travel to europe require vaccine

What are the vaccine requirements for European travel?

Traveling to the European Union (EU) or Schengen Area is a dream for many global tourists, workers, and students alike. However, health and safety measures have become crucial considerations, significantly reshaped by the COVID-19 pandemic. At the time of writing this article, there is no European country that still requires Covid-19 testing or vaccination before allowing entry. That is because. from the beginning of January 2023, the EU COVID vaccine requirements have been lifted by all the countries in the region.

EU nations have now reverted to the same entry measures that applied before the arrival of Covid-19.

Pre-COVID-19 Vaccination Requirements

Before the COVID-19 pandemic, the EU and Schengen Area did not require mandatory vaccinations for travellers, except for certain circumstances. These exceptions usually applied to individuals traveling from countries with high risks of particular infectious diseases.

• Yellow Fever: For travellers from or transiting through countries where yellow fever is endemic, a yellow fever vaccination certificate is required.
• Tuberculosis, Polio, and Other Diseases: Specific vaccines might be recommended depending on the health situation in the travellers’ home country or the EU/Schengen Area member state they intend to visit.

The pre-COVID-19 vaccination recommendations mostly cantered around individual health protection rather than public health security at large.

COVID-19 Impact: From Crisis to Vaccination Rollout

The COVID-19 pandemic drastically changed global travel, and the EU/Schengen Area has been no exception. As the pandemic unfolded, the EU adopted temporary travel restrictions, and stringent health checks became a common feature at borders.

Eventually, as vaccines against COVID-19 became available, they emerged as a key tool in facilitating safer travel. The EU and Schengen countries implemented new vaccination requirements, making COVID-19 vaccinations crucial for traveling to these regions.

Post-COVID-19 Vaccination Requirements

Current vaccine requirements.

Currently, there are no vaccine requirements to enter the Schengen Area for travellers entering the block without a visa. If a Schengen Visa is required, travellers will be advised of any possible vaccine requirements at the time of their consulate interview.

Previous COVID-19 Vaccination Certificates

As part of its response to the pandemic, the EU launched the EU Digital COVID Certificate (previously known as the Digital Green Certificate). The certificate functioned as verification that an individual was inoculated against COVID-19, had a negative test outcome, or had recuperated from COVID-19. Only vaccines approved by the European Medicines Agency (EMA) or a comparable national body were deemed acceptable. They primarily include Pfizer-BioNTech, Moderna, AstraZeneca, and Johnson & Johnson vaccines.

Previous Traveller Health Declarations

Some EU/Schengen Area member states required health declarations or additional health checks from arriving passengers. These measures were put into place to monitor potential COVID-19 symptoms among travellers.

Impacts and Considerations

• Impact on Travel: The COVID-19 vaccine requirement had significantly impacted international travel, with a marked increase in vaccination rates among frequent travellers.
• Equity Concerns: The disparity in global vaccine distribution raised equity concerns. Travellers from countries with slower vaccine rollouts faced greater difficulties in meeting the EU's vaccine requirements.
• Recognition of Vaccines: The EU's acceptance of only certain vaccines posed challenges. Travellers inoculated with vaccines not recognized by the EMA faced restrictions. To make matters confusing, individual member states sometimes had their own regulations and accepted other vaccines.
• Validity and Booster Shots: With ongoing research about vaccine effectiveness and duration, new guidelines concerning booster shots and certificate validity emerged, affecting future travel requirements.

The road ahead

As the global community continues to grapple with the aftermath of COVID-19, the vaccine requirements for entering the EU/Schengen Area will likely remain dynamic. Governments, health authorities, and travellers will need to stay informed and adaptable.

Despite the challenges, these measures underscore the EU's commitment to protecting public health while enabling international travel. As we navigate this new era, the hope remains for a return to normal travel circumstances bolstered by a robust understanding of global health security.

What kinds of vaccinations should I get if I plan to visit Western Europe?

The WHO and CDC recommend that travellers get the following types of vaccinations before they visit Western Europe: rabies, typhoid, hepatitis B, and hepatitis A.

They also recommend the following routine vaccinations: mumps, measles, rubella, diphtheria, tetanus, pertussis, chickenpox, influenza, pneumonia, shingles, polio, and meningitis.

Although these are no longer mandatory, Covid-19 vaccinations are still recommended for all foreigners who want to travel to Europe and for locals who want to travel to a different part of the continent.

Diseases that could be prevented by vaccination, such as mumps and measles, are starting to become increasingly common in parts of Western Europe. We recommend that you double-check your immunization status and get any necessary vaccines before you go.

The COVID-19 pandemic has significantly altered the landscape of travel to the EU and Schengen Area, with vaccinations now playing a central role in travel protocols. These changes underscore the ongoing commitment to safeguarding both public health and the freedom of movement. As we continue to adapt to this evolving situation, vaccines will remain a key factor in navigating international travel and fostering global connectivity in a post-pandemic world. 

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European countries will soon accept vaccinated US travelers. Here are the documents you'll need and how to know when it's safe.

• EU representatives voted Wednesday to allow fully vaccinated US travelers to visit soon.
• Americans will need to prove they've had their shots, but the specific rules may vary by country.
• Greece and Iceland, among the few countries already open to US tourists, are accepting CDC cards. 

Hold on to your vaccination cards: European Union representatives agreed on Wednesday that Americans who have been fully immunized should be allowed to visit the EU's 27 member nations. They won't have to show a negative COVID-19 test result or quarantine upon arrival, NBC News reported . Children may also be able to accompany their vaccinated parents abroad, regardless of their own vaccination status — provided that they have a negative coronavirus test.

The new travel guidelines are expected to be formally approved by the European Council later this week, meaning travel from the US to Europe could be possible this summer.

It's likely that Americans will need to show government-issued vaccine certificates to visit most European countries. For now, neither EU nor US officials have specified whether people will need to show the white vaccination card issued by the Centers for Disease Control and Prevention or other documentation.

Lisa Lee, a public-health expert at Virginia Tech, said European countries will probably have patchwork of different rules for US travelers.

"Some have said they're only going to accept electronic [vaccine records] so it can be verified," Lee told Insider. "Other people are afraid that the CDC cards are too prone to fraud and they won't accept the paper cards."

In an interview with Ouest France, French President Emmanuel Macron said foreign tourists could visit France with a "health pass" starting June 9. Macron didn't expand on what that pass would look like, though.

Spain's tourism secretary, meanwhile, has said the country is prepared to let travelers return in June — as long as visitors show proof they've been vaccinated, recently tested negative for the coronavirus, or recently recovered from COVID-19.

"One thing is clear: All 27 member states will accept, unconditionally, all those who are vaccinated with vaccines that are approved by EMA," Ursula von der Leyen, the European Commission president, told The New York Times in April , referring to the European Medicines Agency. The EMA has authorized all three vaccines used in the US: Pfizer, Moderna, and Johnson & Johnson.

Already, a few European countries — including Greece and Iceland — are allowing visitors from the US. Their policies could offer a hint at what to expect from other nations moving forward.

The US still doesn't recommend travel to Europe 

The CDC currently recommends avoiding all international travel to European countries, with the exception of Iceland and the UK. (The agency says Americans can travel there for essential visits only.) Similarly, the US is denying entry to visitors from the EU or UK unless they're US citizens.

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The Biden administration hasn't said whether it will remove these restrictions in the near future, but travel and aviation groups are pushing the US government to open its borders to more countries , with testing requirements in place.

For now, the US also requires fully vaccinated Americans to test negative before reentering the country.

Lee said this policy helps protect the population from highly transmissible variants that are more prevalent in other countries and might evade protection from vaccines.

"These vaccines are incredibly effective, but they're not 100% —  and they're certainly not 100% or as effective against strains that we don't know about yet that might be developing through transmission, so it's still a good time to be somewhat cautious," she said.

Greece and Iceland are accepting CDC cards as proof of vaccination

As of April 19, Greece is welcoming US travelers with a few stipulations: Visitors are asked to fill out a locator form at least one day before entering or leaving the country. Americans must also provide proof that they've been fully vaccinated — a CDC card is sufficient — or present a negative PCR test.

US travelers don't need to quarantine under this policy, a change that came with the new rule. Previously, Americans entering Greece had to isolate for a week. If a person tests positive upon arrival, however, they'll be transported to a hotel, where Greek authorities will confirm the test results and ask them to stay inside for 10 days. 

US travelers to Iceland can also avoid the nation's mandatory quarantine by presenting a CDC card that shows they are fully vaccinated. Alternatively, a person can provide proof that they've had COVID-19 already — either through a positive PCR or antibody test result.

But those going to Iceland still need to take another COVID-19 test upon arrival, then wait at their accommodation until the results are back (which can take up to 24 hours). Hotels in Iceland may ask to see your CDC vaccination card  as well.

Bulgaria, Croatia, Cyprus, Georgia, Montenegro aren't requiring US travelers to quarantine, either, if they show proof of vaccination. Italy is similarly allowing American visitors to bypass quarantine requirements with a negative COVID-19 test.

UK residents have been able to travel internationally since May 17 — but Americans who want to visit the UK must still present a negative COVID-19 test, quarantine for 10 days upon arrival, and get tested twice during their visit.

Travel requirements aside, an international trip brings risks

Just because a country is accepting US travelers doesn't mean a visit is low-risk. For Americans trying to decide whether to travel or where to go, Lee recommended that fully vaccinated people look at two key metrics: low levels of transmission and case numbers that are declining day over day.

"If you look at Portugal, for example, the incidence is a lot lower than Spain and they're right next to each other," Lee said.

On average, Spain is recording nearly 102 daily cases per 1 million people, while Portugal is recording around 39 daily cases per 1 million people. The CDC defines low transmission as fewer than 5 cumulative new cases per 100,000 people over the prior 28 days, and moderate transmission as fewer than 50 cumulative new cases per 100,000 people over 28 days.

If you're looking to lower your risk of infection, choose less crowded locales where you're unlikely to bump into people who haven't been vaccinated. Opt out of large events like concerts or soccer matches, too. 

"If you're planning a trip to the countryside, that's a very different calculus than if you're planning a trip to the middle of a bustling city," Lee said. 

Of course, outbreaks can also change course quickly, so a country that looks safe now may have high levels of transmission in three months. 

"Check the requirements frequently, right up until the departure date, as every country's policies are going to be changing in response to the way the epidemic evolves," Lee said.

The website Skyscanner offers real-time updates on countries' travel restrictions and quarantine requirements. Make sure to prepare the necessary documentation for each country you plan to visit.

"You don't want to get from one place to another and discover, 'Oh, whoops, they need this piece of paper or that piece of software and I don't have that,'" Lee said.

This story has been updated. It was originally published on May 2, 2021.

Watch: We followed a Delta cleaning crew to see how the airline is sanitizing planes as travel ramps back up

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European Centre for Disease Prevention and Control

An agency of the European Union

• Infectious disease topics
• Disease information
• Questions and answers
• Q & A: COVID-19 and travel

Questions and answers on COVID-19: Travelling

1. what precautions should i take if i need to travel.

Travellers should consult the national policies of their destination country, as well as policies set by their transport provider prior to travel. 

Standard prevention measures to control the spread of COVID-19 that may be recommended during travel include:

• do not travel if exhibiting symptoms compatible with COVID-19
• practice physical distancing (a distance of one to two metres from others)
• follow respiratory etiquette (coughing and sneezing into a tissue or elbow) and good hand hygiene (washing hands with soap and water regularly or using alcohol-based hand sanitisers)
• use a face mask (preferably a medical face mask or FFP2 respirator) in situations where physical distancing cannot be maintained.

Travellers who develop any symptoms compatible with COVID-19 during or after travel should self-isolate and seek medical advice and test for SARS-CoV-2 to exclude a diagnosis of COVID-19.

2. What is the risk of infection with SARS-CoV-2 when travelling?

There may be a risk of infection with SARS-CoV-2 while travelling, so standard prevention measures should be followed.

ECDC, in collaboration with other relevant EU agencies, has developed joint guidance for the  aviation ,  cruise  ship and  railway  sectors for use during the pandemic, including advice on non-pharmaceutical interventions while travelling, the cleaning and disinfection of premises and managing a COVID-19 case on board.

Travel during the coronavirus pandemic (European Commission)

Public health guidance

Guidance for COVID-19 quarantine and testing of travellers

Covid-19: eu guidance for cruise ship operations, covid-19 rail protocol: recommendations for safe resumption of railway services in europe.

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Want to Go to Europe This Summer? Here Are Your Options

For American travelers hoping to head abroad, answers to questions about which countries they can visit and what the future might hold.

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By Ceylan Yeginsu

With the number of people in the United States vaccinated against the coronavirus climbing, Americans are starting to explore their prospects for international travel this summer, a season when Europe is traditionally a big draw.

Most of Europe has been off-limits to most U.S. citizens for over a year, and the continent is currently grappling with a third wave of coronavirus infections and a surge in new, more contagious variants, making it unclear when its borders will reopen. But some European countries have started to welcome vaccinated travelers , including American tourists , and others are making preparations to ease restrictions in time for the summer season.

