Respiratory diseases, including pneumonia, cost healthcare systems billions annually. According to some studies, in the US alone, over 9 billion dollars are spent annually on hospitalizations due to pneumonia, with average hospitalization costs of 20,000 dollars per case. In the EU, respiratory diseases account for about 10% of all healthcare costs, and pneumonia is the leading cause of hospitalization for adults over 65. Preventive vaccination significantly reduces these costs; for example, vaccination against pneumococcal disease and flu has been shown to reduce hospitalizations by up to 60%, easing the burden on healthcare systems during peak seasons while improving outcomes for patients.

On the occasion of European Antibiotic Awareness Day, and ahead of the respiratory infection season, a warning message was sent to the public from the healthcare community: "If we continue to irrationally use antibiotics to treat viral infections (with antibiotics from home medicine cabinets), by 2050, we will no longer be able to distinguish between mild and severe pneumonia; the only place to treat pneumonia will be hospitals, and more people will die from antibiotic-resistant infections than from diabetes, cancer, and other diseases."

When we add the fact that in the world and Europe, especially in the CEE region, fewer citizens are opting to use the potential of prevention of serious complications from infectious diseases through vaccination, we are facing a Pandora’s box full of unwanted outcomes for the youngest and patients with chronic diseases or those in older age groups.

RSV, flu, COVID-19, whooping cough, and pneumococcal disease are significant public health issues for the EU and pose a threat to the most vulnerable groups in society due to their ability to cause severe complications, hospitalizations, and deaths, especially among populations such as older adults, infants, and people with existing chronic conditions (diabetes, cardiovascular diseases, respiratory diseases, neurological conditions, cancer patients, immunocompromised individuals, etc.). These diseases place enormous pressure on healthcare systems, especially during the "winter season," as they can worsen the clinical condition of patients and contribute to economic burdens through healthcare costs and lost productivity.

Additionally, with the growing challenges of antimicrobial resistance and the emergence of new "mixes" of respiratory infections, continuous surveillance and efforts to implement immunization according to expert guidelines are crucial in mitigating the impact of these infectious diseases across Europe on a human, clinical, and economic level. This was emphasized by the president of the Croatian Epidemiological Society, Prof. Dr. Miroslav Venus, and Dr. Vesna Višekruna Vučina from the Croatian Institute of Public Health’s Vaccination Department, as delegate of the director of the Institute, Assist. Prof. Dr. Krunoslav Capak.

Recognizing the significant differences in immunization statistics against threatening respiratory infections between Eastern and Western European countries, along with existing challenges in access to innovations, availability of healthcare professionals, treatment outcomes, and increased mortality, Health Hub, as a regional healthcare think tank, in partnership with leading health institutions and speakers around Europe, positioned Croatia as a leader in advancing health-policy dialogues in the CEE region, in the interest of public health and preventing the consequences of infectious diseases that unfortunately do not recognize borders.

Health Hub brought together international and national experts to discuss one of the most important global priorities of our time – immunization strategy and public health protection by 2030, on the occasion of the UN’s global "Pact for the Future" initiative and the European Health Union of the European Commission.

Health Hub’s Policy Summit "Boosting Vaccine Confidence & Vaccines Uptake for #NextGenEU" was initiated in support of the World Health Organization’s (WHO) global immunization efforts, the UN’s Pact for the Future, and the (post)pandemic Next Generation EU plan, along with recovery and resilience plans in all EU member states.

"International cooperation on immunization strategies is crucial for addressing global health threats, as demonstrated by the COVID-19 pandemic, where coordinated efforts enabled faster vaccine development, fair distribution, and improved public health outcomes. The European Union, through shared knowledge, resources, and expertise, can strengthen its collective response to future pandemics by aligning vaccination strategies and ensuring equal access across member states. Lessons from past pandemics highlight that a unified approach to immunization not only improves preparedness but also fosters resilience in dealing with new infectious diseases that cross borders," said Andrea Čović Vidović, Deputy Head of the European Commission’s Representation in Croatia.

