RIVER-EU
Reducing Inequalities in Vaccine Uptake Across Europe
Learning from Real World Experience in Underserved Communities
RIVER-EU was a European Horizon 2020 research project (2021–2026). RIVER-EU explored how health systems, healthcare professionals and communities can work together to improve vaccine confidence and vaccine uptake among underserved populations. Through research, community engagement and practical implementation activities across Europe, the project generated lessons and recommendations that remain relevant for public health professionals, policymakers and community organisations today.
RIVER-EU Approach
Understanding Needs
Improving vaccine uptake requires more than communication campaigns. RIVER-EU explored how trust, participation, equitable health systems and adaptation to local contexts can help reduce vaccination inequalities.
Measuring Impact
RIVER-EU developed a structured process for adapting and implementing interventions across different settings.
Assessing Transferability
RIVER-EU developed a structured process for adapting and implementing interventions across different cultural and sociodemographic settings.
Tailoring Interventions
This iterative approach helps ensure that interventions are relevant, effective and sustainable in the communities where they are needed most.
Key Principles from the RIVER-EU Guideline
The RIVER-EU Guideline identifies five practical principles that can help healthcare professionals, community organisations and policymakers design and adapt vaccination initiatives across different settings.
These principles together create the conditions for sustainable, equitable and effective vaccination initiatives in diverse communities
Explore RIVER-EU Guidance and Scientific Publications
The RIVER-EU Guideline provides a practical framework for improving childhood immunisation equity in underserved communities. It supports the transfer and adaptation of successful interventions across different settings and offers practical recommendations for researchers, practitioners and policymakers.
Country Experiences and Lessons Learned
RIVER-EU brought together experiences from diverse European settings. The following case studies highlight practical challenges, innovative approaches and lessons learned while working with underserved communities.
poland
Supporting Mothers and Children Displaced from Ukraine
RIVER-EU partners worked with healthcare providers and community organisations to support mothers and children displaced by the war in Ukraine. Activities focused on improving access to trusted health information, vaccination services and practical support within host communities.
Key Lesson
Building trust through communication and practical support services improves engagement with vaccination programmes.
GREECE
Providing Preventive Care for Recent Migrants
Partners in Greece worked with under-served populations through strategies designed to strengthen relationships between communities and healthcare providers. Activities focused on understanding local needs and reducing barriers to access.
Key Lesson
Partnerships between healthcare providers and communities strengthen vaccine confidence and access.
slovakia
Building Trust with Roma Communities
RIVER-EU explored approaches to improving vaccine confidence and access in Roma communities by working closely with community mediators, local organisations and trusted health advocates. The experience highlighted the importance of local ownership and sustained engagement.
Key Lesson
Community ownership and trusted local voices are essential for addressing barriers to vaccine uptake.
NETHERLANDS
Protecting Communities from Vaccine-Preventable Diseases
RIVER-EU partners in the Netherlands examined how different social, cultural and practical factors influence vaccine decision-making. The work emphasised the importance of understanding local realities before implementing interventions.
Key Lesson
Understanding local context enables more effective and equitable intervenable design.
Extended Discussions and Reflections
To complement the formal RIVER-EU project outputs, SEKI has developed a series of in-depth educational podcasts featuring members of the implementation teams in Poland and Slovakia. These extended conversations provide learners with first-hand accounts of the challenges, practical solutions and lessons learned during project implementation, offering perspectives that are not captured in scientific publications or technical reports. The podcast episodes are available through Spotify and other podcast platforms. For each episode, SEKI has also developed a downloadable learner handout and executive summary to support individual learning, teaching and group discussion.
poland
Supporting Mothers and Children Displaced from Ukraine
This extended conversation explores the practical realities of implementing vaccination services for families displaced by the war in Ukraine. Members of the implementation team reflect on the challenges they encountered, how trust was established within host communities, and the lessons learned through day-to-day practice.
Discussion Focus
How can healthcare professionals combine culturally sensitive communication with practical support to improve access to vaccination for displaced families?
slovakia
Building Trust with Roma Communities
In this in-depth discussion, members of the team describe their experiences working alongside Roma community mediators, local organisations and trusted health advocates. The conversation explores how long-term relationships, community ownership and cultural understanding contributed to successful implementation.
Discussion Focus
What practical strategies help build trust, strengthen community partnerships and improve vaccine confidence in underserved populations?
TRANSFERABILITY
Understanding the Theory Behind RIVER-EU
RIVER-EU developed a set of educational resources to explain the methodology behind the project’s implementation framework. These resources introduce key concepts such as needs assessment, transferability assessment, intervention tailoring and implementation evaluation, helping learners understand how evidence-based interventions can be adapted across different populations and healthcare systems.
Discussion Focus
How can successful interventions be critically assessed, adapted and transferred to different communities while respecting local needs, cultures and healthcare systems?
Reflection and Application
Rather than learning from top-down content and multiple-choice questions, RIVER-EU learnings warrants a different, transferability-based approach. To deepen your learning experience, we suggest journaling, using the following reflection questions:
Reflection Questions for SEKI Learners
- Which barriers identified by RIVER-EU exist in your community?
- Which stakeholders should be involved in designing solutions?
- What adaptations would be required in your context?
- How would you measure success beyond vaccination uptake?
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Acknowledgement and Disclaimer
The RIVER-EU project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 964353.
The content of this publication represents the views of the authors only and is his/her sole responsibility; it cannot be considered to reflect the views of the European Commission and/or the European Health and Digital Executive Agency (HaDEA) or any other body of the European Union. The European Commission and the Agency do not accept any responsibility for use that may be made of the information it contains.
