• ViVI: Dr. Barbara Rath, supported by VIVI leadership and members of the think tank
• EAP: Dr. Stefano del Torso, supported by Hans Jürgen Dornbusch (EAP Vaccines Study Group), Robert Russ Russel (EBP) and Andreas Trobisch (YEAP/EJD) and EAP leadership
• EMSA: Jan Skrzypczak, supported my EMSA leadership

1. To develop a shared European platform for vaccine-related education and training activities for healthcare workers and medical students
2. To create a shared infrastructure (website, app) and social media incentives encouraging healthcare workers and medical students to improve their knowledge on immunization, vaccine communication, immunisation safety, and vaccine preventable diseases (VPD)
3. To build the foundation for a European accreditation and evaluation system for continuing medical education and medical student education related to vaccines and immunization

In recent years, vaccine preventable diseases have made a come-back in Europe, with as many as 40’000 measles cases in 20181. In response to online scares, a rise in vaccine hesitancy, and a drop in vaccine coverage rates in European Member States (in some instances below the threshold required to prevent outbreaks), the Commission called for European action in order to strengthen cooperation against vaccine preventable diseases.2 This recommendation was adopted by the European Council in December 20183 resulting in decisive action.

Key instruments in the renewed effort to combat VPD in the EU are the Joint Action on Vaccination (JAV) and the Coalition for Vaccination (CfV). The CfV was launched in Brussels on March 4, 2019 linking Member State representatives with professional and student associations, as well as NGOs and civil society organisations active in the area of vaccination. One of the key concerns raised during the panel discussion and in the subsequent participant forum, is the apparent lack of vaccine know-how among healthcare professionals in Europe.

Emerging pathogens challenge disease prevention programmes, and new vaccines are licensed at a rapid pace. The topic of vaccination lies at the intersection of several rapidly evolving scientific fields including immunology, pharmacology, vaccine research and development, epidemiology. infectious diseases, virology/microbiology, anti-infectives, genomics, as well as planetary health and travel medicine. All of these areas are evolving continuously alongside a changing healthcare infrastructure and policy landscape. The complexity of the topic makes it increasingly difficult for busy clinicians to keep up-to-date. Cross-border healthcare and disease prevention in the EU relies on a coordinated approach to vaccine communication and an intact patient-physician relationship, both of which has been shown to be critical for vaccine acceptance.4,5 In most EU Member States however, vaccine consultations are insufficiently reimbursed, and few educational opportunities are offered during medical school and thereafter.6-8

Research by the Vaccine Safety Initiative (VIVI) revealed that practicing paediatricians spend on average one hour per eight-hour workday on vaccine safety consultations.8 Less than half of these doctors had ever received any formal training in this area. Most felt that they did observe adverse events following immunization (AEFI) during clinical practice, but less that 20% were aware of the accurate AEFI reporting pathway. In the absence of physician know-how, safety signals will likely get misreported or misdirected.9

A joint project with the School of Design Thinking in Potsdam, Germany, revealed that young parents as well as physicians and medical students often avoid the “v-topic” altogether, out of fear of a contentious debate.10 Furthermore, the unfortunate timing of the first vaccine conversation after the birth of a child, may further impair adequate risk communication due to information overload, parental sleep-deprivation, and exhaustion.10 Closer collaboration with prenatal care providers (obstetricians and midwives) will be crucial. Doctors tend to consider patients and their caregivers as passive vaccine recipients rather than active partners in health with “stakes in the game”. Lastly, vaccine consultations are poorly reimbursed, and the time and training available to physicians to listen to the patient voice is often insufficient.7

For busy medical students and physicians, it will be critical to have educational materials easily accessible and available. SEKI will develop short video content and podcasts and other teaching formats that will facilitate vaccine training and “CME on the go”. For those who practice regularly and successfully, a point system with incentives will be provided to help vaccine-hesitant healthcare workers to prioritize vaccine-related educational content over CME activities in areas that they may already be familiar with.