Antonija Margeta from the Ministry of Health emphasized the importance of sharing best practices between countries and understanding the differences in immunization approaches among OECD countries, to which Croatia must align, particularly stressing at the introduction: "The Ministry of Health and the Croatian Government have extensive experience and awareness of the importance of vaccination in preventing serious infectious diseases, especially among vulnerable and high-risk groups. Furthermore, health literacy and prevention are part of our valuable heritage, thanks to the world-renowned Andrija Štampar. Therefore, we are committed to further strengthening health literacy so that our citizens can make informed health decisions based on scientific evidence, aiming to reduce the burden on the system from respiratory diseases while protecting the most vulnerable members of our society and achieving better treatment outcomes."

Seemingly trivial respiratory infections undermine healthcare systems and directly threaten chronically ill and elderly patients, as well as the youngest...

This event, held ahead of the season of threatening respiratory infection "mixes" that are filling clinics and hospitals across the region, and representing a potential "time bomb" for the most vulnerable patient groups covered by immunization programs, opened a series of discussions on challenges, opportunities, and possible solutions: to reduce immunization gaps (especially in the CEE region), strengthen so-called immunization coalitions against respiratory diseases, enhance data-driven strategies, new digital technologies, artificial intelligence, and the value of (in a Europe that connects and protects) exchanging best practices among EU member states for implementation in countries with low vaccination rates, and also to discuss the need for modern health policies concerning the education and immunization of pregnant women in line with European guidelines from expert and public health institutions. The initiative was also supported by the Croatian Medical Chamber, with an opening address from Dr. Maja Vajagić, member of the Public health committee of the Croatian Medical Chamber, who highlighted the Chamber's long-standing activities in this field, the Faculty of Pharmaceutical and Biochemical Sciences of the University of Zagreb and Prof. Dr. Miranda Sertić, Vice Dean for Science, as a delegate of Dean Prof. Dr. Zrinka Rajić, and the Coalition of Healthcare Associations, led by President Prof. Ivica Belina.

Health Hub brought together and connected numerous relevant partners and experts in the fields of health policy, health economics, infectious diseases, epidemiology, public health, digital health, artificial intelligence, health management, representatives from the innovative health industry, patient groups, and biomedical professionals (doctors, pharmacists, etc.).

Daria Kuruc Poje, MA Pharm , a clinical pharmacy specialist and Vice President of the European Association of Hospital Pharmacists, spoke about securing strategic EU health actions in the fight against antimicrobial resistance for a stronger future. Health economist Davor Katavić (Desiderius Consulting) discussed the economic value of immunization for health systems and governments, considering healthier and more productive individuals, viewing immunization as the most cost-effective investment for the best human, clinical, and economic outcomes.

Michele Calabro, Director of EUREGHA (European Reference Network for Regional and Local Health Authorities), recommended strengthening cooperation between local authorities, healthcare professionals, and civil society to build trust and ensure equitable access to vaccines for all populations. He also emphasized improving healthcare infrastructure, streamlining vaccine distribution systems, and investing in digital tools like electronic immunization records to improve vaccine uptake and overcome logistical challenges in reaching those with limited access to immunization.

Challenges such as vaccine hesitancy, distrust in expert information, or low health literacy about vaccines require targeted educational campaigns that address misconceptions and provide clear, accessible information on vaccine safety and effectiveness. Gary Finnegan, editor of Vaccines Today and commissioner of the Coalition for Lifelong Immunization from Ireland, along with respected Croatian editor and health journalist Sanja Kocijančić Petričević from HRT, spoke on this topic.

Laurent Louette, Public Affairs Director of Vaccines Europe, discussed encouraging innovation and recognizing the value of immunization throughout life to protect people from complications of threatening respiratory infections. Associate Professor Dr. Rok Čivljak, an infectious disease specialist and subspecialist in intensive care medicine from the Clinic for Infectious Diseases "Dr. Fran Mihaljević," provided an example of how pneumonia often appears as a complication of respiratory infections in his department, which frequently leads to fatal outcomes. He emphasized that the Croatian Institute of Public Health (HZJZ) has enabled wide patient coverage, offering protection through timely immunization against serious outcomes, whether it’s RSV, flu, or pneumococcal disease. However, continuous promotion of available healthcare system opportunities, updating recommendations, and immunization programs based on infection specifics and available "protective" innovations on the horizon are essential as investments in public health.