Vaccine and health certificates that would help speed travel are under development, which could make it easier for tourism to restart. The 27 member countries of the European Union have endorsed the idea of a vaccine certificate. While individual European countries will still set their own rules, the initiative is expected to establish a coordinated approach across the continent.

“Finally, we have a tangible solution to coordinating and harmonizing travel measures,” said Eduardo Santander, chief executive of the European Travel Commission, an association of national tourism organizations based in Brussels. “I think other countries like the U.S. will also come up with their own technological solutions that will be compatible and after a period of trials this summer, a global standard will be established.”

In the United States, the Centers for Disease Control and Prevention is still recommending against travel — even for those vaccinated — citing the risks of catching and spreading the virus while away from home. And ultimately, the course of the virus will determine what travel looks like across the world. But here’s what we know about how European countries are preparing to restart tourism.

I want to go to Europe this summer. Who will let me in?

Last summer, when the United States reported more coronavirus infections and deaths than any other country, Americans were barred from entering the European bloc for vacation.

There have been a few exceptions: Turkey has been letting U.S. citizens enter if they produce evidence of a negative Covid-19 PCR test before departure, as has Croatia, and several countries that are not members of the European Union, including Albania and Armenia.

As the number of cases has risen in Europe, and vaccination has been sluggish, several European Union countries have gone back into lockdown. France, Belgium and Portugal have reintroduced stringent measures that restrict nonessential travel, even from within the bloc and within what is known as the Schengen Zone, which includes nonmember countries that allow free movement across their borders.

“Right now, in some European countries, it might feel like you are in the middle of a storm, which is how we felt in the U.K a couple of months ago,” said Gloria Guevara Manzo, chief executive and president of the World Travel & Tourism Council , a forum that works with governments to raise awareness about the travel industry.

“But I think once we accelerate the vaccination rollout while applying strong safety protocols and testing, then by the summer we will be in a situation where European countries will be able to open up around the same time,” she added.

But that’s likely to be for travel within Europe, rather than between Europe and the United States.

“The current focus is on opening up internal markets within the E.U and U.K. and then depending on reciprocity agreements, more third countries will be included,” said Eric Dresin, Secretary General of the European Travel Agents’ and Tour Operators’ Association . “But right now, we are not talking about Americans visiting Europe.”

American travelers do have some options, though: Having brought the virus under control, Iceland is allowing all vaccinated travelers — including those from the United States — to enter without being subject to Covid-19 testing or quarantine measures.

Greece, one of the most popular European summer destinations for Americans, announced this month that it would reopen for all tourists in mid-May, as long as they show proof of vaccination, antibodies or a negative Covid-19 test result before traveling. All visitors will be subject to random testing upon arrival.

Turkey said it would not require international travelers to be vaccinated this summer and will re-evaluate testing policies after April 15.

Other European countries like Slovenia and Estonia are letting in vaccinated tourists, but not those from the United States.

Spain, which relies heavily on tourism for its economy, said it would reopen to international visitors in the spring, once between 30 and 40 percent of its adult population is vaccinated. Portugal is also hoping to reopen its borders by May, but it is not yet clear whether Americans will be allowed in.

What about Britain?

Americans were never barred from entering the United Kingdom, which left the European Union last year, during the pandemic and can visit today, but face strict testing and quarantine requirements. In England, where a 10-day quarantine is required, the time can be reduced if a person presents a negative Covid-19 PCR test on day five.

Violations can result in penalties of up to $13,860 and 10 years in prison.

Most of Britain is under strict lockdown and while a stay-at-home-order is to be lifted on March 29, most shops, restaurants and pubs will stay closed until at least mid-April. Scotland has started to ease restrictions and will continue to do so in phases.

Domestic tourism and indoor dining is not expected to resume until May 17 at the earliest. In anticipation of restrictions being lifted, several cruise lines have announced “staycation sailings” around the British Isles starting in June.

Many Britons traveled last summer when the virus seemed to have ebbed, and a recent study found that they brought a significant number of infections back into the United Kingdom. A ban on British travel abroad for leisure was enacted on Jan. 4 and was expected to expire in May, but the government introduced legislation this week that lays down the legal framework to extend the restrictions until the end of June.

It is not clear when exactly the United Kingdom will lift its quarantine requirements for more tourism, but Visit Britain forecasts a slow recovery that will start toward late summer.

Will I need proof that I’m vaccinated to enter Europe?

Earlier this month, the European Commission proposed a digital travel certificate that would prove that a person has been vaccinated, received a negative Covid-19 test result or recovered after contracting the virus.

To travel to the European Union , you will have to tick one of the three boxes.

The document, known as a Digital Green Certificate, would allow European Union residents and their family members to travel freely within the bloc’s member states. The commission is also working to coordinate with the World Health Organization to make sure that the certificates are compatible with systems in countries outside Europe.

The documents would be free and available in digital or paper format and if approved by the European Parliament, the bloc plans to roll them out within three months.

Non-European Union nationals will be able to request a Digital Green Certificate from the member country they plan to visit. The rules for proof of vaccinations will be the same as for European Union nationals: Vaccines that the bloc has authorized will be accepted and individual member states will be able to decide whether to accept others.

“The Digital Green Certificate will not be a precondition to free movement, and it will not discriminate in any way,” said Didier Reynders, the bloc’s top official for justice. “A common E.U.-approach will not only help us to gradually restore free movement within the E.U. and avoid fragmentation. It is also a chance to influence global standards and lead by example based on our European values like data protection.”

If I do go, what happens when I return to the United States?

Currently, all airline passengers age 2 and older traveling to the United States must provide a negative Covid-19 viral test (NAAT or antigen test) taken within three calendar days of travel. States have different quarantine requirements , so travelers should check what their state requires before booking a vacation abroad.

What types of health and safety measures should I expect in Europe?

Each country sets its own rules, but most safety protocols are unlikely to change this summer, even for those who have been vaccinated.

Visitors will be expected to wear masks and keep a safe distance in public spaces. Hotels, restaurants and event spaces will have enhanced cleaning protocols in place, and some may impose capacity restrictions.

“I think it’s very important that governments strike a balance of easing restrictions this summer, while maintaining safety protocols to control the disease,” Mr. Santander of the European Travel Commission said. “We really don’t want to find ourselves in a situation in 2022 where we have to close borders again and go into lockdown for another year.”

Follow New York Times Travel on Instagram , Twitter and Facebook . And sign up for our weekly Travel Dispatch newsletter to receive expert tips on traveling smarter and inspiration for your next vacation. Dreaming up a future getaway or just armchair traveling? Check out our 52 Places list for 2021 .

Ceylan Yeginsu is a London-based reporter. She joined The Times in 2013, and was previously a correspondent in Turkey covering politics, the migrant crisis, the Kurdish conflict, and the rise of Islamic State extremism in Syria and the region. More about Ceylan Yeginsu

clock This article was published more than  2 years ago

Traveling to Europe? What to know about requirements for 5 countries.

Some countries want proof of vaccination, some want a negative test, and some want both

Through both the delta and omicron variant surges, European countries put restrictions in place to contain the virus while allowing in coronavirus -free travelers. Now, some countries are beginning to ease some rules.

Still, the Centers for Disease Control and Prevention has given a Level 4 warning to much of Europe because of high levels of coronavirus transmission, and it recommends Americans avoid travel to top destinations such as Italy, France and the United Kingdom.

The omicron variant hit the European travel industry, which had just begun to recover from the pandemic. However, leaders in the industry are confident that Europe will again be able to offer a safe experience for travelers.

“We have clear rules — people, hotels and restaurants are clearly complying in order for you as an American to not only have the best experience, but the safest one,” said Luís Araújo, the president of the European Travel Commission and Tourism ​​Portugal.

So what kinds of restrictions will Americans encounter when traveling to Europe? Entry requirements can vary widely, from what type of mask to wear on the flight to vaccination proof. We looked at how five major European destinations are handling international visitors.

CDC warning: Level 4

Entry requirements: Fully vaccinated Americans, which now includes being boosted if eligible, need to show proof of vaccination and a signed declaration stating that they do not have symptoms of covid-19.

Unvaccinated travelers may only enter the country for compelling reasons. Unvaccinated people must show proof of a negative test taken 48 hours before departure, take a test once they arrive and then quarantine for 10 days at a location disclosed to the French government.

Restrictions once you’re there: To access most services and businesses in France — including restaurants, museums, concert halls, trains, domestic flights, shopping malls and tourist attractions — people over the age of 12 are required to show a pass sanitaire (health pass).

While some tourist attractions may allow Americans to show the CDC vaccination card for entry, it is generally not accepted. However, travelers can apply for a French health pass at a designated pharmacy; it costs about $41.

Unvaccinated people can obtain a 24-hour health pass with proof of a negative coronavirus test. However, the French Parliament recently approved plans for health pass legislation that, if passed by the Senate and the National Assembly, would require all people over 16 to be vaccinated to receive a health pass.

Starting Jan. 15, adults who received their last vaccination dose more than seven months ago, or people vaccinated with Johnson & Johnson’s vaccine more than two months ago, must have a booster shot to obtain a health pass.

Entry requirements: Only vaccinated Americans can enter Spain for nonessential purposes. Starting Feb. 1, a booster will be required if your last vaccination was more than 270 days before arrival.

Americans will need to download a QR code through the Spain Travel Health portal to prove their vaccination status before arrival. If travelers arrive by air or sea , Spanish border agents will take their temperature and do a visual assessment of their health.

Spain is not mandating a quarantine for anyone entering the country. However, if border authorities suspect travelers of having the coronavirus because of an elevated temperature or visible symptoms, they can require those individuals to take a test.

Restrictions once you’re there: Once in Spain, make sure to check the regional restrictions in the areas you’re looking to visit.

The most common restrictions in Spain include masking in public spaces including outdoors, limited capacity in indoor businesses and restaurants, and proof of vaccination to enter restaurants and other public services.

Entry requirements: Travelers coming from the United States, or who have been in the United States within the past 10 days , must provide proof they are fully vaccinated.

Those who have stayed in a risk area have to fill out a digital entry registration form and present it upon entry. Germany has designated the United States a “high risk area.”

Restrictions once you are there: Within Germany, there are tight restrictions in many regions, allowing only vaccinated or recovered people to enter nonessential businesses and services. Check requirements of the regions you plan to visit because restrictions may change based on the hospitalization rate.

Germany has a widely used open-source app for tracking transmission and cases. The free Corona-Warn-App lets people know anonymously and quickly if they have been near someone infected with the coronavirus.

Entry requirements: Anyone flying to Italy needs to wear an FFP2 mask , not a surgical or cloth mask. Upon arrival, Americans have to fill out a passenger locator form , provide proof of a negative molecular coronavirus test from the past 72 hours or a negative antigen test from within the past 24 hours, and proof of full vaccination or recovery from the coronavirus.

For those without proof of vaccination or recovery, prepare to travel by a private vehicle from your point of entry to a place to quarantine for five days . These travelers must notify the local health authority of their arrival in Italy and test negative at the end of the quarantine.

Children under 6 years old don’t have to take pre-departure tests or prove their vaccination status, as long as they are with a vaccinated parent. Kids over 6 have to take a test, but they don’t have to quarantine unless their parent needs to.

Restrictions once you’re there: Be prepared to wear an FFP2 mask while riding public transportation and in performance venues, whether indoors or outdoors.

Italy uses a “Green Pass” as a vaccination card, but U.S. vaccination cards and documents proving recovery are widely recognized as an equivalent . You will need to carry this documentation for most public attractions and restaurants, as well as for riding local transportation.

Again, restrictions are different depending on the region you are in, so be sure to check local guidance.

Questions and answers on COVID-19 vaccination in the EU

Click on each theme to find relevant questions and answers on COVID-19 vaccination in the EU, vaccine negotiations and its authorisation process.

You can also click on the questions you are interested in to find out more about the topic.

COVID-19 vaccination in the EU

1. which vaccine is now authorised.

Following positive assessment of the European Medicines Agency (EMA) of their safety, quality and efficacy, the Commission has so far given the conditional marketing authorisation for eight vaccines developed by:

• BioNTech and Pfizer , on 21 December 2020
• Moderna, on 6 January 2021
• AstraZeneca , on 29 January 2021
• Janssen Pharmaceutica NV , on 11 March 2021
• Novavax , on 20 December 2021
• Valneva , on 24 June 2022
• Sanofi and GSK, on 11 November 2022
• HIPRA , on 30 March 2023

2. Which potential vaccines is EMA currently reviewing?

The EMA has started rolling reviews of a COVID-19 vaccine from

• Gamaleya Institute, Sputnik V vaccine  on 4 March 2021
• (Vero Cell) Inactivated , developed by Sinovac Life Sciences Co., Ltd, on 4 May 2021

These rolling reviews will continue until enough evidence is available for formal  marketing authorisation application.

3. With which companies has the Commission concluded agreements for vaccines?

The Commission has negotiated intensely to build a diversified portfolio of vaccines for EU citizens at fair prices. Contracts have been concluded with  AstraZeneca  (400 million doses), Sanofi-GSK (300 million doses),  Johnson and Johnson  (400 million doses ),  BioNTech-Pfizer  (2.4 billion doses),  CureVac  (405 million doses),  Moderna  (460 million doses),  Novavax  (200 million),  Valneva  (1.2 million) and  HIPRA  (up to 250 million doses).

