Vaccine Confidence, Healthcare Digitalization, and HPV Vaccination Coverage Across EU Countries
Abstract
Background: HPV vaccination coverage remains highly heterogeneous across EU member states, most lagging behind the 90% target set by the 2024 EU Council Recommendation. This study assesses the independent associations of HPV vaccine confidence and healthcare system digitalization with vaccination coverage across EU countries in 2022.
Methods: First-dose female HPV vaccination coverage by age 15 was obtained from the WHO data portal (2022) for 23 EU countries (four excluded due to missing data). A composite HPV vaccine confidence score (0–100) was derived from the State of Vaccine Confidence in the EU 2022 report as the mean of four country-level items (importance, safety, efficacy, and belief compatibility), justified by their high inter-correlation (r = 0.89–0.97). The Digital Economy and Society Index (DESI 2022) score (0-100) was used a proxy for healthcare system digitalization acting as a measure of systemic digital maturity and the capacity of public infrastructures to support healthcare services. Pearson correlations and multiple linear regression were conducted.
Results: Mean coverage was 70.5% (±19.5%), ranging from 10% (Bulgaria) to 96% (Portugal). Mean confidence score was 75.3 (±7.5) and mean DESI 54.9 (±8.1). Vaccine confidence correlated moderately with coverage (r = 0.60, p = 0.002), as did DESI (r = 0.55, p = 0.006). In the multiple regression model, a 10-unit increase in confidence score was associated with a 13.6 (95%CI 5.5; 21.8) percentage increase in coverage, and a 10-point increase in DESI with 11.1 (95% CI 3.6; 18.5) percentage point increase.
Conclusions: Higher vaccine confidence and greater healthcare digitalization are associated with higher coverage levels, independently of each other. These findings highlight the need for integrated strategies combining targeted communication with investments in digital health systems to improve uptake.
Key messages: • EU countries with higher HPV vaccine confidence show significantly greater first-dose coverage.
• Healthcare system digitalization independently contributes to HPV vaccination coverage, highlighting the role of health information infrastructure as a public health lever.
Related
- Hepatitis B vaccination coverage and factors associated with higher uptake among children aged 5–35 months in eight selected sub-Saharan African countries: a multilevel ordinal logistic regression analysis
- HPV vaccination coverage trends in women across 11 EU countries: a joinpoint analysis
- Patterns, distributions and predictors of human papillomavirus vaccination coverage among girls across 31 African countries
- Editorial: Measuring vaccination perception, confidence, and uptake: advancing instrument development and validation
- Health taxes and universal health coverage in low- and middle-income countries: a scoping review of pathways, challenges and policy lessons.
BibTeX
@article{peruzzo2026vaccine,
title = {{Vaccine Confidence, Healthcare Digitalization, and HPV Vaccination Coverage Across EU Countries}},
author = {E Peruzzo and C Colombo and AM Pezzullo},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.595},
url = {https://doi.org/10.1093/eurpub/ckag169.595},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Vaccine Confidence, Healthcare Digitalization, and HPV Vaccination Coverage Across EU Countries
AU - E Peruzzo
AU - C Colombo
AU - AM Pezzullo
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.595
UR - https://doi.org/10.1093/eurpub/ckag169.595
AB - Background: HPV vaccination coverage remains highly heterogeneous across EU member states, most lagging behind the 90% target set by the 2024 EU Council Recommendation. This study assesses the independent associations of HPV vaccine confidence and healthcare system digitalization with vaccination coverage across EU countries in 2022. Methods: First-dose female HPV vaccination coverage by age 15 was obtained from the WHO data portal (2022) for 23 EU countries (four excluded due to missing data). A composite HPV vaccine confidence score (0–100) was derived from the State of Vaccine Confidence in the EU 2022 report as the mean of four country-level items (importance, safety, efficacy, and belief compatibility), justified by their high inter-correlation (r = 0.89–0.97). The Digital Economy and Society Index (DESI 2022) score (0-100) was used a proxy for healthcare system digitalization acting as a measure of systemic digital maturity and the capacity of public infrastructures to support healthcare services. Pearson correlations and multiple linear regression were conducted. Results: Mean coverage was 70.5% (±19.5%), ranging from 10% (Bulgaria) to 96% (Portugal). Mean confidence score was 75.3 (±7.5) and mean DESI 54.9 (±8.1). Vaccine confidence correlated moderately with coverage (r = 0.60, p = 0.002), as did DESI (r = 0.55, p = 0.006). In the multiple regression model, a 10-unit increase in confidence score was associated with a 13.6 (95%CI 5.5; 21.8) percentage increase in coverage, and a 10-point increase in DESI with 11.1 (95% CI 3.6; 18.5) percentage point increase. Conclusions: Higher vaccine confidence and greater healthcare digitalization are associated with higher coverage levels, independently of each other. These findings highlight the need for integrated strategies combining targeted communication with investments in digital health systems to improve uptake. Key messages: • EU countries with higher HPV vaccine confidence show significantly greater first-dose coverage. • Healthcare system digitalization independently contributes to HPV vaccination coverage, highlighting the role of health information infrastructure as a public health lever.
SN - 1101-1262
SN - 1464-360X
ER -