What do a Quality Charter and a website have in common? Or an Observatory with civic consultations? How do you structure an information campaign for the benefit of chronic patients as opposed to young students? What should we pay particular attention to when addressing the elderly rather than disadvantaged, isolated, and hard-to-reach populations? The answers to these and other questions, when we talk about vaccination policies, are contained in the experiences collected by Cittadinanzattiva-Active Citizenship and published in a handbook which highlights the active role of civil society in supporting public policy on vaccination. Many actors from intermediary bodies in society can play a constructive role, be the driving force, with institutional and non-institutional stakeholders. Various initiatives demonstrate their activism in the vaccination space. To promote these efforts at European level, Active Citizenship Network, the EU branch of Italian NGO Cittadinanzattiva, has published a handbook edited and designed by MD Health. It contains a range of activities to help those who want to invest more in prevention and immunization but don't know where to start.

The WHO has defined community engagement as “a process of developing relationships that enable stakeholders to work together to address health-related issues and promote well-being to achieve positive health impact and outcomes”, and it underlines the “Community and civil society engagement” as a pillar of its “Global Action Plan for Healthy Lives and Well-being for All” [1]. In December 2023, when the European Commission adopted the EU4Health 2024 work program to implement key health policy priorities within the European Health Union, Stella Kyriakides, European Commissioner for Health and Food Safety, emphasised that "Civil society has a crucial role to play in reaching out to our citizens" [2]. This principle applies even more strongly to vaccination policies, as the COVID-19 pandemic demonstrated. Policymakers echoed this view: at the G7 Ministers’ Meeting on Health held on 9-11 October 2024 in Ancona (Italy). Global leaders stated: “We stress that vaccination is an essential preventive measure and reiterate the crucial role of routine immunisation and campaigns”. They highlighted “the importance of raising awareness and involving the general population by providing evidence-based information through campaigns aimed at citizens’ empowerment and increasing health literacy regarding prevention, research and care” [3].

V.I.P. for life-course immunisation promotion

The Vaccination Informal Platform (V.I.P.) for life-course immunisation promotion is a collective of leaders from patient and citizen organisations across Europe, promoted by Active Citizenship Network [4,5], the EU branch of the Italian NGO Cittadinanzattiva [5], as part of the multi-annual EU project #VaccinAction [6]. For several years, the group has united periodically in Brussels with the aim of strengthening the exchange of experiences among the diverse organisations to support public vaccination policies. These meetings [7-10], held twice a year, have facilitated the exchange of practical advocacy experiences in immunisation policies (Figure 1).

Figure 1: Online form for gatering experiences.

Figure 2: Cover of the handbook.

As well as highlighted the need to collect, catalogue and showcase these examples of civic activism. Hence the idea of a handbook. To better harmonise the information, a useful online format has been created. The handbook follows a well-established tradition spanning over 40 years at the Italian NGO Cittadinanzattiva, which promotes citizens' activism for the protection of rights, the care of common goods and the support for people in vulnerable situations, at the national and at the EU level [11]. It was created as part of the fifth edition of our EU project “#VaccinAction - Protecting the Value of Vaccination Across Europe” [12] which focusses on strengthening adult vaccination and safeguarding the value of routine immunization across Europe. It also draws on the continuous exchange of experiences among leaders of patient and citizen organisations (Figure 2).

It is not a manual, nor does it aim to highlight and disseminate best practices (this will likely be the next step in this initiative). Rather, it is deliberately a concise document offering a range of different types of activities for the benefit of those who feel the need to do more in terms of prevention and immunization, but do not know where to start. In total, 16 experiences are included, most of them from Europe [13]. Each one provides detailed information across the following areas: project overview; challenges addressed; stakeholders involved; methodology; results; links & resources; and implementation. Qualitative evaluations are also included, covering the following areas: what was done; what changed; and what to keep in mind (Figure 3).

Figure 3: The same template was used for each experience to capture the following: project title & leading organisation details (including logo, website & country location).

Figure 4: Vaccination Informal Platform (V.I.P.) meeting: 25 June 2024, Brussels.

Figure 5: Save the date of the 2nd Vaccination Informal Platform (V.I.P.) meeting on 2024, realised on 15 of October in Brussels (Belgium).

Figure 6: Vaccination Informal Platform (V.I.P.) meeting: 2 October 2025, Brussels (Belgium).

            Figure 7: Vaccination Informal Platform (V.I.P.) meeting: 3 December 2025, Brussels (Belgium).