EMA has ended the rolling review of CureVac COVID-19 vaccine, after the company informed the Agency that it was withdrawing from the process. This means that the Commission has secured a portfolio of more than 4.2 billion doses. For the Commission it was important from the beginning to build a diversified portfolio of vaccines based on different technologies, to increase the chances that one or more of the vaccine candidates are approved by EMA.

4. Are COVID-19 vaccines safe?

Safety is a fundamental requirement for any vaccine to reach the EU market. Before being made available for purchase and use, any COVID-19 vaccine candidate needs to meet the rigorous requirements and evidence thresholds of the European Medicines Agency’s scientific assessment to receive market authorisation. These requirements are no different from those for any other vaccine produced and used in the EU. The European Medicines Agency (EMA) constantly monitors reports of any side effects after a vaccine is used and publishes regular safety updates .

5. What about risks associated with AstraZeneca and Johnson and Johnson vaccines?

• Our decisions on which vaccines to use are based on science, and a rigorous scientific evaluation of risks and benefits. Safety and protection of public health come first.
• The European Medicines Agency has been very clear – the AstraZeneca and Johnson and Johnson vaccines are effective and the overall benefits in preventing COVID-19 outweigh the risks of very rare and unusual side effects.
• Moreover, this shows that our pharmacovigilance system works: suspected side effects are reported rapidly, information is shared and our experts come together swiftly to assess the way forward.

6. How effective are COVID-19 vaccines?

Effective and broad vaccination is the best strategy to overcome the pandemic.

Based on current evidence, all vaccines authorised in the EU are highly protective against hospitalisation, severe disease and death , with an effectiveness in the general population of over 80%.

Unvaccinated individuals are at a much greater risk of being hospitalised or dying compared to vaccinated individuals. The unvaccinated make up the big majority of people in the most precarious situations in hospitals.

There is a clear link between the level of vaccination and the hospitalisation and death rates: the higher the vaccination rate, the lower the risk of being hospitalised or dying.

In past pandemic waves, an increase in infections also meant a proportional increase of hospitalisations and death rates. In the current pandemic, however, this is no longer the case: increasing infections are no longer leading to a similar increase in hospitalisations and higher death rates. This is another clear sign that the vaccines do their job.

7. How many vaccines have been distributed so far?

By June 2022, more than 1.7 billion doses have been delivered to EU Member States. 86% of adult Europeans have been fully vaccinated.

8. How is vaccination organised?

The Commission has been asking national authorities to prepare as early as possible for organising the fast and accessible deployment of vaccines, according to national vaccination plans and has issued guidance on the large-scale vaccination deployment.

The Commission, Member States and the EMA are working with companies to use the EU's potential for increased vaccine manufacturing capacity to the fullest.

The Commission is following the developments of national vaccination plans very closely and provides support notably by organising joint procurement for vaccination supplies, such as syringes and needles, and running a stress test of the national vaccination plans ahead of deployment together with the ECDC.

9. Who should be vaccinated first?

All Member States have access to COVID-19 vaccines at the same time on the basis of the size of their population.

Most countries have defined priority groups and are further refining who should get priority in these priority groups e.g. older person over 80 years of age. The ECDC published an overview of where EU/EEA countries and the UK are with the development of their vaccination plans/strategies. ECDC is also working on a modelling exercise on prioritisation to support Member States.

10. Does the Commission recommend the vaccination for children?

As President von der Leyen stressed, the decision to vaccinate children is not a political decision, but an evidence-based scientific decision.

This is why it is so important to closely follow the science, and in particular the views of specialists such as EMA on safety and ECDC on the epidemiological aspects.

EMA has given its green light for the use of the BioNtech Pfizer vaccine for children over the age of 5 years. According to the agency, the use of the vaccine for children is effective and safe. Furthermore, scientific evidence demonstrates that children may also get infected and transmit the virus, and vaccination is a good way to protect children.

Ultimately, the establishment and implementation of vaccination strategies is a Member State competence, and a decision to be made by parents with their children.

On the basis of scientific evidence, and trusting the robustness of the data and assessments made by EMA and ECDC, we encourage parents to discuss the vaccination of their children with a medical specialist.

The contracts we concluded with the different vaccine developers allow us to ensure the delivery of a sufficiently high number of doses, as well as of paediatric vaccines in future agreements that take into account the need to also vaccinate children. Moreover, they also allow us to continue to fulfil our responsibilities in terms of vaccine supply to the rest of the world.

11. Are vaccines free for EU citizens?

While this is a Member State responsibility, the large majority of the Member States offer vaccinations free of charge.

12. Will citizens know which vaccine they will be getting?

When a vaccine receives conditional marketing authorisation, the package leaflet with details on the specific vaccine is translated into all languages and published in electronic form by the Commission.

All health care professionals and all patients would therefore have access to a leaflet in electronic form in their own languages.

The vaccine companies are responsible for putting in place the necessary mechanisms to ensure that each patient receives the package leaflet in print form in his/her language upon request without burdening healthcare professionals administering the vaccine.

13. Is vaccination against COVID-19 mandatory?

EU law does not require compulsory vaccination. Vaccination, mandatory or otherwise, is a Member State competence.

However, the Commission continues to call on all eligible citizens to ensure they get their full vaccination against COVID-19. Full vaccination offers the best protection against the virus and its variants, including the Delta variant, and its transmissibility.

This is especially important for the most vulnerable, and those who are at high risk of catching and transmitting the virus.

If we want to beat the variants it is absolutely crucial to proceed with vaccinations and ensure that as many as possible are fully vaccinated. Scientific studies show that full vaccination offers good protection against the variants.

14. When will vaccines allow the control of the pandemic?

According to the ECDC, the proportion of the population that should be vaccinated against COVID-19 to achieve herd immunity, and whether this can be achieved, is not yet known and will depend largely on how well the vaccines work in reducing transmission.

The rapid, full vaccination of all targeted populations - in Europe and globally - is key to controlling the impact of the pandemic.

We therefore need to continue our vaccination campaigns, especially in view of the spread of variants. Given the threat of these variants, it is important to continue ensuring the availability of sufficient vaccines, including adapted vaccines, also in the coming years.

That is why the Commission signed a new contract with BioNTech-Pfizer on 20 May 2021, which foresees the delivery of 1.8 billion doses of vaccines between the end of the year and 2023. The Commission has also exercised the option of 150 million doses of the second Moderna contract.

HERA (European Health Emergency Preparedness and Response Authority) will also work on tackling new variants, aiming to rapidly develop and produce effective vaccines against variants on a large scale.

15. Can we still spread the disease once vaccinated?

Additional evaluations will be needed to assess the effect of the vaccine in preventing asymptomatic infection, including data from clinical trials and from the vaccine's use after authorisation.

Therefore, depending on the epidemiological situation at any given point, even vaccinated people may need to wear masks, avoid indoor crowds, and respect physical distance, and so on. Other factors, including how many people get vaccinated and how the virus is spreading in communities may also prompt revision of this guidance.

16. If I have already had COVID-19 and recovered, do I still need to get the vaccine?

There is not enough information currently available to say if or for how long after infection someone is protected from getting COVID-19 again; this is called natural immunity. Early evidence suggests natural immunity from COVID-19 may not last very long, but more studies are needed to better understand this.

17. Are there enough booster shots available?

To prepare for the future, we drew the lessons from the first phase of our response to the pandemic. It is clear that to defeat the virus decisively, we have to be prepared to ensure the quick availability in sufficient quantities of booster doses as soon as boosters are recommended by the scientific community.

Based on this, we signed a new contract with BioNTech-Pfizer, which foresees the delivery of 1.8 billion doses of vaccines between the end of the year and 2023. This is the world's largest contract for COVID-19 vaccines.

For the same purpose, we have also exercised our option of 150 million doses of the second Moderna contract.

The EU has therefore secured a sufficient number of vaccine doses to launch the booster phase of the response.

Taking into account the Commission’s proposals on the validity period of certificates and the need for boosters, Member States must place their orders in time to ensure that they can administer the doses in a sequential manner, and in line with the Commission’s proposed approach.

18. How quickly can the vaccines be adapted against new variants?

To ensure more flexibility, the Commission amended the regulatory procedure to accelerate approvals, building on what already exists for influenza vaccines. For instance, data requirements are reduced and data can be complemented later. But adapted vaccines still need to meet the EMA’s data requirements as laid out in its new guidance and EMA carries out a rolling review.

• Currently, the vaccines authorised within the EU appear to provide protection against the variants that are prevalent across the EU. Continued health safety measures will also continue to be key for a foreseeable future, so is testing and contact tracing to block transmission chains.
• We also hope that newer technologies such as mRNA vaccines could make the adaptation of existing vaccines even easier.
• We believe that it should be possible to have amended vaccines developed and approved rapidly. Depending on the platform technology used, the time needed to make such changes may vary from 3-4 months up to 6-9 months.

19. How will vaccines’ safety be monitored after authorisation?

The monitoring of the safety and effectiveness of vaccines after authorisation is a requirement under EU law and a cornerstone of the EU's pharmacovigilance system relating to the detection, assessment, understanding and prevention of adverse effects or any other medicine-related problem. The system is exactly the same as for a normal market authorisation.

The safety and effectiveness of vaccines which have received conditional marketing authorisations are rigorously monitored, as for all medicines, through the EU's established medicines monitoring system.

In addition, special measures are in place to quickly collect and evaluate new information. For example, manufacturers must usually send a safety report to the European Medicines Agency every six months. For COVID-19 vaccines, safety reports must be sent every month.

The European Medicines Agency will set up additional large-scale safety monitoring given the exceptionally high numbers of people expected to receive the vaccines.

20. What labelling and packaging information will citizens and health care professionals get with the COVID-19 vaccines?

In order to allow for a rapid deployment of COVID-19 vaccines at large scale, the Commission has developed, with Member States and the European Medicines Agency, labelling and packaging flexibilities for a temporary period. Flexibility in the labelling and packaging requirements is expected to reduce transport costs and storage space, improving the distribution of the doses between Member States and limit possible impact on the production of other routine vaccines. Despite these flexibilities, anyone vaccinated and health care professionals will have access to all the information on the vaccine used.

An example of such flexibilities is the fact that the outer and immediate packaging may only be printed in English. Also, the package leaflet does not have to be included inside the package of the medicinal product, but will be provided separately by the vaccine company, who will be responsible for the distribution of the printed package leaflet locally in the national language(s).

Some Member States do not require the package leaflet to be printed in their national language(s). The leaflet may be printed in English only, but the information contained in the leaflet should still be available in the national language(s), for instance via a QR code printed in the package leaflet and also available in the EMA website in all languages.

21. How will the Commission support Member States in the rolling-out of vaccines?

The Commission stands ready to support Member States to ensure the smooth deployment of COVID-19 vaccines. A number of EU instruments in the programming period 2021-2027 can offer financial support in this regard.

For instance, investments to support health reforms and resilient, effective and accessible health systems are eligible under the Recovery and Resilience Facility (RRF), and can be included in the national Recovery and Resilience Plans. Furthermore, the Cohesion Policy funds (European Regional Development Fund - ERDF and European Social Fund Plus - ESF+) as well as the REACT-EU programme can provide financing to Member States and their regions to strengthen their health systems, both in terms of managing and recovering from the current health crisis and as well as ensuring their resilience in the longer term.

Collectively, these programmes can support a range of investment needs, for example, in health infrastructure, training of health professionals, health promotion, disease prevention, integrated care models, digital transformation of healthcare, and equipment, including critical medical products and supplies to strengthen the resilience of health systems.

In this context, investments to prepare health systems for the roll out COVID-19 vaccines are eligible under these programme, especially given the direct link to the resilience of health systems, the availability of critical medical products and disease prevention. However, it will be up to each Member State to decide on the priorities and content of their Recovery and Resilience Plan and also their Programmes for the Cohesion Policy funds.

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Vaccine negotiations

1. who carries out the negotiations with vaccine suppliers.

The Commission jointly with a Joint Negotiation Team carries out the negotiations with vaccine suppliers. The members of the Joint Negotiation Team – representing seven Member States: France, Germany, Italy, Poland, Spain, Sweden, The Netherlands - are appointed by a Steering Committee. The Steering Committee discusses and reviews all aspects of the Advanced Purchase Agreement (APA) contracts before signature. All EU Member States are represented in this Committee, which meets on a weekly basis.

2. Did all Member States agree with this approach?

All Member States have endorsed this approach, which is at the heart of the EU Vaccines Strategy. At the European Council in June 2020, the Member States of the European Union mandated the Commission to organise the joint procurement of vaccines. As a result, the European Commission has started talks with the most promising vaccine manufacturers.

3. How are Advanced Purchase Agreements negotiated?

The Negotiation Team first holds exploratory talks with the company to find out if there is sufficient common ground to proceed with detailed contractual negotiations. If that is the case, a tender invitation is sent to the company, which then has to propose an offer.

