In Spain last winter, something remarkable happened: paediatric wards fell silent. “Hospitals were empty, and nobody could believe it,” said Dr Javier Díez-Domingo, director of the Vaccine Research Centre in Valencia.

 After the country introduced monoclonal antibodies against Respiratory Syncytial Virus (RSV) for every infant, RSV-related hospitalisations dropped by 83%. Thousands of healthy babies stayed at home, and thousands of parents remained at work. “The investment was good for the babies,” Díez-Domingo said, “but also for the families and the economy.”

The rising burden of RSV amongst infants, as well as pneumococcal disease in older adults, is an unseen crisis in Europe. Across the continent, implementation needs to catch up with innovation, to achieve the level of success already witnessed in Spain. Just how to do that was the focus of the panel at the World Health Summit on 13 October, organised by MSD.

Moreover, prevention must be addressed not only among infants but as a continuum across all population groups. The question is no longer whether Europe can afford immunisation across the life course. It is whether it can afford not to.

Political test of will

Across the continent, infectious-disease specialists, economists and public-health advocates describe the same paradox: vaccines can be victims of their own success. When prevention does work, nothing happens – until a crisis erupts that fills hospitals and adds to costs. 

Professor Walter Ricciardi, chair of the Mission Board for Vaccination in Europe, calls this a fundamental policy blind spot, adding: “Current health-care systems are not fiscally sustainable. Prevention is the only major possibility to grant sustainability.”

Ricciardi argues for a “mission-oriented” model, echoing the Moonshot approach that mobilised all of society toward a single goal. For immunisation, that means uniting ministries of health and finance, researchers, advocates and citizens behind a shared understanding that every dose administered is a down payment on social and economic stability – and prosperity. 

Political leaders, he warns, must look beyond the electoral cycle. “We have to make them see it as an investment with short as well as long-term returns,” he noted. 

That shift is slowly taking shape. The International Longevity Centre UK’s Pneumococcal Vaccination Atlas shows that 89% of European children are covered for pneumococcal disease, yet only 37% of older adults are. 

“We’ve built a cultural norm around the flu jab,” said Patrick Swain of the ILC, “but not around pneumococcal protection.” 

This proves what is possible when prevention is politically prioritised. The challenge now is to extend that same commitment to those at the greatest risk of severe disease, including older adults.

Financing the future, not the fiscal year

Too often, health policies are guided by short-term fiscal thinking or election cycles. Yet, immunisation programs demand sustained funding and multi-year planning to deliver their full public health impact and generate economic returns. 

Dr Sandra Zimmermann of Germany’s WifOR Institute calls this short-term political prioritisation one of Europe’s costliest mistakes: “When we invest in health, we invest in growth,” she said. 

“With infant RSV prevention, you see immediate returns – fewer hospitalisations in the next season, more parents able to work – and long-term effects as well: healthier adults, higher productivity, lower social-security costs.”

Analysis by the Office of Health Economics (OHE) shows that every Euro spent on adult immunisation can yield up to 19 times in wider economic benefits, and the adult pneumococcal vaccination has a 33 times return on investment (RoI). Yet immunisation budgets remain among the first to be trimmed in austerity drives. 

Ricciardi and colleagues have proposed removing immunisation spending from deficit rules altogether, classifying it as a capital investment, similar to infrastructure. 

“It’s the same logic; turning health from a cost centre into a wealth engine. You borrow to build something that lasts,” he said.

That logic is not theoretical. Germany’s nationwide rollout of RSV monoclonal antibodies (mAbs) last year halved the number of cases in a single winter. Each spared hospital bed represented money not spent on critical-care staffing, oxygen, and parental leave – funds that could be reinvested elsewhere in the health system. The returns are visible within months, not decades.

Zimmermann calls this the “triple dividend” of immunisation: economic growth, social equity and labour-market stability. The most significant gains often accrue to women. “When children are not hospitalised or sick, mothers can stay in paid work,” she explained. “Unpaid care decreases, workforce participation increases. The result is not just fairness, but fiscal efficiency.”

Toll on families

That connection between prevention and prosperity is rarely captured in policy spreadsheets. Susan Hepworth, from the National Coalition for Infant Health, described the personal toll of RSV on families. “Sixty-eight percent of parents said watching their child suffer affected their mental health. A third said it strained their relationship; nearly one in five either quit or lost their jobs,” she said. “Two-thirds faced a financial crisis.”