The Vaccine Safety Initiative (VIVI) has a 10-year track record implementing successful training courses for medical students and healthcare professionals in different EU Member States. Following the circular learning model, vaccine education should start early, for example with courses in media literacy as developed by ViVI for first-semesters entitled “Vaccine risk/benefit, what’s in the media and what does the scientific literature teach us?” allowing students to identify online disinformation.11

For senior students taking classes in family medicine and paediatrics, “hands-on” training should be provided in injection techniques and the accurate documentation of immunization events. 12 Modules for senior students and residents included a four-week elective offering supervised vaccine consultations, e-learning methodologies, multi-source evaluation, and objective structured clinical examination and OSCE stations. 8 Students and physicians with academic interest were offered opportunities for dissertations in vaccine safety and perceptions research, VPD surveillance, social science methodologies, quality improvement, health economics, laboratory medicine, infectious diseases, regulatory science, clinical research, and bioethics. Senior doctors usually prefer continuous medical education (CME) activities during weekends and conferences and online courses as well as practice-oriented communication and media training based on the principles of adult learning.13

The European Academy of Paediatrics (EAP) was founded in 1961. Its members include national paediatric societies from over 40 countries across Europe (28 European Union (EU) countries, 4 European Economic Area (EEA) countries and 9 non-EU countries) as well as all 14 UEMS recognised European paediatric subspecialty societies and observer Countries. EAP is also the official paediatric section of the European Union of Medical Specialists (www.uems.eu) that is formally linked with the European Commission and Member States Institutions and is responsible for developing European training standards in paediatrics and paediatric subspecialties. The 32 EU – EEA Countries are the full voting members of EAP. The European Board of Paediatrics (EBP) sits within the EAP and aims to maintain the highest possible standards of training in Paediatrics across Europe. The EBP will contribute an established group working towards compatible training content and criteria across Europe. The EAP is a strong advocate for vaccination 14,15 and best practice standards. In 2018, an EAP network, the EAPRASnet, completed a vaccine confidence survey (publication in progress).

The third Coalition Member participating in SEKI, is the European Medical Students Association (EMSA), whose representatives have voiced a strong interest in improving vaccine education for medical students in Europe. YEAP, the youth-arm of EAP (linked to the European Junior Doctors (EJD) will provide user perspectives and feedback and disseminate to young doctors completing their residency and subspecialty training.

To achieve the goals outlined in the Council Recommendation and the Commission Communication it will be critical to train a vaccine literate physician workforce starting in the first year of medical, nursing or midwifery school continuing throughout professional training and clinical practice. Allied health professionals (especially nurses, midwives, respiratory therapists, physical therapists, and pharmacists) will be actively included for the SEKI program to be scaled after a 1-year pilot.

The SEKI project aims to fight vaccine-preventable diseases and increase vaccination coverage in the European Union. SEKI deliverables are developed in strict compliance with the priorities outlined in the Council Recommendation and the Commission Communication.2,3

Briefly, the SEKI project will consist of a 3-Step program providing a scalable system to improve and link vaccine-related training activities In the European Union.

1. Linking educational resources: Information about existing educational resources will be mapped and collected in one online resource (website and mobile app). This includes training courses developed by European partners (such as the “wise immunizer”, in development at ESPID), weekend-seminars and “vaccination days” as well as high-quality online CME content (such as Medscape) and academic training courses as applicable. Suitable materials from non-EU sources (for example CDC’s “You Call the Shots” program and WHO training materials), from classes targeted to nurses and midwives (“shots for tots and others) and the highly specialized Advanced Course on Immunization (ADVAC) will cross-referenced and integrated into the registry. Professional and scientific societies will be encouraged to set up vaccine education events at conferences and membership assemblies.
2. Pre-post testing: Modules for pre-post testing will be made available to provide structure.
3. Collecting Credit: the opportunity to collect credits and training points over time and to store them in the SEKI system.
4. Lastly, SWOT analysis will be performed by SEKI members in collaboration with the SEKI advisory board to identify any gaps and deficiencies and areas that need additional coverage.