An APA is concluded when both sides have finalised the contractual work. This is discussed and agreed with the Steering Committee. The conclusion of an APA requires the approval of the Commission.

If the APA provides for an obligation for the Member States to purchase vaccine doses Member States have five working days to notify if they wish to opt out. The contract is only signed if at least four Member States are ready to be bound by it.

4. How is an APA different from a contract for deliveries?

In the negotiation process, Member States tell the Commission how much of a certain vaccine they want to order.

But they are then responsible for purchasing the vaccines when they become available, once they prove to be safe and effective. The Commission does not sign contracts for deliveries to individual countries. Advance Purchasing Agreements allow the Commission to secure a certain number of doses. It is then for Member States to purchase these doses, activate potential options included in the APA to order additional doses, and conclude specific contracts with the companies.

5. Are the contracts with the companies publicly available?

The focus for the Commission is the protection of public health and securing the best possible agreements with companies so that vaccines are affordable, safe and efficacious.

Contracts are protected for confidentiality reasons, which is warranted by the highly competitive nature of this global market. This is in order to protect sensitive negotiations as well as business related information, such as financial information and development and production plans.

Disclosing sensitive business information would also undermine the tendering process and have potentially far-reaching consequences for the ability of the Commission to carry out its tasks as set out in the legal instruments that form the basis of the negotiations. All companies require that such sensitive business information remains confidential between the signatories of the contract. The Commission therefore has to respect the contracts it concludes with the companies.

The Commission has published redacted contracts, available on the Commission website .

6. What were the criteria for deciding which vaccines should be ordered?

The production capacity and the ability to deliver on time are the main considerations. Other criteria include liability issues with respect to all contracts and prices. To decide whether an Advance Purchase Agreement should be concluded, the following non-exhaustive criteria were taken into account:

• Soundness of scientific approach and technology used
• Speed of delivery at scale, capacity, timelines for supply
• Logistical challenges, cooling chains etc.
• Coverage of different technologies in order to maximise the chances of having a successful candidate
• Global solidarity, i.e. a commitment to making future doses of vaccines available for lower and middle income countries

7. What is the price the EU Member States pay for the vaccine?

Vaccines have to be affordable. This is also part of the rationale for doing this together as a team: this reduces costs for everyone and gives us a stronger negotiating position.

When it comes to prices, all companies require that such sensitive business information remains confidential between the signatories of the contract.

The details of the contracts concluded are known to the Commission and all 27 Member States, who make the decisions for the vaccine of their choice and pay the purchase price.

Even after a contract has been concluded with the EU, the manufacturers still have an interest in marketing their vaccines on the world market in the best possible way. Therefore, there is a legitimate interest of the companies, which have made very large investments in research and in production capacity, that the terms of the contracts with the EU are not publicly available during this phase of intense global competition. Due to contractual obligation, the Commission cannot indicate at this stage the specific pricing per dose.

The Commission has mobilised funds to increase the production capacity of the suppliers that it signed APAs with. It has provided more than €2 billion from the Emergency Support Instrument. Member States have agreed to contribute an additional €750 million.

An important point and principle is that the price of the vaccine is the same for all EU Member States.

8. Who decides how many vaccines a Member State gets?

Member States indicate early on in the negotiation phase with a company if they are interested in a particular vaccine and what quantity they would want to buy.

Once the contract is concluded, the vaccines are allocated according to a distribution key, based on the size of the population. So Member States receive vaccines under the same conditions – on a pro-rata basis, at the same price.

Adjustments of quantities of vaccines between Member States are possible, according to their needs. For instance, a Member State may decide not to buy additional vaccines from the options negotiated, in which case other Member States can take over those options and buy more of that particular vaccine.

9. Who orders the vaccines?

Member States place orders with vaccine suppliers directly, indicating the timing and place of deliveries of vaccines, for instance, and specifying logistic aspects.

10. Who distributes the vaccines?

Delivery to national distribution hubs is ensured by the manufacturers. Further distribution to vaccination centres is ensured by Member States, who are also responsible for the vaccination of their population.

11. Do producers have enough capacity to manufacture the vaccines?

There is already substantial vaccine production capacity in the EU. The Commission has supported the increase in production capacity – and continues doing so.

It has frontloaded money to support the production capacities of all the vaccine suppliers it signed contracts with, allowing larger volumes of vaccines to be produced. The European Investment Bank is providing additional financial support, backed by the EU budget. This has been the case for CureVac and BioNTech, for example. 

The capacity to supply within the EU is also one of the main criteria taken into account when engaging on negotiations with companies.

Authorisation process of COVID-19 vaccines

1. how are covid-19 vaccines authorised in the eu, independent scientific safety, efficacy and quality assessment by the european medicines agency.

Any vaccine developer that wishes to put a vaccine on the market in the EU, should first request a marketing authorisation for the vaccine. The request is submitted to the European Medicines Agency (EMA), which assesses the safety, efficacy and quality of the vaccine. If the EMA gives a positive recommendation, the Commission can proceed with the authorisation of the vaccine on the EU market.

In response to public health threats such as the current pandemic, the EU has a specific regulatory tool in place to allow early availability of medicines for use in emergency situations. In such emergency situations, the Conditional Marketing Authorisation (CMA) procedure is specifically designed to enable marketing authorisations as quickly as possible, as soon as sufficient data becomes available. It provides the EU with a robust framework for accelerated approval and post-authorisation safety and safeguards and controls.

For its assessment, the EMA will undertake an independent, thorough and robust review of all the evidence submitted by the vaccine developer.  The process contains several checks and balances and is based on a system of peer reviews with many experts involved: two rapporteurs responsible for the assessment, a peer reviewer, specialised Committees and working parties (e.g. the Pharmacovigilance Risk Assessment Committee (PRAC) for safety, the Biologics Working Party for quality) and finally EMA's Committee on Human Medicines (with members from all Member States) which issues the recommendation.

The Committee on Human Medicines will only issue a positive recommendation when the evidence shows convincingly that the benefits of vaccination are greater than any risks from the vaccine.

Marketing authorisation by the European Commission

The European Commission is legally responsible for the marketing authorisation. Following a positive recommendation from the EMA's Committee for Medicinal Products for Human Use (CHMP), the Commission will verify the soundness of all elements supporting the marketing authorisation. These include scientific justifications, product information, educational material to health care professionals, labelling, obligations for the vaccine developer, conditions for use, and possible obligations for Member States.

The Commission is also responsible for ensuring that all necessary information is available to patients and health care professionals across the EU in their national language.

Before taking its decision, the Commission consults the Member States who are responsible for the marketing and use of the product in their countries (through the Comitology process – examination procedure). In case of a qualified majority of Member States in favour of the authorisation, the Commission can proceed with the adoption of its decision to authorise the marketing of the vaccine.

As a result, the vaccine may be marketed everywhere in the EU. Vaccine developers do not need to request any further authorisations in the different EU Member States.

2. What is the EU doing to accelerate the authorisation process?

The European Medicines Agency (EMA) and the Commission are making full use of the provisions under EU legislation for emergency situations to speed up the procedure for approval, whilst fully ensuring that all requirements in terms of efficacy, quality and safety of the vaccine are fully assessed.

In view of the urgency due to the COVID-19 pandemic, EMA has put in place rapid review procedures to assess applications in the shortest possible timeframes while ensuring robust scientific opinions. Key to speeding up the process are ‘rolling reviews', allowing EMA in public health emergencies to assess data for promising medicines or vaccines as they become available instead of waiting until all trials have concluded to start its work.

Through these rolling reviews, EMA can start evaluating data while the development is still ongoing, and before the vaccine developer has submitted a request for marketing authorisation. The rolling review assesses data on the vaccine's quality as well as results from laboratory studies. EMA also looks at results on the vaccine's efficacy and initial safety data emerging from large-scale clinical trial as they become available. This significantly shortens the normal assessment times while maintaining the principles of quality, safety and efficacy.

In the context of the rolling reviews, a dedicated group of experts, the COVID-19 EMA pandemic Task Force, has been established on the development, authorisation and safety monitoring of COVID-19 vaccines and is responsible for thoroughly assessing the scientific data. Hence, when a marketing authorisation is requested, the formal assessment can proceed much more quickly, as the data have already been scrutinised during the rolling review.

Moreover, EMA assesses the data with a view to issue a Conditional Marketing Authorisation (CMA). Such an authorisation ensures that the safety, efficacy and quality of the vaccine is demonstrated and that the benefits of the vaccine outweigh its risks, whilst at the same time allowing the vaccine developers to submit additional data also after the marketing authorisation (contrary to a normal marketing authorisation where all data are submitted before the authorisation is granted).

The European Commission is also ensuring that the process leading to the marketing authorisation can take place as quickly as possible by shortening administrative steps, such as the period for consulting Member States and by allowing for the translation of the product information in all official languages to take place in the first instance in electronic form to save time.

Whilst the average standard process for the authorisation of medicinal products takes 67 days, including 22 for the consultation of Member States, by making use of the provisions specifically provided for under EU legislation for emergency situations, the Commission will be able to proceed with a marketing authorisation within 3 days following a positive recommendation from EMA.

3. What are the main differences between the EU's Conditional Marketing Authorisation and the Emergency Use Authorisation issued by some other countries?

A Conditional Marketing Authorisation (CMA) follows a controlled and robust framework providing safeguards that emergency use authorisations might not. In reality, an emergency use authorisation is not an authorisation of the vaccine but an authorisation of the temporary use of the unauthorised vaccine. The CMA ensures that all pharmacovigilance, manufacturing controls including batch controls for vaccines and other post-approval obligations apply in a legally binding manner and are evaluated by EMA's scientific committees on a continuous basis and a regulatory action can be taken, if necessary. Notably:

• It ensures a rigorous monitoring, through the EU pharmacovigilance system, of the safety of the medicine across the EU. Additionally, there may be special measures to collect and evaluate all new information rapidly emerging in order to meet the specific demands of the pandemic and mass vaccination.
• It ensures post-authorisation safety monitoring and allows the collection of additional data in a structured manner. A risk management plan (RMP) is implemented by the company as agreed before authorisation, forming an enforceable feature of the authorisation.
• Rigorous manufacturing including batch release for vaccines and distribution, are subject to the same ongoing controls as for all authorised medicines. The monitoring of the manufacturing processes ensures that the medicine is manufactured and controlled according to high pharmaceutical standards in the context of large scale commercialisation.
• That the medicine's conditions for use are presented in all EU languages in electronic form in the immediate instance.
• The provision of an investigation plan for future use of the medicine in children.

These are essential elements to ensure a high level of protection for citizens during the course of a mass vaccination campaign and is a key component of EU Vaccine Strategy. All 27 EU Member States have formally signed up to the EU Vaccine Strategy proposed by the Commission in June, agreeing jointly to follow the conditional marketing authorisation procedure through the European Medicines Agency for COVID-19 vaccines. By following this route the safety, efficacy and quality of the vaccines will be thoroughly assessed and the trust of citizens will be safeguarded.

An Emergency Use Authorisation (EUA) allows for the temporary use of a medicine under specific conditions as long as emergency circumstances apply. The medicine however remains unlicensed and cannot be put on the market, contrary to a (conditional) marketing authorisation.

Whilst Emergency Use Authorisations are allowed under the EU pharmaceutical legislation, the use of a vaccine for which a Member State has issued such an authorisation is restricted to the authorising Member State only under its responsibility. Some third countries are also using similar procedures to allow the temporary emergency use of COVID-19 vaccines prior to authorisation.

4. What is the difference in liability between EU Conditional Marketing Authorisation vs Emergency Use Authorisations?

Under an EU Conditional Marketing Authorisation (CMA), liability is with the holder of the marketing authorisation. The marketing authorisation holder will be responsible for the product and its safe use.

The CMA is valid for a one-year period, on a renewable basis and contains the same rights and liability for its holder as per that of a standard marketing authorisation. In addition, the holder of a CMA has specific obligations such as to complete or conduct new studies within a defined time period in order to confirm that the benefit/risk balance remains positive.

In the case of an Emergency Use Authorisation to temporarily authorise the distribution as an unauthorised product (Art. 5(2) of Directive 2001/83), EU legislation requires Member States to remove administrative and civil liability from the manufacturer and marketing authorisation holder, when this emergency use is recommended or required by the Member State. 

5. What are the different data requirements between an Emergency Use Authorisation and a Conditional Marketing Authorisation, and what are the potential consequences of these?

In case of a Conditional Marketing Authorisation (CMA) EMA thoroughly assesses all required information to confirm that the benefits outweigh the risks of the medicine.

For instance, in addition to the data demonstrating safety and efficacy, the data submitted in a marketing authorisation application for a COVID-19 vaccine must include information on:

• the group of people to be given the vaccine;
• the vaccine's pharmaceutical quality and purity;
• manufacturing and controls of batches;
• compliance with international requirements for laboratory testing and conduct of clinical trials;
• types of immune responses;
• side effects e.g. with regard to older people, or pregnant women;
• labelling and package leaflet;
• the way risks will be managed and monitored once the vaccine is authorised.

