Why are Europe’s underserved still unprotected? A call to address structural barriers to immunisation

<h2>Summary</h2> Persistent immunisation inequities hinder progress towards public health goals across the WHO European region. In this Health Policy, we synthesise evidence from three EU-funded projects—RIVER-EU, AcToVax4NAM, and RISE-Vac—to identify key structural barriers and enabling factors that affect vaccine uptake among underserved populations, including people of minoritised ethnicity, newly arrived migrants, and people living in prison. Through a health-systems lens, we present actionable, system-level policy recommendations aligned with current EU and WHO strategies. These recommendations include enhancing service integration, prioritising inclusive governance, strengthening data systems, and addressing underinvestment in vaccine delivery. Our findings are directly relevant to the implementation of the European Immunization Agenda 2030, health-related conclusions of the EU Council (2024, 2018), and Principle 16 of the European Pillar of Social Rights. By addressing structural determinants, our recommendations offer opportunities to improve vaccination uptake among both underserved groups and the general population. We aim to contribute timely evidence to support health-system reforms that build trust, resilience, and equity across Europe.