AI, Smart & Digital Strategies for Immunization Use Artificial Intelligence and Digital Technologies to Predict Public Health Threats...

The summit also looked into the "digital present and future," emphasizing how eHealth tools play a key role in improving vaccination coverage by providing timely digital reminders to individuals, ensuring vaccines are administered according to schedule. Electronic immunization records offer secure and easily accessible documentation of vaccination history, reducing the risk of missed doses and improving continuity of care. Additionally, mHealth apps provide valuable real-time information on vaccines, helping educate the public, addressing vaccine uncertainties, and empowering individuals to make informed decisions about their health. Speakers included Prof. Dr. Stjepan Orešković, Head of the Leadership and Management of Health Services program, Marius Geanta (Director of the Center for Innovation in Medicine, Romania), Jelena Curać (Assistant Director for IT at the Croatian Health Insurance Fund), and Tamara Buble (Department of Health Informatics and Biostatistics, Croatian Institute of Public Health).

"AI, Smart & Digital strategies for immunization use artificial intelligence and digital technologies to optimize vaccine distribution, track immunization data, and predict disease outbreaks, improving the overall effectiveness of public health services. These strategies support personalized, data-driven approaches to immunization, ensuring timely reminders, targeting specific groups, and improving vaccine resource management and digital health literacy," stated Prof. Ricardo Baptista Leite, MD, Director of the global agency HealthAI and founder and President of UNITE, a global network of parliamentarians dedicated to reducing infectious diseases as a global health threat.

Immunization Coalitions Should Be National Centers of Excellence to Strengthen Vaccination and Restore Trust in Scientific Information...

Respected pediatric infectious disease specialist, Prof. Goran Tešović, President of the National Coalition for Immunization, highlighted the challenges and opportunities facing national immunization coalitions:

"It is important to encourage the establishment of immunization coalitions in the EU and the region as a key measure to improve cooperation between governments, healthcare providers, and public health organizations in order to improve vaccination coverage in member states. Coalitions like the one in Croatia can promote the exchange of best practices, resources, and data, helping to address regional disparities in vaccination rates and ensuring equal access to vaccines. By working together in a unified effort, EU coalitions can strengthen public trust in vaccination and encourage coordinated responses to threats from new infectious diseases."

Prof. Dr. Sc. Siniša Skočibušić, Director of the Institute for Public Health of the Federation of Bosnia and Herzegovina, and Vlatka Martinović (Clinical Hospital Mostar, Federation of Bosnia and Herzegovina) shared the experiences of the Federation in public health protection through immunization, with a vision for the future in which their immunization coalition, along with all ecosystem stakeholders, plays an important role.

Pharmacists also have a very important role in the implementation of immunization across the EU, as easily accessible healthcare professionals for vaccine distribution, education, and support in immunization. In many European and global countries, pharmacists are increasingly involved in vaccine administration, especially for influenza and COVID-19, which improves the availability of immunization services for these respiratory threats. The role of pharmacists in immunization was discussed by Ana Soldo, President of the Croatian Pharmaceutical Chamber, as well as representatives of the International Pharmaceutical Federation who provided a detailed review.

One of the memorable sessions at the European Health Forum in Gastein few years ago aimed to help all stakeholders in the health ecosystem understand and recognize the various components of the immunization ecosystem while encouraging ongoing dialogue among them. Ivan Bumber, mag. pharm., Policy & Public Affairs Lead ASB-HUB for Eastern Europe at Pfizer, spoke about the contribution of the innovative healthcare industry in addressing looming public health challenges, such as infectious diseases.

Recommendations for immunization of pregnant women by science and public health authorities, as well as the protection of future mothers and children from respiratory infections, were discussed by specialists in gynecology and obstetrics, Prim. Dr. Sc. Nenad Veček, Prim. Dr. Sc. Ulla Marton, and Prim. Dr. Sc. Tatjana Nemeth Blažić (Croatian Institute of Public Health, Volim zdravlje).