The Conditional Marketing Authorisation procedure provides the necessary assurance to citizens that the full range of requirements are being applied as mass vaccination programmes are rolled out including independent controls performed on vaccine batches by the network of Official Medicines Control Laboratories (OMCLs) before the vaccine reaches the patient.

If a Member State grants an Emergency Use Authorisation, it decides itself which data is required for such authorisation, and which requirements it will impose for the vaccine's use and supervision.  It is therefore possible that less detailed data is required and that less strict obligations are imposed than under the Conditional Marketing Authorisation process, relating to for example:

• the manufacturing process of the vaccine;
• the good manufacturing practice (GMP) status certification of the facilities in which the vaccine is to be manufactured;
• The extent of the clinical data, including size of the safety database and efficacy clinical data analyses available.

Whilst the full use of the provisions specifically provided for under EU legislation for emergency situations speeds up the procedure for approval, the robustness of the assessment framework of a CMA and the extent of the data assessed by the EMA may result in a process that requires more time than an emergency use authorisation procedure.

6. What about the labelling? Should it not be provided in all languages?

The package leaflet for centrally authorised COVID-19 vaccines will be translated into all languages and published in electronic form by the Commission. This is one of the requirements of the Conditional Marketing Authorisation, which is a centralised procedure for the authorisation of medicinal products.

Moreover, and in order to allow for a rapid deployment of COVID-19 vaccines at large scale, the Commission has developed, with Member States and the European Medicines Agency, other labelling and packaging flexibilities. Flexibility in the labelling and packaging requirements can facilitate the rapid deployment of the vaccine by increasing production capacity, reducing transport costs and storage space, improving the distribution of the doses between Member States and limit possible impact on the production of other routine vaccines. For instance, the outer and immediate packaging may only be printed in English.

Also, the package leaflet does not have to be included inside the medicinal product carton but it may be provided separately by the vaccine company.

In addition, some Member States do not require the package leaflet to be printed in their national language(s). The leaflet may be printed in English only, but the leaflet info should still be available in the national language(s), for instance via a QR code printed in the package leaflet.

All health care professionals and all patients would therefore have access to a leaflet in their own languages. The vaccine companies have to put in place the necessary mechanisms to ensure that each patient receives the package leaflet in his/her language upon request without burdening healthcare professionals administering the vaccine.

7. What is pharmacovigilance? How will vaccines be monitored post authorisation under the Conditional Marketing Authorisation?

The monitoring of the safety and effectiveness of vaccines after authorisation is a requirement under EU law and a cornerstone of pharmacovigilance. EU law requires vaccine companies (i.e. marketing authorisation holders), national competent authorities and the EMA to follow a number of monitoring (pharmacovigilance) processes after a product has been authorised.

In addition, the European Centre for Disease Prevention and Control (ECDC) and the European Medicines Agency (EMA), in close collaboration with the Commission, Member States, European and international partners are establishing enhanced vaccine effectiveness, coverage, safety and impact monitoring activities including studies specifically for COVID-19 vaccines. These additional, independent monitoring studies are being proposed to collect and analyse vaccination data from public authorities across Member States on the effectiveness and safety of the vaccines.

These studies will help characterise the safety and efficacy of the vaccine along its life cycle. This additional data can also be used to complement regulatory actions as necessary, e.g. changes in the conditions of use, warnings and related changes to product information for health care professionals and patients.

Under the CMA process, vaccine companies are notably responsible for:

• the continued monitoring of safety of vaccines;
• reporting of serious adverse events;
• keeping the product information up to date, conducting safety and effectiveness studies;
• looking at performance of their products in the larger populations on the market and
• submitting regular safety and benefit risk reports to the EMA.

Member States are responsible for:

• supervising the collection of information on suspected side effects, in the assessment of signals, periodic safety update reports, post-authorisation safety studies and risk management plans;

EMA is responsible for:

• monitoring all reported suspected adverse reactions, new or changing safety issues. if detected, will be rapidly assessed by the Pharmacovigilance Risk Assessment Committee (PRAC) and any necessary risk minimisation action will be taken;
• providing supplemental guidance and requirements to vaccine manufacturers for drafting risk management plans of COVID-19 vaccines;
• monthly summary safety post approval reports from manufacturers (in addition to 6 monthly Periodic Safety Update Reports);
• developing and maintaining EudraVigilance, a system for managing and analysing information on suspected adverse reactions to medicines authorised in the European Economic Area (EEA). EudraVigilance is a single repository for reports of suspected adverse reactions seen in healthcare practice and clinical trials. It is used by Member states, the Agency and industry;
• analysing information and establishing studies in the general population to follow both the safety and the effectiveness of the vaccines.

Transparency and communication on this process will be key and is essential for sustaining and supporting public confidence in vaccines and vaccination.

Export transparency

1. what is the rationale for introducing a transparency and authorisation mechanism for exports of covid-19 vaccines.

The objective of a transparency and authorisation mechanism for exports of COVID-19 vaccines is to ensure timely access to COVID-19 vaccines for all EU citizens and to tackle the current lack of transparency of vaccine exports outside the EU.

The European Union has supported the rapid development and production of several vaccines against COVID-19 with a total of €2.7 billion and it is important to protect the integrity of this substantial investment from the EU budget.

The Commission is concerned by the lack of transparency around the ways some companies are operating and wants to have complete information in order to ensure they fulfil their contractual commitments.

It is not our intention to restrict exports any more than absolutely necessary, and the Union remains fully committed to international solidarity and its international obligations.

2. What is the nature of the measures the Commission has adopted?

To address this very serious and immediate public health issue, the Commission has adopted a temporary export transparency and export authorisation mechanism on the basis of Regulation 2015/479 on common rules for exports.

This is not an export ban. This measure would specifically target exports of COVID-19 vaccines covered by an Advance Purchase Agreement (APA) with the EU. These exports will be subject to an early notification and authorisation before they are effectively shipped outside the EU.

A large number of exports will be exempted from the mechanism.

3. How long will the measure be in place?

This measure was originally envisaged to last until 31 March 2021, and has been extended until 31 December 2021.

The EU will not extend it beyond that date. This means that, as of 1 January 2022, vaccine producers will no longer have to request an authorisation for the export of vaccines outside the EU.

Transparency of exports will continue to be ensured through a new monitoring mechanism that will provide the European Commission with timely, company-specific vaccine export data. The Commission will continue to monitor the ongoing epidemiological situation in order to take appropriate measures if necessary.

4. Does the Commission measure cover trade between the EU Member States?

An export authorisation foreseen in the Regulation is required for exports outside the Union market (whether or not originating in the Union).

Such authorisation shall be granted by the competent authorities of the Member State where the vaccines are manufactured and shall be issued in writing or by electronic means.

5. Which exports will be exempt?

• Exports to Republic of Albania, Andorra, Bosnia and Herzegovina, the Faeroe Islands, the Republic of Iceland, Kosovo * , the Principality of Liechtenstein, Montenegro, the Kingdom of Norway, the Republic of North Macedonia, the Republic of San Marino, Serbia, the Swiss Confederation, Vatican City State, the overseas countries,  territories listed in Annex II of the Treaty of the Functioning of the European Union, and exports to Büsingen, Heligoland, Livigno, Ceuta and Melilla, Algeria, Egypt, Jordan, Lebanon, Libya, Morocco, Palestine * , Syria, Tunisia, Armenia, Azerbaijan, Belarus, Georgia, Israel, Moldova and Ukraine.
• Exports to any of the 92 low and middle-income countries in the COVAX Advance Market Commitment list.
• Exports of COVID vaccines purchased and/or delivered through COVAX, UNICEF and PAHO with destination to any other COVAX participating country.
• Exports of purchases by EU Member States under the EU Advance Purchase Agreements and redirected to a third country as a donation or resale.
• Exports in the context of a humanitarian emergency response.
• Exports to facilities located on the continental shelf of a Member State or the exclusive economic zone declared by a Member State pursuant to the United Nations Convention on the Law of the Sea.

6. What if a third country has an APA with a manufacturer in the EU?

The Commission is mindful of APAs contracted by third countries, and will endeavour to ensure that the expectations of these countries to obtain their deliveries will be met.

We call on companies with APAs to meet their obligations to deliver on their commitments.

7. Has the Commission reacted at the request of the Member States? Did the Commission act on its own initiative?

Member States are part of the Steering Committee which discusses all decisions in the context of the negotiations with vaccine producers and their follow-up, including the possibility to include a transparency and authorisation mechanism in relation to the exports of vaccines.

8. Do Member States have a discretion under the measure adopted by the Commission? How does the system work?

Member States are required to set up export authorisation regimes.

Companies request an export authorisation in the Member State where the vaccine is manufactured.

Member States will process applications for export authorisations as soon as possible and no later than two working days after receiving all the required information.

This period may be extended by a further two working days but only under exceptional circumstances and for duly justified reasons.

In deciding whether to grant an export authorisation under this Regulation, Member States, together with the Commission, shall assess whether the volume of exports is not such that it poses a threat to the execution of the Advance Purchase Agreements the EU has concluded with vaccine manufacturers.

Upon receiving the request, Member States must immediately notify the Commission of any application and, after analysis, submit their draft decision to the Commission. If the Commission would disagree with this draft decision, it shall issue an opinion and the Member State shall decide on the request for authorisation in accordance with the Commission's opinion.

In order to allow the relevant authorities to assess the request for export authorisation, vaccine producers subject to this Regulation are requested to provide relevant data on their exports since 29 October 2020 together with their first request for export. They should also provide the number of vaccine doses they distributed in the Union since 1 December 2020 broken down by Member States.

Even after authorising an export, the competent Member State authorities can verify the information submitted by the exporter.

9. What if a company refuses to provide the retroactive data?

The absence of such information may lead to export authorisations being refused.

10. Will there be a publication of the actions? Who will publish these and where?

The Commission will regularly report on the authorisations granted and refused.

11. What type of proposal is the export authorisation scheme?

It's an implementing act.

12. Is the regulation compatible with WTO and G20 commitments?

It is in line with all of the EU's international obligations and commitments.

The EU strongly supports the principle that any measures deemed necessary to prevent or relieve critical shortages are implemented in a manner that is targeted, transparent, proportionate, temporary and consistent with WTO obligations.

The measure is also fully in line with what the EU has proposed in the context of the WTO trade and health initiative as it gives particular consideration to the interest of the least developed and developing countries with scarce manufacturing capacities and which are highly dependent on imports. The scheme also ensures that the operation of the COVAX facility is not impeded.

The EU will ensure transparency about this measure towards its trading partners at the WTO.

*This designation is without prejudice to positions on status, and is in line with UNSCR 1244/1999 and the ICJ Opinion on the Kosovo declaration of independence.

Q&A on HERA (European Health Emergency preparedness and Response Authority)

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Will I Need a Booster Shot to Travel? These Countries Require It for Entry

Countries around the world are requiring tourists to have received a booster shot against COVID-19.

As testing and being vaccinated against COVID-19 has become the norm in preparing for travel these days, receiving a booster shot is increasingly becoming a new requirement before take off. In fact, several countries — and even cruise lines — have started requiring travelers to have a booster dose of a COVID-19 vaccine for entry.

"The booster shots have definitely been really helpful to reduce the risks of serious disease so it makes good sense to require it," Dr. Gigi Gronvall, a senior scholar at Johns Hopkins Center for Health Security, told Travel + Leisure . "There's no magic solution here, but if you do get exposed, infected, your course of illness will be shorter."

The Centers for Disease Control and Prevention recommends people 12 and older get a booster dose of the coronavirus vaccine at least five months after completing their primary COVID-19 vaccination series, or two months after receiving a Johnson & Johnson shot. The agency considers people "up to date" on their shots "until the time they are eligible for a booster."

"We continue to learn about this virus and what's needed to protect against it," Gronvall added.

Last year, the European Commission adopted rules for travel within the EU, determining its Digital COVID Certificate would be valid for 270 days (about 9 months) after the final shot of someone's initial vaccine series. Following that, travelers will have to get a booster shot. While currently, Americans who were vaccinated in the United States are not eligible to obtain an EU Digital COVID Certificate, several countries have started requiring the booster shot using the 270-day metric.

These are the countries and destinations that welcome American travelers and have implemented booster requirements — for either entry or easier entry — and what to know before going.

Rules on boosters: Austria requires travelers have their COVID-19 booster shot if 270 days have passed since their last vaccine. Travelers who have their booster shot are also exempt from a pre-arrival PCR test. Travelers who have not received a booster shot must show proof of a negative PCR test taken within 72 hours.

What else is needed to enter: Alternatively, Austria allows travelers who show proof they contracted COVID-19 and recovered to enter the country with a PCR test. Travelers who are fully vaccinated and show proof of recovery are exempt from the PCR test. Children under 12 are also exempt from showing proof of vaccination or a negative test if they are accompanied by a fully vaccinated or recovered adult.

Proof of vaccination or recovery is required in Austria to visit hotels, restaurants, cultural institutions, ride ski lifts, and more.

