Portugal's Adult Vaccination Crisis: Why Healthcare Professionals Say Your Protection is Being Overlooked

The Portugal Ministry of Health faces growing pressure to overhaul its vaccination program as a landmark survey reveals that 67% of health professionals now advocate for a comprehensive revision of the National Vaccination Program (PNV), with the goal of aligning it more effectively with the needs of the country's aging adult population. The call comes amid declining public understanding of who qualifies for free immunization and mounting frustration over the financial barriers that keep residents from accessing recommended vaccines outside the official scheme.

Why This Matters

• 57% of residents cite cost as the single biggest obstacle to obtaining non-PNV vaccines, a limitation health professionals openly acknowledge.

• Only 51.9% of the population now understands that the PNV is intended for all residents, a drop of 5.7 percentage points since 2023.

• Pharmacists (82.9%) and physicians (75.5%) are urging targeted expansions to better protect adults and the elderly.

Erosion in Public Literacy Signals Communication Gap

The study, conducted between January 28 and April 6 by Apifarma—the Portuguese Association of the Pharmaceutical Industry—surveyed nearly 800 health professionals across six specialties and more than 2,000 citizens. While consensus remains strong on the fundamental role of vaccination in public health and disease prevention across the lifespan, the data reveal worrying erosion in key understanding metrics compared to three years ago.

The sharpest decline centers on awareness of program eligibility. Just over half of respondents (51.9%) now correctly identify the PNV as a universal service for all children and adults residing in Portugal, down nearly 6 percentage points. Similarly, the proportion of parents who consider it desirable for their children to be called for vaccination has slipped to 95.2%, a drop of 1.2 percentage points—still high, but trending downward.

Study authors conclude that these shifts underscore an urgent need to reinforce communication and health literacy around vaccines, particularly as new immunizations enter the market and epidemiological landscapes shift.

The Professional Consensus: Time to Adapt

Among the health workers surveyed—including 151 general practitioners, 79 pediatricians, 104 internists, 42 pulmonologists, 57 gynecologists, 202 nurses, and 158 pharmacists—the call for reform is resounding. Pharmacists lead the charge, with 82.9% supporting a program revision tailored to adults, while general practitioners and internists hover around 75.5%.

The rationale is straightforward: Portugal's population is aging, and the current PNV framework—rooted in pediatric immunization since its 1965 inception—has not kept pace. While the program does include adult booster shots for tetanus and diphtheria, and is set to expand to offer free HPV vaccination to men and women up to age 26 (a policy scheduled to be formalized by the Direção-Geral da Saúde on April 22, 2026), professionals argue that a more robust adult schedule is overdue.

Respiratory diseases—including pneumococcal infections—and invasive meningococcal disease remain the top concerns for family doctors, pediatricians, and nurses. Yet the program's responsiveness to these threats, particularly in vulnerable elderly populations, is seen as insufficient.

Cost: The Silent Gatekeeper

Beyond the official program, medical recommendation remains the decisive factor in whether residents pursue non-PNV vaccines. But the chasm between clinical advice and patient action is wide, and it's paved with euros. More than 57% of citizens point to cost as the primary constraint on vaccine uptake, a figure that health professionals confirm when explaining why they hesitate to recommend optional immunizations more frequently.

Reference pricing for non-PNV vaccines in Portugal includes:

• Hepatitis A: approximately €20 per dose

• Varicella (chickenpox): €40–50 per dose

• Respiratory Syncytial Virus (RSV): €198.52 per dose

When set against household budgets—especially for families, retirees, or those on modest incomes—these sums represent meaningful barriers. The consequence is predictable: residents forego protection against herpes zoster, advanced pneumococcal strains, RSV, and other preventable diseases, leaving gaps in herd immunity and exposing individuals to avoidable morbidity.

What This Means for Residents

For anyone living in Portugal, the implications are practical and immediate. If you or a family member falls outside pediatric age brackets, your access to the full spectrum of recommended vaccines depends on either your willingness to pay out-of-pocket or the clinical judgment that you qualify for a risk-based exemption under the PNV.

