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Astra Forum Foundation supported the publication of the scientific work. The team highly values the expert knowledge and experience of professor Argirova, who is a member of the Advisory Council of the Foundation

Vaccination is one of the most powerful and accessible invention in the history of public health. It is the most effective method for prevention of infectious diseases, considering that immunization saves millions of people from diseases, disabilities and death every year. Currently, there are vaccines against numerous non-infectious, autoimmune and even oncological diseases.

In addition, a significant number of combination vaccines (mainly for pediatric use) have been developed, that save time for parents and are less traumatic for the child, compared to administering several individual vaccines. Public health authorities are involved in monitoring and investigating any case of side effects or complications, related to the vaccine. Lifelong immunization is a process that involves immunization with required and recommended vaccines from birth throughout a person’s lifetime, including vaccines that are recommended for adult patients.

Continuous efforts are being made to invent new vaccines to prevent and treat diseases such as HIV infection, malaria and tuberculosis. The list of vaccines is constantly growing. For example, the first cancer vaccine, the cervical cancer vaccine, has been in use since 2006 and around 4 million doses of the two known vaccines have already been administered worldwide without significant side effects.


Although antibiotics prevent a large proportion of deaths each year and are still the main treatment option for potentially fatal bacterial infections, the prescription levels, associated with their misuse or overuse, have led to medicinal resistance to become a global health urgent situation.

Antibiotics sometimes cause infections from which patients do not always recover. Therefore, the role of vaccines is also important in combating antibiotic resistance to prevent complications from vaccine-preventable diseases. Vaccine-preventable diseases can cause life-threatening complications, hospitalization, etc. in some cases. Vaccination provides the longest lasting and most effective protection against disease at any age. Getting children vaccinated at the right time is important and helps ensure they get the protection they need as early as possible to fight diseases before they are exposed to them. Immunization is also important for adults to help promote healthy aging.

We should remember that childhood immunization does not guarantee lifelong immunity against certain diseases such as tetanus and diphtheria. Adults need booster doses to maintain immunity. Adult vaccination may also be recommended for protection against a disease common in adulthood (e.g. herpes zoster).

Lifelong vaccination is a process that involves starting immunization with the first mandatory vaccines after a child is born and continuing throughout a person’s lifetime with the human papillomavirus (HPV) vaccine in adolescents and later with influenza vaccines that are recommended for adult patients. Immunization in childhood is the necessary basis for immunization in adulthood and old age. Re-immunizations (e.g., tetanus vaccine) are also part of the lifelong vaccination process.

Within the European Union, each country has its own national public health policy, including a national immunization program and vaccination scheme.

Immunization calendars

Immunization calendars in different EU countries are similar, but not identical. Differences relate to age and target population (e.g. all children of a certain age or only children at risk), type of vaccine (some ingredients may differ), number of doses and intervals between doses, and whether the vaccine is administered alone or in combination with other vaccines. Factors that explain these differences may include disease severity, disease levels and tendencies in different countries, resources and structure of health systems, political and cultural factors, and sustainability of the vaccination program.

Differences in vaccination calendars do not mean that some schedules are more effective than others. Rather, different circumstances are taken into account when drawing them up. All EU countries provide the same level of protection.

All EU countries recommend seasonal influenza vaccination in the elderly and in primary risk groups.

Despite the well-established and time-tested benefits of vaccines in protecting public health, there has been a rather worrying recent tendency towards decreasing vaccination coverage. The World Health Organization has reported that global coverage has dropped from 86% in 2019 to 83% in 2020. An estimated 23 million children under the age of 1 have not received essential vaccines, which is the highest number since 2009. In 2020, the number of entirely unvaccinated children increased by 3.4 million.

In the last decade, the phenomenon of hesitation towards vaccination has become a worrying tendency in Bulgaria as well. Research among parents of children up to the age of 7 revealed a number of factors that influence their attitudes towards vaccination. For example: opinions and information from the Internet, parent forums and other sources of non-scientific information.

A number of false claims have led to the public’s hesitation to vaccinate both children and adults.


The negative trend of mistrust has become particularly noticeable in Bulgaria, including toward the COVID-19 vaccines. A 2022 study by Popova et al. on attitudes towards COVID-19 vaccination in Bulgaria showed that only about 25% of respondents had completed a series of COVID-19 vaccinations and only 34% had a positive attitude towards vaccination.

Misinformation, “fake news” and lack of political unity further contribute to low vaccination rates.

Another important vaccination is the one against HPV. The National Health Insurance Fund (NHIF) reports that about 3,000 girls are vaccinated against HPV in Bulgaria every year.

Investments in vaccine prevention have definitely paid off, as cervical cancer has been shown to decrease by ∼80% ∼90%.

There are several other examples of diseases that can be prevented with vaccination, such as rotavirus gastroenteritis. Rotaviruses are the most common cause of severe gastroenteritis in early childhood and are the leading cause of hospitalization. As of April 2017, 51 730 children have been vaccinated against rotavirus in Bulgaria, with a ∼50% reduction in the morbidity.

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