Rules on boosters: Croatia requires a booster dose for anyone who received their initial vaccine shots more than 270 days ago. Unvaccinated travelers can also enter by showing proof of a negative PCR test taken within 72 hours of arrival, proof of a negative rapid antigen test taken within 24 hours of arrival, or proof they contracted COVID-19 and recovered within the past 180 days.

What else is needed to enter: All tourists must show a certificate of reservation or paid accommodation while in Croatia.

Rules on boosters: All travelers 18 and older who have been vaccinated for more than 9 months will need a booster shot to enter.

What else is needed to enter: Travelers also need to show proof of a negative PCR or antigen test taken within 48 hours of their departure. Visitors will also need to download a digital certificate to enter places like restaurants and cafes as well as travel on long-distance trains.

Rules on boosters : Greece does not require American travelers to be boosted to enter the country, but does require proof of vaccination to access places like indoor restaurants. For this purpose, a vaccine is valid for 7 months and travelers must receive a booster to remain valid after that time period.

What else is needed to enter : All U.S. travelers must arrive with proof of a negative COVID-19 PCR test taken within 72 hours of their arrival or a negative rapid antigen test taken within 24 hours of their arrival.

Rules on boosters : Iceland welcomes vaccinated travelers without restrictions, but requires them to be boosted if it has been more than 270 days since the final shot of their initial vaccination series.

What else is needed to enter : Travelers must show proof of a negative COVID-19 PCR or antigen test taken within 72 hours of their departure for Iceland. Travelers who have contracted COVID-19 and recovered within the past 180 days are exempt from the pre-arrival test.

Rules on boosters: Israel requires travelers to have recieved a booster shot if 180 days have passed since their initial vaccine series. Travelers must also be fully vaccinated with two doses of the Pfizer or Moderna vaccine or one dose of the Johnson & Johnson vaccine within six months of travel. Israel was one of the first countries to implement a booster requirement.

What else is needed to enter: All vaccinated international tourists must also show proof of a COVID-19 PCR test taken within 72 hours or a rapid antigen test taken within 24 hours before their flight, and get tested with another PCR test upon arrival.

Netherlands

Rules on boosters: The Netherlands requires a booster dose for vaccinated travelers who received the final dose of their initial vaccine series more than 270 days before their trip. Travelers who received a booster dose at least seven days before their trip are not required to self-quarantine upon arrival.

What else is needed to enter: Travelers must also show proof of a negative COVID-19 PCR test taken within 48 hours of their departure or a negative antigen test taken within 24 hours of their departure.

Rules on boosters: To enter the country, Spain requires international travelers from the U.S. to show proof they are vaccinated and have received a booster dose if more than 270 days have passed since the final dose of their initial vaccine series.

What else is needed to enter: Travelers must also fill out a Spain Health Control form, which can be obtained through the Spain Travel Health portal or through apps on Androidor iOS devices.

Switzerland

Rules on boosters : American travelers can enter Switzerland if they have been fully vaccinated within the past 270 days. If it has been more than 270 days since the final dose of their initial vaccination series, they must be boosted.

What else is needed to enter : Vaccinated travelers have to fill out an entry form, but are exempt from pre-arrival testing.

Alison Fox is a contributing writer for Travel + Leisure. When she's not in New York City, she likes to spend her time at the beach or exploring new destinations and hopes to visit every country in the world. Follow her adventures on Instagram .

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Think Travel Vaccine Guide

As a health care provider, be sure to prepare your globe-trotting patients for travel by providing a quick pretravel risk assessment, consultation, and care. THINK TRAVEL:

• Ask your patients if they plan on any international travel .
• Make sure they are up- to- date on all routine vaccines before their trip.
• Hepatitis A
• Hepatitis B
• Yellow fever
• Japanese encephalitis
• Meningococcal diseases

For destination-specific vaccine recommendations, search CDC’s Destination pages.

Think about...

*Travelers may also need routine (non-travel) vaccines or boosters before travel including influenza; measles, mumps, and rubella (MMR); tetanus (Td or Tdap); varicella; pneumococcus; and polio. Check CDC’s Destination Pages for country-specific vaccine recommendations.

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European vaccine requirements and recommendations for travellers

This website does not belong to, nor is it affiliated with, the EU. The official website of the European Union is europa.eu.

• You are advised to get some vaccinations before travelling to countries in the EU
• COVID-19 vaccination is no longer mandatory for Europe, but it remains recommended

Health and safety is top priority when travelling overseas. Although European countries are considered safe destinations, there are some preventative measures visitors can take to promote well-being.

This article explains:

• Recommended vaccines to travel to EU destinations
• COVID-19 vaccine information for travelling to Europe
• Other health advice for your trip to Europe

You should consider speaking with a medical professional before your trip to Europe. They may have specific recommendations depending on your health circumstances.

Recommended vaccines for travelling to the EU

As mentioned above, there are no mandatory vaccinations for Europe. However, visitors may take into consideration the following recommendations.

Vaccines recommended for all travellers to Europe

You can use your trip to Europe as an opportunity to get up-to-date with routine vaccinations .

According to the US Centers for Disease Control and Prevention CDC), routine vaccinations trips to Spain, France, and other European countries include:

• Diphtheria-Tetanus-Pertussis
• Seasonal flu
• Measles-Mumps-Rubella

Being up-to-date with primary and booster doses of these vaccines is recommended for all travellers, regardless of health situation and travel plans.

European vaccines that depend on travel plans and health condition

A medical professional may recommend that travellers get vaccinated against Hepatitis A and/or Hepatitis B before travelling to Europe.

Hepatitis A

• How is it spread?

Hepatitis A is spread through consuming contaminated food or water

• Should I get vaccinated?

Recommended if you are visiting rural areas or planning to eat street food. Risk is highest where sanitation is poor.

• Other considerations

If you have a medical condition which increases your chances of disease, consider getting this vaccine for Europe. Men who have sex with men and people who inject drugs are also at higher risk.

Hepatitis B

Hepatitis B is spread through infected blood, contaminated needles, and sexual intercourse.

If you are staying in Europe for a long period or visiting frequently, this is recommended. It is also an advisable vaccine for children who are more prone to cuts.

The risk of contracting this disease is highest for people who have an underlying medical condition, people who change sexual partners often, men who have sex with men, and people who inject drugs.

Do I need a COVID-19 vaccine to travel to Europe?

COVID-19 vaccines are no longer mandatory to travel to countries in the EU. You will not be asked to present proof of your vaccination status.

Nevertheless, travellers are advised to get vaccinated against COVID-19 before any overseas trips, including to Europe.

Other health recommendations for your trip to Europe

Aside from EU travel vaccines, there are some other things to take into consideration when preparing for your trip:

• Travel insurance : comprehensive travel insurance covering healthcare in Europe is highly recommended for all travellers and obligatory for Schengen visa applicants .
• Medication : if you are travelling to Europe with medication, check whether there are any restrictions for your destination
• Avoid travel if unwell : postpone travel plans if you feel unwell in the days leading up to your trip

If you do need medical treatment whilst travelling in Europe, care is of a high standard . Locate your nearest hospital or medical centre when you arrive in case of an emergency.

Most travellers enjoy a safe stay in Europe. By following vaccination recommendations and speaking to a healthcare professional, you can further increase your chances of good health throughout your trip.

Search Smartraveller

Proof of vaccination while travelling.

Last updated: 16/02/2022

Proving your vaccination status has become another item to tick off on your checklist when planning an overseas trip.

Many countries have eased border entry rules for travellers who can prove they’re fully vaccinated.  For this critical purpose, international vaccination certificates issued by countries around the world, including Australia’s International COVID-19 Vaccination Certificate (ICVC), are widely accepted. All you need to do is make sure you meet your destination’s definition of fully vaccinated, as this may differ from Australia’s definition.

So your ICVC will allow you to leave Australia and enter your destination. But beyond the border is where things can get a little more complicated.

Some countries need proof of vaccination as a condition for using services such as public transport. They may also need it for entering restaurants, shops, theatres and other venues. This is often done through ‘vaccine passports’, which are issued by local authorities and linked to local smartphone apps, similar to Australia’s domestic COVID-19 Digital Certificate and state check-in systems.

These systems have generally been designed for local residents, not international travellers. If you’re just visiting a country for a short stay, you may not be able to get a local vaccine passport.  And the local smartphone app might not be able to read the vaccination certificate you brought from Australia.

Australians are not alone in this. Apps used in Europe aren’t configured to read digital certificates from North America, and vice versa. The same applies to most certificates from Asian countries.

Governments around the world are working hard to iron out these issues. Some have already put workable digital solutions in place. But it will be some time yet before we’re moving around overseas countries as smoothly and conveniently as before the pandemic.

Vaccine passports aren’t an issue everywhere. In many countries, it’s enough just to show a printout of an Australian ICVC. In some countries, you only need to prove your vaccination status at large events. And many countries don’t require vaccine passports at all.

But rules can change quickly. It’s important to know the requirements of your destination and keep up to date so you don’t get caught out.

Travel to Europe

European countries have relatively widespread vaccination checks. 

The local vaccine passport is the European Union’s Digital COVID Certificate (DCC), also known as a ‘Green Pass’.

EU apps that scan and verify DCCs haven’t been configured to read other certificates. Travellers with vaccination certificates from Australia, the United States, Canada, Japan, China, India, Brazil and other locations can sometimes face difficulties. Australia is working with other countries to encourage the European Commission to address this.

In the meantime, individual European countries are taking steps to minimise inconvenience to travellers. Some will recognise a print-out of an Australian ICVC. Others will let you use your ICVC to apply for a local vaccine certificate, which may be recognised in other EU countries. Before travelling to any EU country, make sure to check what it will accept before you leave Australia.

Our embassies continue to advocate to streamline processes further with other governments, wherever travellers face difficulty accessing domestic services and venues. But understanding what the requirements of each country are before you travel there is the best way to avoid unexpected problems.

Before you travel It’s your responsibility to know all the rules and requirements for Australia and all your destinations before you travel.  Stay up to date with all of the latest proof of vaccination requirements by reading the travel advice for your destination and transit locations . Understand what your destination means by “fully vaccinated”. Contact the nearest Embassy or Consulate of the countries you plan to visit, to confirm what proof of vaccination is required. Check whether your airline has COVID-19 vaccination or testing requirements. Read our step-by-step guide to travel during COVID-19 to find out what else you need to think about before you plan your trip.  

• About the Handbook

Vaccination for international travellers

Ensure that travellers are up to date with routine vaccines. Also consider other vaccines based on travel itinerary, activities and risk of disease exposure.

Recently added

This page was added on  09 June 2018 .

Updates made

This page was updated on 16 August 2024 .  View history of updates

Millions of Australians travel overseas every year. More than half of these trips are to destinations other than New Zealand, North America and Europe. 1

This page helps with making decisions about travel vaccines. Also check the disease-specific chapters in this Handbook for details about specific vaccines.

See also Infographic. Vaccination for international travellers .

Health risks of overseas travel

Health risks associated with international travel include exposure to:

• infective agents
• altitude and temperature extremes
• other physical, psychological and environmental hazards
• poor-quality or limited access to clean water, shelter, hygiene and sanitation facilities, and health and medical care

The level of health risks depends on factors such as:

• the traveller’s underlying physical and mental health and physiological state
• the itinerary and activities undertaken
• the duration of exposure to various hazards during travel

Travellers at increased risk of serious travel-associated infections include:

• young children and infants
• pregnant women
• people with underlying medical conditions, especially immunocompromising conditions due to disease or medical treatment
• people spending extended periods in multiple regions with poor resources or in remote areas
• people participating in events where large numbers of people will gather, such as major sporting, cultural, social or religious events
• migrant families travelling back to their region of origin to visit friends and relatives

Those travelling to visit friends and relatives are more likely to: 2

• have closer contact with local populations
• stay in remote or rural areas
• consume higher-risk food and beverages

Those travelling to visit friends and relatives are less likely to: 2,3

• recognise the health risks associated with travelling
• seek pre-travel health advice
• obtain the recommended vaccines or prophylaxis

Common infections acquired by travellers

Exposure to infectious diseases is one of the many health hazards of international travel. Some of these diseases are vaccine preventable. Although some of these diseases are present in Australia, the risk of acquiring them overseas may be higher because of:

• higher disease incidence in other countries
• increased risk of exposure from participating in certain activities while travelling

Foodborne and waterborne infections

It is common for travellers to ingest contaminated food or beverages, resulting in an illness. 4-6  Practicing safe eating and drinking habits is essential to minimise the risk of contracting food and waterborne diseases while travelling. These include treating water or only drinking bottled water, avoiding undercooked meat, and avoiding raw fruit and vegetables (unless they can be peeled or washed in safe water prior to eating). Most infections are diarrhoeal diseases due to enteric pathogens, but some are due to extra-intestinal microorganisms, such as hepatitis A virus and Salmonella enterica serotype Typhi (causing typhoid).

Vaccines are available against hepatitis A, typhoid and cholera.

Vector-borne infections

Insect-borne — especially mosquito-borne — infections, such as malaria and dengue, are important causes of fever in Australian travellers returning from endemic areas, particularly Southeast Asia and Oceania. 4,6

A dengue vaccine (Dengvaxia) is available for the prevention of secondary dengue infections (not primary prevention of initial dengue infection ) in select individuals. See Clinical advice: ATAGI statement on use of Dengvaxia® for Australians .