The Coalition for Vaccination will provide the ideal platform to extend training opportunities to other professional groups and subspecialties (including obstetricians-gynaecologists. internal medicine and public health and general practitioners, pharmacologists, nurses and midwives) and to facilitate dissemination in different EU Member States languages. VIVI, EAP and EMSA will leverage their respective international networks to extend the reach of the SEKI program.

May include representatives of DG SANTE/CHAFEA and the 3 Co-chairs for the CfV, i.e. the Standing Committee of European Doctors (CPME), the Pharmaceutical Group of the European Union (PGEU), and the European Federation of Nurses Associations (EFN).

On a regular basis, the project team will reach out to an External Advisory Panel drawing from established liaisons at VIVI and EAP.

1. Hoffman BL, Felter EM, Chu KH, et al. It's not all about autism: The emerging landscape of anti-vaccination sentiment on Facebook. Vaccine 2019; 37(16): 2216-23.
2. Commission EU. Strengthened Cooperation against Vaccine Preventable Diseases. April 26, 2018. https://eur-lex.europa.eu/legal-content/GA/TXT/?uri=COM:2018:245:FIN (accessed May 5 2018).
3. Council EU. Council recommendation on strengthened cooperation against vaccine-preventable diseases. December 7, 2018. https://eur-lex.europa.eu/legal-content/GA/TXT/?uri=OJ:JOC_2018_466_R_0001 (accessed 30 December 2018.
4. Kundi M, Obermeier P, Helfert S, et al. The impact of the parent-physician relationship on parental vaccine safety perceptions. Current drug safety 2015; 10(1): 16-22.
5. Larson HJ, Clarke RM, Jarrett C, et al. Measuring trust in vaccination: A systematic review. Hum Vaccin Immunother 2018; 14(7): 1599-609.
6. Mc Hugh SM, Browne J, O'Neill C, Kearney PM. The influence of partial public reimbursement on vaccination uptake in the older population: a cross-sectional study. BMC public health 2015; 15: 83.
7. Holt D, Bouder F, Elemuwa C, et al. The importance of the patient voice in vaccination and vaccine safety-are we listening? Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases 2016; 22 Suppl 5: S146-s53.
8. Rath B, Muhlhans S, Gaedicke G. Teaching vaccine safety communication to medical students and health professionals. Current drug safety 2015; 10(1): 23-6.
9. Muehlhans S, von Kleist M, Gretchukha T, et al. Awareness and utilization of reporting pathways for adverse events following immunization: online survey among pediatricians in Russia and Germany. Paediatric drugs 2014; 16(4): 321-30.
10. Seeber L, Michl B, Rundblad G, et al. A design thinking approach to effective vaccine safety communication. Current drug safety 2015; 10(1): 31-40.
11. Broniatowski DA, Jamison AM, Qi S, et al. Weaponized Health Communication: Twitter Bots and Russian Trolls Amplify the Vaccine Debate. Am J Public Health 2018; 108(10): 1378-84.
12. Maurer W, Seeber L, Rundblad G, et al. Standardization and simplification of vaccination records. Expert Rev Vaccines 2014; 13(4): 545-59.
13. Oubari H, Tuttle R, Rath B, Bravo L. Communicating vaccine safety to the media and general public. Current drug safety 2015; 10(1): 80-6.
14. Dornbusch HJ, Hadjipanayis A, Del Torso S, et al. We strongly support childhood immunisation-statement from the European Academy of Paediatrics (EAP). European journal of pediatrics 2017; 176(5): 679-80.
15. Grossman Z, van Esso D, Del Torso S, et al. Primary care pediatricians' perceptions of vaccine refusal in europe. The Pediatric infectious disease journal 2011; 30(3): 255-6.