Multiply those stories by tens of thousands of infections each year, and the human and economic losses become inseparable. The ILC estimates that increasing prevention spending by just 0.1% of GDP could unlock 9% more economic contribution from Europeans over 50 through extended work and volunteering.

“We need a life-course approach,” the Pneumococcal Vaccination Atlas urges, recommending that all national health systems fund pneumococcal protection for every age group.

Innovation without inequality

We are at a juncture where immunisation policies need to keep pace with innovation. New RSV monoclonal antibodies can protect every infant and updated pneumococcal conjugate vaccines cover a broader range of strains. 

The danger lies in uneven funding, inequitable access and adoption. However, competing public-health priorities and limited awareness among policymakers hinder integration of these innovations into national programmes.

Díez-Domingo sees the risk firsthand. “RSV affects both extremes of life,” he said. “We have monoclonal antibodies for children, but we need equal focus on adults with pneumococcal disease. Immunisation must not stop at childhood; it has to become a lifelong system of care.”

Even within Europe’s wealthiest states, equity gaps persist. Only fifteen countries reimburse pneumococcal vaccination for children, at-risk groups and older adults alike. In others, seniors pay out of pocket or rely on fragmented local schemes. 

“When immunisation depends on postcode,” Swain observed, “we create two-tier immunity.”

Communication as currency

If financing is the fuel of immunisation, communication is its ignition. Hepworth admitted that health advocates often lose policymakers by using jargon. 

“When someone comes into an office and starts with scientific words they’ve never heard of, their eyes glaze over,” she said. “What’s missing is the compelling economic data and the human impact.”

The antidote is storytelling grounded in evidence. ILC’s European Pneumococcal Vaccination Atlas turns vaccine coverage data into visual league tables that spur political pride and competition. 

Regions like Galicia have already turned that pride into policy, celebrating their early adoption of RSV antibodies as a marker of civic leadership. “Policymakers love to see their region climb the rankings,” Swain noted.

But Ricciardi warned that effective communication also means confronting organised misinformation. 

“Disinformation about vaccines is disseminated in a structured way and is well-funded,” he said. “Governments must treat information integrity as part of national health security.” 

Hepworth agreed, arguing that public memory of disease has faded. “People have forgotten what vaccine-preventable disease looks like. Storytelling restores that memory.”

Prevention, prosperity and political will

The link between prevention and national wealth is no longer speculative. In Germany, the health sector now contributes €490 billion to the country’s GDP and employs 7.7 million people, surpassing the automotive industry. 

Yet, as Zimmermann pointed out, health still struggles to be seen as an economic driver. “We need the positive feedback loop,” she said. “Investments in health make citizens healthier and more productive, which enables them to generate wealth that funds further innovation. That is how prosperity sustains itself.”

Demographics make the case unavoidable. Europe’s over-65 population has tripled since 1960, while its working-age population has remained relatively stable. 

“If we want to keep economies functioning,” Swain said, “we have to keep people healthy longer.” Immunisation, he added, is the simplest and most immediate way to do it.

But sustaining that progress will depend on the political will to budget for tomorrow, ensuring equitable access rather than the next headline. 

Ricciardi advocates for classifying expenditure on immunisation outside the fiscal-deficit cap. Hepworth insists on constant advocacy to keep immunisation visible long after innovations arrive. Each, in their way, is arguing for permanence—for a Europe that budgets for immunity the way it budgets for infrastructure.

Health systems that learn to prevent

Immunisation, once viewed as a cornerstone of child health, has become a barometer of how seriously societies value prevention—and how willing they are to fund it for everyone. Strong pediatric immunisation programs lay the foundation for lifelong systems of care, extending the benefits of prevention to older adults. 

Europe has the knowledge, the technology, and—after years of pandemic fatigue—the public awareness. What it needs now is the political will to treat immunisation as both a right and a responsibility shared across generations. As Chataway concluded to the conference audience: “Empty hospital beds—that’s what success looks like.”

The return on RSV and pneumococcal immunisation is measured not only in lives saved, but in the societies that thrive when prevention is valued, funded, and equally accessible.

Christopher Nial is senior partner and co-lead of EMEA Global Public Health, FINN Partners.

The World Health Summit panel was supported by MSD. 

Image Credits: FINN Partners.