Japanese encephalitis occurs throughout much of Asia and the Western Pacific region, including eastern Indonesia and Papua New Guinea. 7 Yellow fever occurs only in parts of Africa and South America, 8 and tick-borne encephalitis occurs in parts of Europe and Asia. 9

Vaccines are available against Japanese encephalitis , yellow fever and tick-borne encephalitis .

Some other vector-borne diseases and parasitic (including protozoal and helminthic) diseases are also important for international travellers. Some are preventable through appropriate barrier precautions and chemoprophylaxis (for example, malaria). 9

Aerosol-borne infections

Vaccine-preventable infections transmitted by aerosols and/or droplets include: 9

• influenza (the most common vaccine-preventable infection among travellers) 10
• meningococcal disease
• varicella (chickenpox)

The incidence of measles and mumps is higher in many overseas countries, including some developed countries, than in Australia.

Tuberculosis is a rare infection in travellers. 11 Expatriates who live in endemic areas for a long time are more likely to acquire tuberculosis than short-term visitors. 12

Vaccines are available against all of these diseases.

Bloodborne and sexually transmitted infections

Some Australian travellers may be at risk from bloodborne and sexually transmissible infections, such as chlamydia, gonorrhoea, hepatitis B, hepatitis C, HIV and mpox (monkeypox). In some areas, healthcare workers using non-sterile medical equipment or other poor infection control practices may transmit these viruses and other bloodborne agents.

Vaccines are available against hepatitis B and mpox.

Exotic infectious agents

Travellers may be exposed to a variety of other exotic infections, such as:

• rabies from bites or scratches from rabid dogs, bats and other mammals in many countries
• schistosomiasis from exposure to water infested with the parasites, especially in Africa
• leptospirosis through activities such as rafting or wading in contaminated streams

Of these diseases, vaccines are available only against rabies.

Recommending travel vaccines

Although recommending appropriate vaccines is important, it is not the only part of a pre-travel medical consultation. Travel vaccines — those relevant for travelling — include all relevant vaccines, not just the ones that prevent diseases that most commonly occur overseas.

Do not recommend a vaccine based only on the destination country, because there is no single ‘correct’ list of vaccines for travel to any particular country.

There are 3 categories of travel vaccines:

• routinely recommended vaccines (not specific to travelling overseas)
• selected vaccines based on travel itinerary, activities and likely risk of disease exposure
• vaccines required by the International Health Regulations 2005 (IHR) or for entry into specific countries

Questions for a pre-travel medical consultation

During a pre-travel medical consultation, ask questions about the traveller’s:

• personal information, including age and whether they are pregnant or planning pregnancy
• underlying medical conditions, particularly immunocompromising conditions, and current medicines
• vaccination history (including adverse events following immunisation) and allergy history
• purpose of travel and intended activities, especially those associated with various environmental risks and hazards
• plans for travel insurance

Also ask about their itinerary in detail, including:

• date of departure and time available for vaccinations
• specific localities and routes
• rural versus urban stay
• duration of stay
• likely access to health care and other services
• likelihood of changing the planned itinerary

This information helps to tailor recommendations about preventive vaccination or chemoprophylaxis for exposure risks during the proposed trip. It also allows the clinician to advise about other appropriate preventive health measures (for example, food and water precautions, avoiding bites from mosquitoes or other arthropods) and about managing possible health conditions during travel.

Organisational requirements for vaccination

Some overseas organisations, such as schools, colleges and universities, require evidence of vaccination or immunity against some vaccine-preventable diseases, such as measles and meningococcal disease. Consider these requirements when planning and scheduling vaccines before departure.

Routinely recommended vaccines (not specific to travelling overseas)

Vaccinate all prospective travellers according to the recommended vaccination schedule appropriate for their age, underlying health conditions, occupation and lifestyle. Vaccines might include, for example, pneumococcal polysaccharide vaccine for an older person, or hepatitis B vaccine for a first aid officer. 

Also ensure that all children are vaccinated according to the National Immunisation Program schedule. In exceptional circumstances, give the National Immunisation Program vaccines at the minimum age rather than the recommended age (see Table. Minimum acceptable age for the 1st dose of scheduled vaccines in infants in special circumstances ). Children vaccinated using the minimum age rather than the recommended age may need extra vaccine doses to ensure adequate protection. Observe the minimum interval requirements between doses (see Table. Minimum acceptable dose intervals for children <10 years of age ). The chances of being exposed to some diseases, such as measles and mumps, may be greater during overseas travel, even to other developed countries.

For some itineraries, it may be appropriate for the traveller to receive some booster doses earlier than the routine recommended time. An example may be diphtheria-tetanus booster.

Diphtheria, tetanus and pertussis

Vaccinate adult travellers against tetanus before departure, particularly if:

• their risk of sustaining a tetanus-prone wound is high
• there could be delays in accessing health services where they can receive tetanus toxoid boosters safely, if required

Offer dTpa vaccine during a pre-travel consultation if the traveller has never received a dose of dTpa . This provides protection against pertussis (see Pertussis ). 

For high-risk travel, consider giving a booster dose of either dTpa or dT vaccine if more than 5 years have passed (see Tetanus ).

Hepatitis B

Most Australian children born since 2000 have been vaccinated against hepatitis B under the National Immunisation Program or state and territory school-based vaccination programs.

Hepatitis B vaccine is recommended for long-term or frequent travellers to regions of intermediate or high endemicity of hepatitis B, including:

• Central and South America

This is because travellers may be exposed to hepatitis B virus through bloodborne routes (including during emergency medical or dental procedures) or sexual routes. According to 1 survey, about half of Australian travellers who spent at least 3 nights in Southeast or East Asia participated in at least 1 activity that had a risk of hepatitis B transmission. 13

See also Hepatitis B .

Influenza, pneumococcal disease, and respiratory syncytial virus (RSV)

Older travellers and those with any relevant underlying medical or behavioural risk factors should receive pneumococcal vaccine. See Pneumococcal disease for more details.

Older travellers and those with medical risk factors for severe RSV disease should receive RSV vaccine.

See also RSV for more details.

Consider influenza vaccine for all travellers, especially if they are travelling to a region during its influenza season. Influenza vaccine is particularly relevant if:

• there is an influenza epidemic at the traveller’s destination
• the person is travelling in a large tourist group, especially one that includes older people
• the person is travelling on cruises, where people are relatively confined for days to weeks

See also Influenza for more details. 

Measles, mumps and rubella

Inadequately vaccinated young adult travellers are responsible for most current measles outbreaks in Australia. This occurs when they acquire the infection overseas and bring it back to Australia. Some countries, regions or communities — including developed countries — have a higher incidence of measles and mumps than Australia. 9

Australians born during or since 1966 who have not received the recommended 2 doses of MMR (measles-mumps-rubella)–containing vaccines are recommended to receive MMR vaccine before travelling. This also applies to infants 6–12 months old travelling to areas with measles outbreaks or where measles is endemic . The exception is for pregnant women, because MMR is a live vaccine and is contraindicated in pregnancy. 

People born before 1966 do not need to receive measles-containing vaccine (unless serological evidence indicates that they are not immune). This is because circulating measles virus and disease were prevalent before 1966, so most people would have acquired immunity from natural infection .

However, confirmed cases of measles have occurred in people born before 1966. 14 If in doubt about a person’s immunity, it may be faster and easier to vaccinate the person than conduct serological testing . See Serological testing for immunity to measles . 

See also Measles . 

Unvaccinated travellers are recommended to receive varicella vaccine if they either:

• have not had clinical disease, or
• have an uncertain history of clinical disease and serology shows a lack of immunity 

The exception is for pregnant women, because varicella vaccine is a live vaccine and is contraindicated in pregnancy.

See also Varicella .

Meningococcal disease

Vaccination against meningococcal serogroups A, C, W-135, Y and B is recommended for certain age and population groups who are at increased risk of meningococcal disease.

In addition, MenACWY (quadrivalent meningococcal) vaccine is recommended for people who are:

• planning travel to, or living in, parts of the world where epidemics of serogroup A, C, W-135 or Y meningococcal disease occur, particularly the ‘meningitis belt’ of sub-Saharan Africa 15
• planning travel to mass gatherings, such as pilgrims travelling to the Hajj in Saudi Arabia

Seek up-to-date epidemiological information to determine whether a traveller needs meningococcal vaccination. See Accessing up-to-date travel information.

The Saudi Arabian authorities require that all pilgrims travelling to Mecca (for the Hajj or Umra) have evidence of recent vaccination with the quadrivalent meningococcal vaccine. 16  See Requirements for travellers to Mecca and Accessing up-to-date travel information .

See also Meningococcal disease .

Poliomyelitis

Ensure that all travellers are age-appropriately vaccinated against polio (see Poliomyelitis ).

If the person is travelling to a country where wild poliovirus is still circulating, they should receive inactivated poliovirus ( IPV ) vaccine if they have not completed a 3-dose primary course of any polio vaccine. Travellers who have completed the primary course should receive a single booster dose.

The World Health Organization (WHO) Global Polio Eradication Initiative website website has an up-to-date list of polio-affected countries.

Documented evidence of polio vaccination is not routinely required for travellers under the International Health Regulations. However, documented evidence of vaccination may be temporarily required according to WHO recommendations in response to new evidence of the spread of wild poliovirus (see Vaccines required by the International Health Regulations or for entry into specific countries and Documentation and certificates ).

International polio epidemiology and associated travel requirements can change. Check the Australian Government Department of Health website for current recommendations for Australian travellers .

Ensure that all travellers are age-appropriately vaccinated against COVID-19. Foreign governments may require evidence of COVID-19 vaccination before a traveller is allowed to enter. The Australian-issued International COVID-19 Vaccination Certificate is a secure way to prove COVID-19 vaccination history that has been developed to meet agreed international travel standards. Parents and carers of children <14 years of age, adolescents ≥14 years of age and adults can get a copy of their COVID-19 vaccination certificate at any time:

• using their Medicare online account through myGov
• through the Medicare Express Plus mobile app
• by calling 1800 653 809 (free call)

See also COVID-19 .

Vaccines based on travel itinerary, activities and likely risk of disease exposure

Use a risk assessment approach when recommending travel vaccines. Weigh the potential risks of disease exposure and protective benefits from vaccination against potential adverse effects, and the non-financial and financial costs of vaccination.

Prioritise vaccines for diseases that are:

• common and of significant impact, such as influenza and hepatitis A
• less common, but have severe potential adverse outcomes, such as Japanese encephalitis and rabies

Consider booster doses, where appropriate (see disease-specific chapters in this Handbook for recommendations). If the person is departing for travel soon, consider an accelerated schedule, if appropriate, such as for hepatitis B vaccine or the combination hepatitis A-hepatitis B vaccine (see Hepatitis A and Hepatitis B ). Although immunity may be established sooner with the accelerated schedule, people who receive an accelerated schedule need another dose about a year later to complete the course and ensure long-term protection.

Most travellers do not need cholera vaccine. 16,17  The risk of a traveller acquiring cholera is very low if they avoid contaminated food and water.

No country requires travellers to have certification of cholera vaccination. No country has official entry requirements for cholera vaccination

See also Cholera .

Hepatitis A

Hepatitis A vaccine is recommended for all travellers ≥1 year of age travelling to moderately or highly endemic countries (including all developing countries). The exceptions are people who have evidence of natural immunity after previous infection .

Normal human immunoglobulin is no longer used to protect travellers against hepatitis A.

See also Hepatitis A .

Japanese encephalitis

While now considered an emerging disease in Australia, Japanese Encephalitis is more likely in travellers to endemic regions overseas. 18 Japanese encephalitis ( JE ) vaccine is recommended for travellers spending a month or more in endemic areas in Asia, Papua New Guinea or the outer islands of Torres Strait during the JE virus transmission season.

Consider JE vaccination for shorter-term travellers, particularly if:

• travel is during the wet season 
• travel may be repeated
• the person will spend a lot of time outdoors 
• the person’s accommodation has no air-conditioning, screens or bed nets

Check a reputable source before travel for information about JE virus activity — for example, Health Information for International Travel (the ‘Yellow Book’) . 19

A traveller’s overall risk of acquiring JE in these JE - endemic countries is likely to be low (<1 case per 1 million travellers). Determine the specific risk according to the: 17

• season of travel
• regions visited 
• duration of travel
• extent of outdoor activity
• extent to which the person avoids mosquito bites 

See also Japanese encephalitis .

Before travel to rabies- endemic regions, advise people about:

• the risk of rabies infection
• avoiding close contact with wild, stray and domestic animals — especially dogs, cats, monkeys and bats 
• the importance of appropriate immediate wound care of all animal bites and scratches 

See also Rabies and other lyssaviruses, including Australian bat lyssavirus .

