Background

Since the creation of the Expanded Program on Immunization (EPI) in 1974 to reduce global infant mortality, the scope of immunization has evolved to include lifelong immunization strategies. The life course approach to immunization states that people should receive all recommended doses of vaccines throughout their lives to achieve maximum prevention benefits against vaccine-preventable diseases at all ages, across generations and in their communities. Moreover, more and more vaccines are coming to market that are specifically designed, approved, recommended and ultimately implemented in adult vaccination programs, reflecting the increasing recognition of immunization as a lifelong public health strategy and investment.

Most vaccines used in the European Union (EU) undergo an evaluation and marketing authorization by the European Medicines Agency (EMA)/Committee for Medicinal Products for Human Use (CHMP) before they are approved and recommended at the (sub)national level (=the centralized procedure (CP) laid down in Regulation No 726/2004). The CP involves a single evaluation process, resulting in an EU-wide marketing authorization granted by the European Commission (EC), which is valid across all EU Member States, as well as Iceland, Norway, and Liechtenstein. Nevertheless, exceptions exist and vaccines that were introduced prior to the formation of EMA in 1995 were exclusively approved by regulators at the (sub)national level in EU countries (=the mutual recognition (MRP)/decentralized procedure (DCP) laid down in Directives 2001/83/EC and 2004/27/EC). As of now, no comprehensive overview exists of all vaccines for adults authorized, recommended and implemented within the EU.

The EU vaccines for adults tracker and landscape

To fill this gap, the Adult Immunization Board (AIB, www.adultimmunizationboard.org) created a “vaccines for adults tracker and landscape” that aims to provide an overview of the current different vaccines for adults implemented in the EU, approved by EMA and/or national authorities. It serves as a valuable resource for researchers, health care providers and policy makers to understand the range of vaccines currently authorized and implemented for adults across the EU for different infectious diseases. It includes information on key attributes of each vaccine. The AIB tracker also allows users to search for vaccines for adults through various criteria such as pathogen type, manufacture, vaccine platform, route of administration, antigen, adjuvant, classification etc. This tracker does not rank or make specific recommendations regarding these vaccines for adults. Vaccine types and the recommendations for them differ between and/or within EU countries. Country-specific recommended vaccines can be found at official (sub)national public health websites1 and the European Centre for Disease Control (ECDC) vaccine scheduler provides a general European overview (https://vaccine-schedule.ecdc.europa.eu/).

For the tracker and landscape, vaccines for adults are defined as vaccines authorized for individuals who are 18 years of age or older. To ensure a comprehensive overview of vaccines for adults including vaccines authorized by the centralized or the mutual recognition/decentralized procedure the following data sources were investigated up to April 2025: EMA database (European public assessment reports (EPAR) and product information), the World Health Organization (WHO) Market information for access to vaccines (MI4A/V3P), Heads of Medicines agencies (HMA) - Mutual Recognition Information (MRI) product index, national registers of authorized medicines, and pertinent literature on vaccines for adults. We included only established vaccines for adults in our dataset. Established vaccines were defined as those that had already achieved authorization and had a currently functional production facility or licensed facilities on standby for the production of vaccine. Data from the various sources were compared and analyzed in order to establish a reliable list of vaccines authorized, recommended and implemented in the EU. A standardized form was used to collect data about the vaccines for adults. Anthrax, Pandemic Influenza, Hepatitis E, Leptospirosis, Adenovirus and Q-fever vaccines are not included, as these vaccines are not licensed or only available under specific circumstances in the EU. We directly contacted our AIB advisors and Vaccines Europe, an association that represents vaccine companies operating in Europe, to review the list of vaccines for adults.

As with any overview, the search method used for this review strikes a balance between completeness and feasibility. It is inevitable that we missed some vaccines and that the EU adult vaccine landscape will evolve over time. A recent publication anticipated over the next 10 years potentially 100 risk-adjusted products (risk-adjusted using probability of technical and regulatory success [PTRS] values by stage of development) designed to protect against 40 different disease areas 2,3. Some established vaccines will also disappear from the European market, as we saw in 2023–2024 for example for COVID-19 (Vaxzevria from AstraZeneca, Jcovden from Janssen and VidPrevtyn Beta from Sanofi), hepatitis B (PreHevbri, VBI Vaccines), MenABCWY (Penbraya from Pfizer) and at many national levels for Herpes zoster (Zostavax, MSD).

Adult immunization board

The adult vaccine tracker and landscape is made by the AIB. The AIB is an independent, European, multidisciplinary group of recognized experts in the field of adult immunization established with the aim of contributing to the reduction of mortality and morbidity from vaccine-preventable infections and diseases in European adults4. The primary goal of the AIB is to provide evidence-based guidance on fundamental, technical and strategic issues, while monitoring the progress of adult immunization programs at European and (sub)national levels.

