Fifty years of vaccination in Spain: evolution, achievements and challenges for Public Health

e202610086

Abstract

Vaccination has been one of the most effective public health strategies in Spain, evolving from isolated campaigns to the implementation of a common vaccination schedule. Initiated in 1975 with seven basic vaccines, the schedule was progressively consolidated, culminating in the 2018 approval of a unified calendar agreed upon by the Ministry of Health and the autonomous communities. This model has maintained very high childhood vaccination coverage and has contributed to smallpox eradication, the elimination of polio and rubella, and the maintenance of measles elimination for several years. Its success relies on interterritorial governance, evidence-based and ethical decision-making, and robust epidemiological surveillance.

Despite these achievements, important challenges remain: coverage gaps between doses and age groups; territorial and organizational variability; incomplete vaccination in part of the adult population; vaccine hesitancy; and the sustainability of the schedule as new interventions are introduced. The recent measles situation also reinforces the need to close immunity gaps and maintain sensitive epidemiological and microbiological surveillance.

The current approach promotes lifelong immunization, including adults, pregnant women, and immunocompromised individuals. Technologies such as mRNA vaccines and genomic surveillance offer new possibilities. The COVID-19 pandemic highlighted the need for strong international coordination and community engagement. Thus, the common vaccination schedule stands as a pillar of healthcare cohesion, and its future depends on political consensus, scientific innovation, and equity.