About this report

This white paper is an evidence-based call to action for Belgian policymakers on the prevention of pneumococcal disease in older adults and high-risk groups.
This paper is founded on a strong scientific basis, combining insights from the existing literature and semi-structured interviews with leading experts in the field.
The interviews, analyses, and recommendations were conducted by Möbius Business Redesign NV.

The following experts in the field participated in the semi-structured interviews:

• Prof Dr Marie Bruyneel, Department of Pneumology, CHU Saint-Pierre
• Prof Dr Steven Callens, Department of Internal Medicine and Infectious Diseases, University Hospital Ghent (UZ Gent)
• Prof Dr Stefanie Desmet, Laboratory of Clinical Microbiology, University Hospitals Leuven (UZ Leuven)
• Apr Nicolas Echement, Association Pharmaceutique Belge (APB)
• Mr Nathanael Eyer, Agence pour une Vie de Qualité (AVIQ)
• Prof Dr Johan Flamaing, Department of Geriatric Medicine, University Hospitals Leuven (UZ Leuven)
• Prof Dr Isabel Leroux-Roels, Department of Internal Medicine, University Hospital Ghent (UZ Gent)
• Dr Ioannis Passaris, Infectious Diseases in Humans, Sciensano
• Dr Belinda Perin, Agence pour une Vie de Qualité (AVIQ)
• Dr Peter Persyn, Medical and Ethical Counsel, Korian
• Mr Johan Staes, CEO, Vlaams Onafhankelijk Zorgnetwerk (VLOZO)
• Dr Stefan Theugels, Medical Director, Domus Medica
• Prof Dr Bert Vaes, Academic Centre for General Practice, Department of Public Health and Primary Care, KU Leuven
• Prof Dr Pierre Van Damme, Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute, University of Antwerp
• Dr Jeroen van den Brandt, President, Domus Medica
• Prof Dr Steven Van Gucht, Infectious Diseases Epidemiology, Sciensano
• Prof Dr Yves Van Laethem, Professor Emeritus of Infectious Diseases, CHU Saint-Pierre

Executive summary

1.1. Context

Pneumococcal disease, caused by the bacteria Streptococcus pneumoniae, presents a substantial public health challenge, leading to severe infections such as pneumonia, bacteremia, and meningitis. Recent data from the Belgian National Reference Centre for invasive Streptococcus pneumoniae show a concerning rise in the most severe form of pneumococcal disease, with 2,120 infections in 2024, compared to 1,750 in 2023. These infections, disproportionately affect older adults and people with pre-existing conditions, contributing to significant morbidity, mortality and healthcare costs, and leading to substantial pressure on the healthcare system.
In Belgium, pneumococcal disease annually contributes to 5,800 hospitalisations, with an average hospital stay of 11 days, and 430 deaths per year. With Belgium’s ageing population, the burden of this disease is expected to rise, emphasising the need for targeted preventive measures.

1.2. Pneumococcal vaccination as the key

Vaccination is a well-established strategy for reducing the risk of pneumococcal disease. It has been shown to contribute to a reduction in the incidence of severe pneumococcal diseases, mortality, and complications such as cardiovascular events. Moreover, vaccination does not only lead to health benefits but also offers economic benefits by contributing to a decrease in healthcare utilisation and costs. Additionally, it may play a role in supporting global efforts to combat antimicrobial resistance by reducing the need for antibiotics.
Belgium has a strong foundation for pneumococcal disease prevention. As a leading country in implementing childhood vaccination programmes, Belgium demonstrates a commitment to public health. Key strengths for adult pneumococcal vaccination include the available guidelines by the Superior Health Council, regional vaccination targets, a well-established surveillance system for severe pneumococcal disease and national reimbursement for certain high-risk groups. There is also a demonstrated willingness from both healthcare providers and policymakers to enhance vaccination strategies further.

Despite these positive efforts, vaccination coverage among adults in Belgium remains low. Although there are no national data available, estimates suggest that only 19% of adults aged 65 years and older and 34% of high-risk adults are vaccinated against pneumococcal disease. This is in stark contrast with other European countries like the Netherlands, where the vaccination coverage is up to 73% in older adults. The current coverage gap contributes to preventable hospitalisations and deaths, and rising healthcare costs, despite the availability of vaccines.
Several barriers persist, including reimbursement for only a subgroup of people at increased risk, leading to financial inequity, low public and healthcare provider awareness, and a complex vaccination process without a systematic approach to inform eligible patients, discouraging vaccination uptake. Also, incomplete data on vaccination coverage and the impact of pneumococcal disease on healthcare use limit the ability to assess and refine vaccination policies. Addressing these challenges through stronger policy interventions is essential to reduce the impact of pneumococcal disease in Belgium.

1.3. What actions are needed to strengthen pneumococcal disease prevention?

Based on insights from existing literature and interviews with Belgian experts, the following recommendations were developed:

1 Develop an adult vaccination programme

Establish a comprehensive adult vaccination programme with a clear, user-friendly vaccination schedule, modelled after existing childhood immunisation programmes. This schedule should outline recommended vaccines for adults at different ages and life stages, including pneumococcal vaccination. Ensure that all vaccines within the programme are funded to reduce financial and administrative barriers for both the patient and the healthcare provider.

2 Increase awareness and strengthen educational initiatives

Increase awareness among both the public and healthcare providers, about the risks of pneumococcal infections and the benefits of vaccination. The government should integrate pneumococcal vaccination messaging into existing flu and COVID-19 campaigns using traditional and social media to maximise impact. Additionally, the education for healthcare providers should be enhanced by including the importance of proactive vaccination, and overall prevention strategies in the curriculum.

3 Improve accessibility and streamline vaccination processes

Implement proactive invitation systems that are supported by the government, enabling healthcare professionals to directly reach ‘their’ eligible patients and ensure seamless access to vaccines by making them readily available for healthcare professionals in medical practices and healthcare facilities, reducing logistical barriers and simplifying the vaccination process for patients and healthcare providers.

4 Foster multidisciplinary collaboration and shared responsibility

Promote a collaborative approach to vaccination at the local community level, by leveraging local networks, expertise and resources to effectively inform eligible individuals, including hard-to-reach patients. Strengthen coordination among key stakeholders, including general practitioners, specialist doctors, pharmacists, and nurses, for example by a population health management approach facilitated by barometers, ensuring that vaccination efforts and awareness are a shared responsibility.

5 Strengthen monitoring and data collection

Ensure that vaccination status is consistently documented and accessible to all healthcare providers to facilitate preventive care. Enhance existing data collection and surveillance systems for pneumococcal disease to provide up-to-date insights into disease burden. Expand data collection to include vaccination status, healthcare data, and serotypes causing infections. This will enable a better assessment of vaccination programme effectiveness and support evidence-based policy improvements.

Read the full white paper here.