Trends observed in the first version of the vaccines for adults tracker and landscape

Table 1 shows the first version of the EU vaccines for adults tracker and landscape. In April 2025, we identified 87 vaccines for adults authorized in the EU against 30 infectious diseases (21 are viral and 9 are bacterial). These include vaccines used in routine adult vaccination programs or to catch-up missed childhood or adolescent vaccinations, other personal risk-based vaccines (e.g., vaccines indicated in pregnancy to protect the newborn and/or the mother, for specific medical conditions or lifestyles), travel-related vaccines and occupational-activity related vaccines. An overview of the vaccines per category is presented in Table 25. This table represents an updated version of the one originally included in the first technical meeting report of the AIB. 66% (N = 57/87) of the vaccines protect against viruses, while 30% (N = 26/87) protect against bacteria. Three diphtheria, tetanus, (pertussis), polio vaccines (3% (N = 3/86) protect against both, bacteria and virus. No fungal or parasitic vaccines for adults are currently authorized in the EU.

Table 1 EU vaccines for adults tracker and landscape (last update April 2025)
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Table 2 Overview of current vaccines for adults landscape in Europe (>18-year-old)
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The current vaccine products are using different approaches and technologies. The most common type of vaccines for adults are subunit vaccines (N = 39), followed by by inactivated vaccines (N = 30), live-attenuated vaccines (N = 17), and messenger nucleic acid vaccines (N = 6)6. Most vaccine products are available for seasonal influenza (N = 14), followed by Td(ap)-(IPV) (N = 9) and SARS-CoV-2 (N = 5).

Most vaccines are given intramuscularly (N = 78), only 3 vaccines are given via oral administration (Vivotif/Typhoral for Salmonella Typhi, Dukoral for Cholera, and Vaxchora for Cholera), 2 are most commonly administered subcutaneously (Imvanex® for Mpox, and Stamaril® for Yellow Fever), and the 4 BCG vaccines against Tuberculosis are administered intradermally. No intranasal vaccines for adults are currently authorized in the EU.

Most adult vaccines are used before exposure, but some vaccines such as rabies, varicella, hepatitis B, hepatitis A, Mpox and MMR vaccines are also used as post-exposure prophylaxis in adults under certain circumstances. The Zaire ebola vaccine, Zabdeno/Mvabea, is currently the only heterogenous vaccine regimen authorized under conditional marketing in adults in the EU; nevertheless off-label heterogeneous vaccine regimens are used as well (e.g. SARS-CoV-2 vaccines). Currently four combination vaccines are available for adults (Td(ap)-(IPV), HepA/B, MMR-(V), MenACWY) although logistically more combination vaccines might be highly valuable (e.g. RSV/Influenza/SARS-CoV-2)7,8. The production of a combined vaccine used for immunisation against Hepatitis A and typhoid has discontinued in 2021, and it is no longer available (Viatim®, Sanofi). 38 out of 87 vaccines for adults contain an adjuvant, most adjuvants are alum-based.

New versions of vaccines for adults are being released with updated or additional antigens compared to previous formulations. These updates are designed to account for periodic changes (e.g. SARS-CoV-2, seasonal influenza) and/or to improve protection against type replacement or enhancement (e.g. Streptococcus pneumoniae). In Europe, from 2025/2026 (Northern Hemisphere), influenza vaccines will move from quadrivalent vaccines back to trivalent vaccines, containing two A strains and only one B strain, as influenza B/Yamagata virus has no longer been consistently detected since early 20209.

Most vaccines have a EU brand name, however, it’s important to mention that some vaccine preparations are sold under multiple brand names in different countries and regions. Currently, most vaccines that are implemented in the EU have a manufacturing step in the EU.

Next steps of the vaccines for adults tracker and landscape

Next versions of the AIB tracker and landscape will be published on the AIB website (www.adultimmunizationboard.org) and will be updated on an annual basis. The AIB is exploring opportunities to enhance the tracker’s scope and functionality through partnerships and potential integration with related initiatives (e.g., International Federation on Ageing (IFA) Global Atlas for Adult Vaccination, WHO Overview of National Immunization Schedules (work in progress), and the ECDC vaccine scheduler).

Conclusion

In the EU, multiple vaccines are used to protect adults against a variety of infectious diseases. Sustained efforts to advance research, implementation, public awareness, accessibility, and uptake of adult vaccination are essential to ensure optimal protection and to reduce the burden of current and emerging infectious diseases. These actions are critical for enhancing protection against vaccine-preventable infections across all age groups, generations, and communities, thereby reinforcing a life-course approach to immunization.