Recommendations for rabies vaccination as pre-exposure prophylaxis

When deciding whether to give a pre-travel prophylactic rabies vaccination, assess the:

• likelihood of exposure to potentially rabid animals
• access to appropriate health care and availability of post-exposure prophylaxis , including rabies immunoglobulin , should there be an at-risk exposure
• timeliness of access to health care after exposure

Use a lower threshold for recommending rabies pre-exposure prophylaxis for children travelling to endemic areas.

Benefits of vaccination as pre-exposure prophylaxis

Pre-travel rabies vaccination:

• ensures that the traveller has received a safe and efficacious vaccine
• simplifies the management of a subsequent exposure because the person will need fewer doses of vaccine
• means that rabies immunoglobulin — which is often extremely expensive, and difficult or even impossible to obtain in many developing countries — is not needed
• reduces the urgency of post-exposure prophylaxis

Mpox is a viral zoonotic illness caused by monkeypox virus . Previously, mpox was endemic to rainforest areas of Central and West Africa. Since 2022, there has been a multi-country outbreak in regions that are not endemic for mpox, including Australia. Mpox is often transmitted through close, sustained physical contact, with cases in the global outbreak primarily involving sexual contact.

Vaccination is recommended only for specific population groups at risk of exposure (See Mpox ). If travellers are eligible for mpox vaccination, they should receive two doses of mpox MVA-BN vaccine (JYNNEOS) before travel. 

Tick-borne encephalitis

Tick-borne encephalitis (TBE) is caused by a tick-borne RNA flavivirus. The disease may involve the central nervous system. TBE is prevalent in parts of central and northern European temperate regions, and across northern Asia. Travellers are at risk when hiking or camping in forested areas in endemic regions during the summer months.

Safe and effective vaccines are available. Vaccination is recommended only for people with a high risk of exposure.

TBE vaccine is not registered in Australia, but a small stock of vaccine may be available for use under the Special Access Scheme .

Tuberculosis

Vaccination with BCG (bacille Calmette–Guérin) vaccine is generally recommended for tuberculin-negative children <5 years of age who will be staying in high-risk countries for an extended period (3 months or longer).

Vaccinating older children and adults appears to be less beneficial. However, consider vaccinating tuberculin-negative children aged ≥5 years but <16 years who may be living or travelling for long periods in high-risk countries.

A high-risk country is one that has a tuberculosis incidence of >40 per 100,000 population.

For travellers who need BCG vaccine, consider the following precautions when scheduling their vaccination visits:

• If possible, give BCG vaccine at least 3 months before the person will arrive in an endemic area.
• Give other live viral vaccines (for example, MMR , varicella, yellow fever) at the same time or with a minimum 4-week interval after BCG vaccination.
• A tuberculin skin test (TST; Mantoux), performed by trained and accredited healthcare practitioners, is recommended before receiving BCG vaccine for all individuals (except infants aged <6 months).
• People may suppress reactions to tuberculin for 4–6 weeks after viral infections or live viral vaccines, particularly measles infection and measles-containing vaccines.

State and territory tuberculosis services can provide tuberculin skin tests and BCG vaccine.

See also Tuberculosis .

Typhoid vaccine may be recommended for travellers ≥2 years of age travelling to endemic regions, including: 

• the Indian subcontinent
• most Southeast Asian countries 
• several South Pacific nations, including Papua New Guinea 

This advice is also relevant for those travelling to endemic regions to visit friends and relatives.

Inactivated parenteral and live oral typhoid vaccine formulations are available.

See also Typhoid fever .

Yellow fever

Yellow fever vaccine is recommended for all people ≥9 months of age travelling to, or living in, an area with a risk of yellow fever virus transmission. 20

To minimise the risk of introducing yellow fever, some countries require documented evidence of yellow fever vaccination for entry, in line with the International Health Regulations (see Vaccines required by the International Health Regulations or for entry into specific countries ).

When assessing the need for yellow fever vaccination, consider:

• the risk of the person being infected with yellow fever virus
• country entry requirements
• individual factors such as age, pregnancy and underlying medical conditions 

Vaccination is generally not recommended for travel to areas with a low probability of yellow fever virus exposure — that is: 

• where human yellow fever cases have never been reported 
• where evidence suggests only low levels of yellow fever virus transmission in the past 

However, consider vaccination for a small subset of travellers to lower-risk areas who are at increased risk of exposure to mosquitoes or who are unable to avoid mosquito bites. 20

People aged ≥60 years are at increased risk of severe adverse events after primary yellow fever vaccination. Weigh the adverse effects of vaccinating people in this age group against the potential for yellow fever virus exposure and, in turn, the benefits of vaccination. 17

See also Yellow fever .

Booster doses

Most people do not need a booster dose of yellow fever vaccine. A single dose induces protective antibody levels that last for many decades. However, certain people are recommended to receive a booster if their last dose was more than 10 years ago and they are at ongoing risk of yellow fever virus infection . See Yellow fever .

Vaccines required by the International Health Regulations or for entry into specific countries

Yellow fever requirements.

The International Health Regulations require yellow fever vaccination for travelling in certain circumstances. This is to:

• protect travellers who are likely to be exposed to yellow fever 
• stop importation of the virus into countries that have the relevant vectors (see Yellow fever ).

Some countries may require documented evidence of yellow fever vaccination as a condition of entry or exit (see Planning and documenting vaccines ). This includes countries that do not currently have yellow fever circulating.

Australia’s yellow fever travel requirements are detailed in the Australian Government Department of Health’s yellow fever fact sheet .

Contact the relevant embassies or consulates in Australia to confirm the entry requirements for yellow fever vaccination for the countries a traveller intends to enter or transit through. 

Requirements for travellers to Mecca

Each year, Saudi Arabia’s Ministry of Health publishes the requirements and recommendations for entry visas for travellers on pilgrimage to Mecca (Hajj and Umra). 16

For pilgrims travelling directly from Australia, only evidence of MenACWY vaccination is currently mandatory. However, check the current requirements when advising prospective Hajj and Umra pilgrims (see Meningococcal disease and Accessing up-to-date travel information ).

Temporary requirements

The International Health Regulations may temporarily introduce requirements for other vaccine-preventable diseases in response to changes in disease epidemiology that are of international health concern. An example is for polio vaccination.

Because country vaccination requirements are subject to change at any time, confirm all current vaccination requirements for the countries a traveller intends to enter or transit through before travel. See Poliomyelitis and Accessing up-to-date travel information .

Planning and documenting vaccines

Ideally, start vaccination courses early enough before departure to allow:

• monitoring of any possible adverse events 
• time for adequate immunity to develop

Requirements for multiple vaccines

A traveller may need multiple vaccines before they depart. Apply the standard recommendations and precautions when giving multiple vaccines (see Administration of vaccines ).

A traveller may need more than 1 clinic visit if they need multiple vaccines or doses (for example, rabies pre-exposure prophylaxis or hepatitis B vaccine). Pay special attention to scheduling of these visits, and consider:

• dose interval precautions (for example, for multiple live vaccines)
• requirements for pre-vaccination tests (for example, tuberculin skin test)
• potential interference by some antimalarials, if relevant (for example, rabies vaccine)

Documentation and certificates

It is important to document travel vaccines: 

• in the clinic’s record
• in the traveller’s record that they can carry with them 
• on the Australian Immunisation Register

The record should also include all the other routinely recommended vaccines that the traveller has ever received. 

For yellow fever vaccination, a traveller needs to have an International Certificate of Vaccination or Prophylaxis (ICVP), which only Yellow Fever Vaccination Centres can provide under the International Health Regulations (see Yellow fever ). 

Travellers may also need an ICVP for other vaccine-preventable diseases, such as polio, based on temporary recommendations.

See also Accessing up-to-date travel information .

Vaccinating travellers with special risk factors

See Vaccination for women who are planning pregnancy, pregnant or breastfeeding , Vaccination for people who are immunocompromised and the disease-specific chapters in this Handbook for recommendations for travellers who are pregnant or immunocompromised.

Accessing up-to-date travel information

International travellers’ health risks constantly change. Up-to-date information, and knowledge of the changing epidemiology and current outbreaks of infectious and emerging diseases are essential. Reliable online information sources include:

• World Health Organization (WHO) for disease outbreak news, and its Travel and health section for specific advice on travel and health, including travel vaccination recommendations
• Travelers’ health , United States Centers for Disease Control and Prevention (CDC)
• Travel health information , Australian Government Department of Health
• Smartraveller , the Australian Government’s travel advisory and consular information service, which provides up-to-date advice about health, safety and other risks of specific destinations for Australian travellers

The following resources have comprehensive technical advice on international travel and health, including vaccination:

• the latest edition of WHO’s International travel and health
• the CDC’s Health Information for International Travel (the ‘Yellow Book’)
• Australian Bureau of Statistics. 3401.0 – Overseas arrivals and departures, Australia, Mar 2018 (accessed May 2018). 
• Paudel P, Raina C, Zwar N, et al. Risk activities and pre-travel health seeking practices of notified cases of imported infectious diseases in Australia. Journal of Travel Medicine 2017;24(5):tax044.
• Heywood AE, Watkins RE, Iamsirithaworn S, Nilvarangkul K, MacIntyre CR. A cross-sectional study of pre-travel health-seeking practices among travelers departing Sydney and Bangkok airports. BMC Public Health 2012;12:321.
• Chen LH, Leder K, Barbre KA, et al. Business travel-associated illness: a GeoSentinel analysis. Journal of Travel Medicine 2018;25.
• Angelo KM, Kozarsky PE, Ryan ET, Chen LH, Sotir MJ. What proportion of international travellers acquire a travel-related illness? A review of the literature. Journal of Travel Medicine 2017;24.
• Freedman DO, Weld LH, Kozarsky PE, et al. Spectrum of disease and relation to place of exposure among ill returned travelers. New England Journal of Medicine 2006;354:119-30.
• Halstead SB, Hills SL, Dubischar K. Japanese encephalitis vaccines. In: Plotkin SA, Orenstein WA, Offit PA, Edwards KM, eds. Plotkin's vaccines. 7th ed. Philadelphia, PA: Elsevier; 2018.
• Staples JE , Monath TP, Gershman MD, Barrett AD. Yellow fever vaccines. In: Plotkin SA, Orenstein WA, Offit PA, Edwards KM, eds. Plotkin's vaccines. 7th ed. Philadelphia, PA: Elsevier; 2018.
• World Health Organization (WHO). Chapter 6: Vaccine-preventable diseases and vaccines . In: International travel and health. Geneva: WHO; 2017. 
• Steffen R. Travel vaccine preventable diseases-updated logarithmic scale with monthly incidence rates. Journal of Travel Medicine 2018;25.
• Denholm JT, Thevarajan I. Tuberculosis and the traveller: evaluating and reducing risk through travel consultation. Journal of Travel Medicine 2016;23.
• Lachish T, Tenenboim S, Schwartz E. 35 - Humanitarian Aid Workers. In: Keystone JS, Kozarsky PE, Connor BA, et al., eds. Travel Medicine (Fourth Edition). London: Elsevier; 2019. (Accessed 6 July 2023). https://www.sciencedirect.com/science/article/pii/B9780323546966000355
• Leggat PA, Zwar NA, Hudson BJ. Hepatitis B risks and immunisation coverage amongst Australians travelling to Southeast Asia and East Asia. Travel Medicine and Infectious Disease 2009;7:344-9.
• Winkler NE, Dey A, Quinn HE, et al. Australian vaccine preventable disease epidemiological review series: measles, 2012-2019. Commun Dis Intell (2018) 2022;46.
• World Health Organization (WHO). Epidemic meningitis control in countries of the African meningitis belt, 2017. Weekly Epidemiological Record 2018;93:173-84.
• World Health Organization (WHO). International travel and health: health conditions for travellers to Saudi Arabia for the pilgrimage to Mecca (Hajj) . 2017 (accessed May 2018). 
• Freedman DO, Chen LH. Vaccines for International Travel. Mayo Clinic Proceedings 2019;94:2314-39.
• Furuya-Kanamori L, Gyawali N, Mills DJ, et al. The Emergence of Japanese Encephalitis in Australia and the Implications for a Vaccination Strategy. Trop Med Infect Dis 2022;7.
• Hills SL, Rabe IB, Fischer M. Infectious diseases related to travel: Japanese encephalitis . In: CDC yellow book 2018: health information for international travel. New York: Oxford University Press; 2017. 
• World Health Organization (WHO). International travel and health (accessed Apr 2018). 

Page history

Updates to reflect new recommendations for RSV vaccines, Abrysvo and Arexvy. 

Updates to reflect availability of the mpox vaccine, JYNNEOS. Updates to include recommendations for use of JYNNEOS in specific populations, including travellers in risk groups. 

Minor updates to clinical guidance around routinely recommended vaccines (not specific to travelling overseas), including the addition of advice regarding COVID-19.

Editorial update to reflect changes to pneumococcal vaccine recommendations for older adults and people with medical risk factors.

Guidance on vaccination of travellers against measles, mumps and rubella updated to reflect advice in the Measles chapter.

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Acknowledgement

The Department of Health and Aged Care acknowledges First Nations peoples as the Traditional Owners of Country throughout Australia, and their continuing connection to land, sea and community. We pay our respects to them and their cultures, and to all Elders both past and present.

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