BACKGROUND:
Across the European Union and European Economic Area, population ageing and the rising prevalence of chronic conditions are increasing vulnerability to respiratory infections among older adults. Despite strong evidence supporting adult immunization, vaccine uptake remains suboptimal. Fragmented eligibility criteria, inconsistent national guidelines, and variable vaccine schedules continue to limit access and contribute to missed vaccination opportunities. Strengthening adult vaccination policy is essential to supporting healthy ageing, improving system efficiency, and advancing health equity.

METHODS:
The International Federation on Ageing conducted a two-pronged analysis to examine the feasibility of a common adult respiratory vaccination schedule. A policy audit reviewed national eligibility criteria and vaccination schedules for five respiratory diseases across all European Union and European Economic Area countries. In parallel, an expert think tank convened specialists in vaccine policy, infectious disease, health economics, and public health to assess benefits, challenges, and implementation considerations. Findings were synthesized using a socio-ecological framework to identify system-level opportunities and barriers.

RESULTS:
The policy audit revealed substantial variation across countries, with no consistent alignment in eligibility criteria or vaccination timelines across respiratory vaccines. Only a minority of countries reported routine co-administration practices. Expert discussions identified key barriers, including diverse governance structures, infrastructure constraints, workforce capacity, and limited representation of older adults in policy development. At the same time, participants highlighted clear benefits of a common schedule, including simplified delivery, reduced administrative burden, improved communication, strengthened public trust, and enhanced equity in access for high-risk populations.

CONCLUSIONS:
Establishing a common adult respiratory vaccination schedule represents a promising strategy to improve coverage, reduce missed opportunities, and strengthen health system resilience. Advancing this approach will require coordinated policy action, standardization of age and risk-group definitions, strengthened co-administration guidance, and sustained multi-sector engagement.