We must not act in isolation or in silos – citizens need to be educated and more proactive in promoting the values of prevention…

Important regional and national health topics are often commented on or resolved in a kind of "silos," which is why Health Hub aimed with this event to present to the region and bring to a common „field“ all possible opportunities for improving public health when it comes to protecting against respiratory infectious diseases, especially after the lessons learned from the pandemic that, unfortunately, took many lives.

"We must not act in isolation or in silos. Distrust in immunization, science, and institutions requires us to seek beacons in global initiatives, exchange best practices among countries, put all our projects, publications, knowledge, and networks on the same table, and find the most effective solution in which we will have educated citizens, and we will not prematurely lose lives due to complications from infectious diseases and growing antibiotic resistance," said Anita Bujanić, Founder and CEO of Health Hub.

Partners, supporters, and participants of this Summit included: the European Commission, the European Parliament, the Ministry of Health of the Republic of Croatia, the Croatian Institute of Public Health, the Croatian Health Insurance Fund, the Croatian Coalition for Immunization, the Faculty of Pharmacy and Biochemistry at the University of Zagreb, the Center for Innovations in Medicine (Romania) - INNOMED, the Institute for Public Health of the Federation of Bosnia and Herzegovina, EUREGHA - The Reference Network for European Regional and Local Health Authorities, the global AI health agency Health AI, UNITE - Parliamentarians Network for Global Health, Vaccines Europe, Vaccines Today, International Pharmaceutical Federation, representatives of the healthcare industry, the Croatian Medical Chamber, the Croatian Pharmaceutical Chamber, the Coalition of Health Associations, Desiderius Consulting, and the Leadership and Management of Health Services Department at the Faculty of Medicine, University of Zagreb.

Data on the "burden of disease" that respiratory infections represent for individuals and the system:

RSV (Respiratory Syncytial Virus)

RSV affects more than 64 million people annually worldwide, and severe cases require expensive hospitalization, especially in infants and older adults. Research shows that immunization against RSV can reduce hospitalizations by up to 80% in these groups. An example of this is the respiratory syncytial virus (RSV), where a survey by the European Health Management Association showed that healthcare staff were most affected at the peak of the RSV season. According to the ECDC, RSV appears to be a common respiratory virus causing mild cold-like symptoms, but in infants under six months old, people over 65, and those with weakened immune systems, RSV can cause severe illness and even death. Survey respondents (healthcare professionals) reported increased workloads, high levels of stress, and exhaustion contributing to burnout. In outpatient care, 84% of respondents in primary healthcare and 90% of respondents in emergency care agree/strongly agree that increased workload is the main impact of the RSV season. In hospitals, 88% of respondents in pediatric departments and 88% in pediatric intensive care departments also agree/strongly agree that increased workload is the main impact (in addition to clinical complications for vulnerable groups).

Pneumococcal Disease

Pneumococcal disease in adults represents a significant public health threat worldwide. Due to the aging population and increased prevalence of underlying medical conditions, adults are at greater risk of pneumococcal infections, leading to higher hospitalization rates, disability, and mortality. Various cost-benefit analyses show that every dollar invested in pneumococcal vaccination saves 4 to 5 dollars in treatment costs, especially for high-risk populations such as the elderly. Studies suggest that every euro spent on preventive healthcare generates a return of 14 euros in healthcare and social care. Regarding immunization, a recent report showed that adult immunization provides a 19-fold return on investment for society and the economy, and in the case of pneumococcal immunization, the return can be as high as 33 times.

Influenza

Although influenza is primarily considered a respiratory infection causing significant respiratory mortality, evidence suggests that influenza also places a burden on both patients and the healthcare system due to its broader impact on the disease (cardiovascular complications, neurological complications, worsening of chronic conditions, increased susceptibility to secondary bacterial infections, functional decline, pregnancy outcomes) – all of which can lead to increased risk of hospitalization and death.

In the European Union, it is estimated that seasonal influenza vaccination prevents up to 37,000 deaths annually.