{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T02:21:59Z","timestamp":1790907719672,"version":"4.1.0"},"reference-count":42,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T00:00:00Z","timestamp":1785974400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004319","name":"Pfizer","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100004319","id-type":"DOI","asserted-by":"crossref"}]},{"name":"COPAC\u2014Coalition of Organisations of Patients with Chronic Diseases in Romania"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>Central and Eastern Europe (CEE) carries some of the widest immunisation gaps in Europe, and improving coverage there is often treated as a problem of access infrastructure. On 14 May 2026, a multi-stakeholder meeting hosted at the Romanian Parliament brought together around twenty-five speakers, among some fifty participants in all, from Romania, Poland, the Czech Republic, and Bulgaria, together with international contributors, to agree which barriers to vaccine confidence matter most in the region, which interventions are deliverable within 12 to 24 months, and how responsibility for them should be divided among stakeholders. This Perspective synthesises that discussion as a set of strategies for coverage. Meeting-derived priorities are set against published coverage and confidence data for the region and against the published intervention literature. We argue that the central problem across the region is eroded trust rather than missing information, because misinformation succeeds mainly where trust has already broken down, a process deepened by a historically conditioned, post-communist distrust of public institutions. The two recommendations carried most strongly, as both high in expected impact and achievable within 12 to 24 months, were continuing professional education for primary care on vaccine communication and the resourcing of locally trusted community figures, including health mediators working with marginalised populations. We then show how system-design reforms already demonstrated in the region, in particular pharmacy-based vaccination, direct reimbursement, and targeted outreach to under-vaccinated and marginalised groups, turn restored confidence into measurable coverage while narrowing inequities. We close with a 12-to-24-month agenda for CEE, organised around a clear multi-stakeholder division of labour. These are stakeholder-derived priorities that now require implementation and evaluation.<\/jats:p>","DOI":"10.3390\/vaccines14080678","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T08:08:02Z","timestamp":1786003682000},"page":"678","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["From Confidence to Coverage: A Multi-Stakeholder Perspective on Vaccination in Central and Eastern Europe"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-6776-4709","authenticated-orcid":false,"given":"Teodor Cristian","family":"Blidaru","sequence":"first","affiliation":[{"name":"Faculty of Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, Dionisie Lupu 37, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Sinclair","sequence":"additional","affiliation":[{"name":"International Longevity Centre UK (ILC-UK), The Foundry, 17 Oval Way, London SE11 5RR, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petr","family":"Smejkal","sequence":"additional","affiliation":[{"name":"Department of Hygiene and Epidemiology, Institute for Clinical and Experimental Medicine (IKEM), V\u00edde\u0148sk\u00e1 1958\/9, 140 21 Prague, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7258-3434","authenticated-orcid":false,"given":"Yasmin","family":"Maor","sequence":"additional","affiliation":[{"name":"Infectious Disease Unit, E. Wolfson Medical Center, HaLochamim St. 62, Holon 5822012, Israel"},{"name":"Gray Faculty of Medical and Health Sciences, Tel Aviv University, Ramat Aviv, Tel Aviv 6997801, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7883-2427","authenticated-orcid":false,"given":"Ernest","family":"Kuchar","sequence":"additional","affiliation":[{"name":"Department of Paediatrics with Clinical Assessment Unit, Medical University of Warsaw, \u017bwirki i Wigury 63A, 02-091 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5271-1945","authenticated-orcid":false,"given":"Catherine","family":"Weil-Olivier","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Paris Cit\u00e9, 85 Boulevard Saint-Germain, 75006 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7557-2546","authenticated-orcid":false,"given":"Mariano","family":"Votta","sequence":"additional","affiliation":[{"name":"Active Citizenship Network\u2013Cittadinanzattiva, Via Imera 2, 00183 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4506-1737","authenticated-orcid":false,"given":"Lumini\u021ba","family":"V\u00e2lcea","sequence":"additional","affiliation":[{"name":"COPAC\u2014Coalition of Organisations of Patients with Chronic Diseases in Romania, Str. \u021aepe\u0219 Vod\u0103 22, 021525 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7819-5464","authenticated-orcid":false,"given":"Valeriu","family":"Gheorghi\u021b\u0103","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, Dionisie Lupu 37, 020021 Bucharest, Romania"},{"name":"\u201cAgrippa Ionescu\u201d Clinical Emergency Hospital, Str. Arh. Ion Mincu 7, 011356 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,6]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization, and UNICEF (2024). WHO\/UNICEF Estimates of National Immunization Coverage (WUENIC), 2023 Revision, UNICEF. Available online: https:\/\/www.who.int\/teams\/immunization-vaccines-and-biologicals\/immunization-analysis-and-insights\/global-monitoring\/immunization-coverage\/who-unicef-estimates-of-national-immunization-coverage."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Stanescu, A., Ruta, S.M., Cernescu, C., and Pistol, A. (2024). Suboptimal MMR Vaccination Coverages\u2014A Constant Challenge for Measles Elimination in Romania. 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