Key vaccines frequently recommended but not currently covered include:

• Herpes zoster (shingles) for adults over 50

• Pneumococcal conjugate vaccines beyond the PNV formulation

• Meningococcal ACWY for travelers or at-risk groups

• Hepatitis A and B for those outside designated risk categories

• RSV vaccines for older adults and those with chronic conditions

The planned HPV expansion (set for 2026) is a notable exception, extending free coverage to young adults up to 26, a demographic currently required to pay privately. This change reflects the kind of adaptive policy health professionals are seeking across the board.

Evolving Framework: The "Blue Book" and Ongoing Revisions

In March 2026, Portugal's Direção-Geral da Saúde adopted the "Livro Azul de Vacinas – Programa Nacional de Vacinação e outras estratégias de imunização" (Blue Book of Vaccines) as the national technical reference for immunization and vaccination strategy. This living document is designed to evolve with scientific evidence, international recommendations, technological innovation, and emerging public health needs, signaling an institutional willingness to modernize.

The PNV itself remains a universal, free, accessible, and equitable program by design, principles enshrined since its founding nearly six decades ago. Yet the disconnect between those principles and the lived reality of cost-prohibitive optional vaccines is a tension the system has yet to resolve.

Fragmented Knowledge Among Nurses and the Public

While vaccination schedules for children are well understood, the study reveals greater uncertainty among the public in distinguishing adult immunizations. Vaccines for RSV, COVID-19, and hepatitis generate confusion about age-appropriate administration, and even among nurses—frontline vaccinators—certain vaccines like rotavirus, pneumococcal disease, and Haemophilus influenzae type b spark hesitation.

Nurses report feeling capable of providing general vaccination counseling but recognize the need for specialized training in emerging areas such as immunization for migrant populations, whose health histories and documentation may differ from native-born residents.

The population at large associates the PNV overwhelmingly with pediatric care and traveler vaccines (yellow fever, dengue), but shows weaker recognition of adult-focused immunizations. 86% know the PNV is free, yet only half grasp who is actually entitled to it. The tetanus vaccine remains the most recognized PNV component, though more than 20% of respondents still fail to associate it with the program.

Pharmacists Push for Expanded Role

Portugal's community pharmacists continue to advocate for a more active role in vaccine administration, a shift already underway in many European jurisdictions. Proponents argue that decentralizing immunization to pharmacy settings could improve access, reduce wait times, and relieve pressure on health centers. Opponents, however, warn that such moves risk dislocalizing vaccination from the public health system, potentially undermining equity and siphoning resources from the Serviço Nacional de Saúde (SNS).

The debate mirrors broader questions about how Portugal can sustainably finance an expanding vaccine portfolio without further burdening household budgets or fragmenting the delivery infrastructure that has made the PNV a public health success story.

European Context: Where Portugal Stands

Across the European Union, adult vaccination programs vary widely in scope, funding, and delivery. A 2019 cross-national study found that the 42 European countries surveyed averaged seven vaccines per adult program, ranging from one to 18. Common policies included influenza (all 42 countries), tetanus (31), diphtheria (30), and pneumococcal vaccines (29).

Portugal's approach—universal, state-funded, centrally coordinated—aligns with Western European models but lags behind countries like Germany, where statutory health insurance covers most vaccines recommended by the Standing Committee on Vaccination (STIKO), including many "optional" immunizations that remain out-of-pocket in Portugal. In decentralized systems such as Spain, regional health authorities tailor recommendations, creating variation but also flexibility.

The common thread across Europe is a recognition that adult vaccination has historically been undervalued and underfunded relative to pediatric programs. Portugal is no exception, and the professional consensus documented in the Apifarma study suggests the country is approaching a tipping point where policy must catch up to demographic and epidemiological reality.

The Path Forward

The survey's findings arrive at a moment of transition. With the Blue Book framework now established, the Direção-Geral da Saúde has the architecture for iterative, evidence-based updates. The planned HPV expansion demonstrates political willingness to act when the case is clear. What remains to be seen is whether Portugal will extend that logic to a broader suite of adult vaccines, removing cost barriers and rebuilding public understanding of a program that, for all its strengths, risks losing relevance if it cannot adapt.

For residents, the immediate takeaway is straightforward: consult your médico de família (family doctor) about your vaccination status, especially if you are over 50, have chronic conditions, or have not received a tetanus-diphtheria booster in the past decade. Ask explicitly about non-PNV vaccines and whether you might qualify for risk-based coverage. And if cost is a barrier, say so—your experience is data that policymakers urgently need to hear.