The role of disease surveillance in maternal pertussis vaccination programmes in Europe: lessons for the future

Maternal vaccination is a powerful tool for protecting the health of mothers and infants but the role of surveillance systems in supporting vaccination programme design and implementation is underexplored. This paper considers how surveillance and post-implementation monitoring have helped to shape the timing and rationale for introduction of, and progressive change in, maternal pertussis vaccination in seven high-income European nations (England, Finland, France, Germany, Italy, the Netherlands and Spain). We show that differences in surveillance system design and in programme decision-making have had important implications for both timing of introduction and programme structure in each country, but that contingency has been a key factor especially where countries introduced vaccination as an outbreak response measure. To help better position surveillance and monitoring systems to provide a basis for decision-making on future maternal vaccination programmes, national and pan-European decision-makers should support greater harmonisation of case definitions and laboratory confirmation approaches; improve capture of maternal vaccination uptake and factors influencing overall trends and known and emerging inequities; invest in consistent, attitudinal data collection to better understand trends and the role of patient perceptions in influencing uptake; and support increased uptake through training of healthcare professionals to help them communicate confidently with pregnant women. This article contributes to the Lancet Regional Health–Europe series "The Future of Maternal Vaccination in Europe".