What you will find in the handbook

These are concrete experiences, not ideas or recommendations, but expressions of civic activism. They are diverse in several ways: some are supported by EU-funded projects, while many are funded by private entities; some were implemented before COVID-19 pandemic and others after; and while most were implemented across EU Member States, some were undertaken outside the EU. They also differ in terms of their geographical impact - some are purely local, many have a national scope and a few are European in reach. The target audiences vary too. Some initiatives are aimed specifically at the adult population, while others at young students. Additional focus placed on chronic patients, disadvantaged and isolated groups, hard-to-reach populations (such as refugees, migrants and prisoners), policymakers or the general public. The specific subject matter also differs. Some experiences focus on specific vaccination, such as meningitis, shingles, pneumococcal, hepatitis B or respiratory syncytial virus (RSV). Others, which we have categorized as “vaccination policy”, encompass a broader spectrum of activities, including vaccines against infectious respiratory diseases, addressing vaccination hesitancy, increasing uptake and improving access. In short, these experiences are deliberately varied, but they share an underlying unifying message: the necessity - not just the usefulness - of involving organized civil society in public health. This is the unifying thread among the organizations that collaborate with Active Citizenship Network in the Vaccination Informal Platform (V.I.P.) (Figure 4-7).

Who is it aimed at and for what purpose?

The handbook is aimed primarily at the many voices of civil society who, by browsing a catalogue of opportunities and reading about concrete, established experiences, may feel encouraged to become more active in supporting public vaccination policies within their own communities. The main aim of the booklet is to demonstrate, in a practical way, how intermediary bodies of the society, when recognized as a stakeholder, can play an active role in support of public policy on vaccination. The ultimate goal is to broaden the narrative around vaccination, which tends to focus on hesitant or hostile attitudes, while overlooking the active and constructive role played by Civil Society Organisations (CSOs) and Patient Advocacy Groups (PAGs). This handbook aims to show that civil society is part of the solution.

Each of the authors confirms that this manuscript has not been previously published by another international peer-review journal and is not under consideration by any other peer-review journal. Additionally, all of the authors have approved the contents of this paper and have agreed to the submission policies of the journal.

Authors’ Contribution

Each named author has substantially contributed to managing the described initiative and drafting this manuscript.

To the best of our knowledge, the named authors listed on the first page declare that they do not have any conflict of interest, financial or otherwise.

This publication received no direct funding. The activities described took part of the EU project “#VaccinAction - Protecting the Value of Vaccination Across Europe”, carried out by Cittadinanzattiva-Active Citizenship Network and realized thanks to the unconditional support of CSL Seqirus, GSK, MSD, Pfizer, Sanofi.

The authors gratefully acknowledge the associations who wanted to share their experiences, by participating in information gathering.

1. WHO: Community engagement: a health promotion guide for universal health coverage in the hands of the people. 2020.
2. EU Commission, directorate-general for health and food safety: commission adopts EU4Health 2024 Work Programme with a €752.4 million funding to strengthen the European Health Union 5 December 2023.
3. G7 Italia 2024: documents of the health ministers' meeting in Ancona. 2024.
4. VaccinAction2021. VaccinAction 2022. VaccinAction2023. Vaccinaction 2023. VaccinAction2024. VaccinAtion 2024. Vaccination 2025.
5. Active citizenship network (ACN) is one of the most widespread and flexible European networks. Established in 2001, it is coordinated by Cittadinanzattiva, the Italian non-profit organization founded in 1978, independent from any political affiliation, trade unions, private companies and public institutions.
6. Cittadinanzattiva APS is an organization, founded in Italy in 1978, which promotes citizens' activism for the protection of rights, the care of common goods, the support for people in conditions of weakness in Italy and abroad.
7. Brussels (Belgium): active citizens in Europe advocate for (adult) vaccination. 2024.
8. Brussels (Belgium): vaccination informal platform (V.I.P.) for life-course immunization promotion. Focus on VPRDs: flu, pneumococcal pneumonia, RSV. 2024.
9. Brussels (Belgium): active citizens in Europe Advocate for (adult) vaccination - EU Workshop. 2025.
10. I Brussels (Belgium): The future of vaccine development: research, data, participation. 2025.
11. Mission of Cittadinanzattiva.
12. Protecting the value of vaccination across Europe. 2025.
13. Free download of the handbook Supporting public vaccination policies: a collection of grassroots mobilisation initiatives across Europe.