Europe is preparing to combine its flu and COVID-19 vaccines into a single seasonal shot. But the more pressing problem is not scientific — it is whether anyone will actually get vaccinated. Across the EU, uptake among the most at-risk has collapsed, and the systems meant to fix that are not keeping pace.
The European Medicines Agency has issued a positive opinion on a combined COVID-19 and flu vaccine developed by Moderna — a step toward folding two seasonal shots into one. But the arrival of smarter tools is running into a more fundamental problem: the vaccines already available are not being used.
Across Europe, vaccination systems remain fragmented, uneven, and poorly adapted to routine adult immunisation. The combined vaccine is not just a scientific step forward — it is a test of whether European systems can translate innovation into uptake.
Innovation without uptake
Across the EU, COVID-19 vaccination coverage among those most at risk has dropped sharply. The European Centre for Disease Prevention and Control (ECDC) recorded median uptake of just 8.7 per cent among people aged 60 and above during the 2024–2025 campaign. The World Health Organization’s target is 75 per cent.
The public health burden has not disappeared. COVID-19 continues to drive hospitalisations and excess mortality across Europe, particularly among older adults. Seasonal waves persist alongside influenza, straining healthcare services every winter.
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“Only 7 to 9 per cent of those who are eligible go and get the vaccine. That’s a very, very low number,” said epidemiologist Prof. Sir Jonathan Van-Tam of the University of Nottingham.
“There’s a lack of awareness of the continued health burden that COVID-19 still causes. That includes medical professionals,” said Prof. Dr. Leif Erik Sander of Charité University Hospital in Berlin.
A divided Europe
Moderna, whose combined vaccine received the EMA opinion, warned that booster coverage has declined substantially despite ongoing risk — particularly among adults aged 65 and above. As COVID-19 has moved into an endemic phase, risk perception has decreased, reducing demand for seasonal boosters.
In the UK and Denmark, structured seasonal campaigns and proactive outreach have kept uptake in older adults relatively high — between 40 and 60 per cent. In Germany, France and Italy, the numbers remain in the low double digits, reflecting weaker infrastructure and fewer systematic recall mechanisms.
The shift from centralised pandemic campaigns to fragmented delivery has reduced visibility and weakened recall systems. “We would encourage governments to continue reinforcing national awareness campaigns while also promoting easy and equitable access to vaccination,” Moderna said, pointing to automatic outreach and pharmacy-based delivery as practical fixes.
The missing recommendation
“The one thing that always tips the balance is a personal recommendation from a trusted healthcare practitioner,” Prof. Sir Van-Tam said. “If that personal recommendation doesn’t happen, uptake is lower.” The gap is particularly visible in high-risk groups. “Cancer patients don’t get the recommendation to get the COVID vaccine from their oncologist,” said Juan-Jose Ventura of Cancer Patients Europe.
Exclusive contracts have limited choice for healthcare professionals across several markets. As these arrangements phase out from 2026, the market is expected to reopen to multiple suppliers — though procurement reform alone is unlikely to resolve deeper structural weaknesses in delivery.
A simpler shot, the same problem
A combined shot reduces two vaccination decisions to one — a change that could improve uptake, particularly if aligned with existing flu programmes. It could also reduce visits, ease administrative burden, and streamline delivery across primary care and pharmacies. But as Moderna acknowledged, combination vaccination is an opportunity, not a solution. Europe is entering a new phase of vaccine innovation.
It makes no sense to have relatively high uptake of seasonal flu vaccines and really very poor uptake of COVID vaccines on the European mainland.
—Prof. Sir Jonathan Van-Tam
“It makes no sense to have relatively high uptake of seasonal flu vaccines and really very poor uptake of COVID vaccines on the European mainland,” said Prof. Sir Jonathan Van-Tam. The same logic applies to next-generation vaccines.
The tools are becoming simpler and more advanced. The systems that must deliver them are not — and unless that gap is addressed, next-generation vaccines risk becoming the latest example of a familiar paradox: scientific leadership without public health impact.
