containing vaccine
(MCV1)
9

10. Number of countries categorized by national MCV1 coverage
estimate—WHO European Region, 2014–2018
10Data source: WHO/UNICEF Estimates of National Immunization Coverage (WUENIC) as of 15 July 2019
MCV1: measles-containing vaccine, first dose
N (total # of countries in the Region) = 53
28
30
26
29
29
16
12
17
15
18
9
11
10
9
6
0 10 20 30 40 50
2014
2015
2016
2017
2018
Number of countries
Year
≥95% 90–94% <90%

11. Countries categorized by national MCV1 coverage estimate—
WHO European Region, 2018
11Data source: WHO/UNICEF Estimates of National Immunization Coverage (WUENIC) as of 15 July 2019
Countries with <90%
MCV1 coverage estimate
Country % coverage
San Marino 89
Estonia 87
Monaco 87
North Macedonia 83
Bosnia and Herzegovina 68
Montenegro 58
Disclaimer: The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or
area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. © WHO 2020. All rights reserved.
MCV1: measles-containing vaccine, first dose
N (total # of countries in the Region) = 53

12. Number of countries with ≥90% MCV1 reported coverage in
≥90% of districts—WHO European Region, 2014–2018
12
MCV1: measles-containing vaccine, first dose
Data source: WHO/UNICEF Joint Reporting Form on immunization (JRF) as of 10 December 2019
N (total # of countries in the Region) = 53
N (total # of countries in the Region with more than one administrative level) = 49
23 22 21 21 19
0
10
20
30
40
50
2014 2015 2016 2017 2018
Numberofcountries
Year
≥ 90% districts with ≥ 90% MCV1 reported coverage

13. Number of children unvaccinated with MCV1—WHO European
Region, 2014–2018
13Population source: United Nations, Department of Economic and Social Affairs, Population Division. World Population Prospects: The 2019 Revision.
Data source: WHO/UNICEF Estimates of National Immunization Coverage (WUENIC) as of 15 July 2019
MCV1: measles-containing vaccine, first dose
Number of surviving infants ranged from 11.05 million in 2018 to 11.32 million in 2014
0
100
200
300
400
500
600
700
800
900
2014 2015 2016 2017 2018
Numberofchildren(inthousands)
Year
Unvaccinated (0 dose)

14. Summary of second dose measles-containing
vaccine (MCV2)
14

15. Number of countries categorized by national MCV2 coverage
estimate—WHO European Region, 2014–2018
15Data source: WHO/UNICEF Estimates of National Immunization Coverage (WUENIC) as of 15 July 2019
MCV2: measles-containing vaccine, second dose
N (total # of countries in the Region) = 53
*No coverage estimate for Finland (2014-2015) and Ireland (2014-2018).
20
17
19
18
22
13
15
11
15
12
18
19
22
19
18
2
2
1
1
1
0 10 20 30 40 50
2014
2015
2016
2017
2018
Number of countries
Year
≥95% 90–94% <90% No coverage estimate*

16. Countries categorized by national MCV2 coverage estimate—
WHO European Region, 2018
16Data source: WHO/UNICEF Estimates of National Immunization Coverage (WUENIC) as of 15 July 2019
Countries with <90%
MCV2 coverage estimate
Country % coverage
Italy 89
Netherlands 89
Switzerland 89
Cyprus 88
Estonia 88
United Kingdom 88
Bulgaria 87
Turkey 87
Belgium 85
Austria 84
Czech Republic 84
San Marino 84
Greece 83
Montenegro 83
Romania 81
France 80
Monaco 79
Bosnia and Herzegovina 76
Disclaimer: The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or
area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. © WHO 2020. All rights reserved.
MCV2: measles-containing vaccine, second dose
N (total # of countries in the Region) = 53

17. Links to routine immunization information
17
• Immunization data reported annually through the WHO/UNICEF Joint Reporting Form on
immunization (JRF)
https://www.who.int/immunization/monitoring_surveillance/data/en/
• WHO/UNICEF Estimates of National Immunization Coverage (WUENIC)
http://apps.who.int/immunization_monitoring/globalsummary/timeseries/tswucoveragebcg.html
• Polio laboratory network
www.euro.who.int/poliolabnetwork