A Half-Century of Immunization: Spain’s Pioneering Approach

In 2025, Spain commemorates the 50th anniversary of it’s first national vaccination calendar, a landmark achievement focused on protecting its youngest citizens.This initiative, which began in 1975, initially included five crucial vaccines: diphtheria, tetanus, pertussis (DTP), polio, and smallpox. The program has evolved considerably over the decades, adapting to new scientific evidence, emerging epidemiological needs, and the availability of innovative vaccines. This journey offers valuable insights for the U.S. public health system, particularly as it navigates its own immunization challenges and strives for equitable healthcare access.

The Early Years: Building a foundation for Public Health

Spain’s initial forays into nationwide vaccination campaigns predate the 1975 calendar. As early as 1963, oral polio vaccines were administered to children aged 2 months to 7 years. Subsequent campaigns in 1965 targeted diphtheria,tetanus,and pertussis using the DTP vaccine,alongside polio immunization. measles vaccinations followed between 1968 and 1970 across 11 provinces, though high rates of adverse reactions led to the program’s temporary suspension.

Barcelona took a pioneering step in 1973, introducing the first official vaccination schedule for newborns in the city. This encompassed not only the aforementioned vaccines but also included immunizations against smallpox (antivariological), rubella, and tuberculosis. These early initiatives laid the groundwork for the complete national program that would follow.

Expanding the Arsenal: From Five to Eighteen

the 1975 national calendar marked a significant turning point. The General Directorate of Health spearheaded the implementation of this program, which initially covered diphtheria, tetanus, pertussis, polio, and smallpox. By 1977, measles vaccines, using a safer strain than previously used, were added. Rubella vaccination followed in 1978, initially focusing on girls. This strategic approach was driven by epidemiological priorities and the safety profiles of available vaccines. Public acceptance was reportedly high, driven by the palpable impact of these diseases on child health.

Over the years, the Spanish vaccination program has continually adapted to include new threats and utilize scientific advancements. In 1996, vaccines against hepatitis B (HBV) and tetanus-diphtheria were introduced for adolescents, followed by haemophilus influenzae type B the following year. The 21st century saw further expansion, incorporating hepatitis B vaccination for newborns and infants, meningococcal B vaccination (introduced in 2023), HPV vaccination for males at age 12, annual influenza vaccination for children aged 6 to 59 months, and rotavirus vaccination in 2024. By 2025, the calendar includes COVID-19 vaccination for at-risk groups and systematic immunization against respiratory syncytial virus (RSV) for newborns and infants under 6 months. This proactive and adaptive approach underscores Spain’s commitment to safeguarding public health through immunization.

Decentralization and Coordination: A Balancing act

Between 1979 and 1985,Spain underwent a process of decentralization,transferring public health responsibilities from the central government to its autonomous communities (CC.AA.). The passage of the General Law of Health 14/1986 on April 25 facilitated the creation of the Interterritorial Council of the National Health System (CISNS) in 1987. This council serves as a crucial coordination body between the state and the autonomous communities, ensuring a unified approach to public health initiatives.

In 1991, the Vaccination Program and Registration Paper (referred to as “presentation”) was established as a scientific-technical advisory body to the Public Health Commission (CSP) Ministerial. With the presentation’s guidance, the first CISNS vaccination calendar was agreed upon in 1995 and implemented in 1996. This framework ensures that any new vaccine or modification to the existing vaccination schedule undergoes rigorous evaluation by the CSP, based on the presentation’s report, before being ratified by the CISNS. This multi-layered approach emphasizes scientific rigor and collaborative decision-making in shaping Spain’s immunization policy.

Adapting to Change: A Living Document

The evolution of Spain’s vaccination calendar reflects a dynamic process, constantly adapting to new challenges and opportunities. As the original article notes, “Over time, vaccination and immunizations calendars have adapted based on epidemiological needs, new scientific evidence, new vaccines available, vaccination experience in other countries, as well as economic and even political aspects.” This flexibility is essential for maximizing the effectiveness of immunization programs and responding to emerging health threats.

For example, Spain transitioned from the oral polio vaccine (OPV) to the inactivated polio vaccine (IPV) in 2004, aligning with global recommendations to minimize the risk of vaccine-derived polio.The program also shifted to acellular pertussis vaccines to reduce adverse reactions associated with whole-cell vaccines. more recently,the vaccination schedule shifted from a 3+1 pattern (hexavalent vaccines at 2,4,and 6 months,and pentavalent at 18 months) to a 2+1 pattern (2,4,and 11 months) between 2016 and 2017.This change necessitated the addition of an IPV dose for children born after the change, starting in 2023.

A Lifelong Approach: Extending Protection Beyond childhood

A significant conceptual shift occured in 2019 with the transition from a children-focused vaccination calendar to a “common vaccination calendar throughout life.” This expanded scope includes recommended vaccinations during pregnancy and for older adults, recognizing the importance of immunizing individuals across the lifespan.In 2024, the calendar was officially renamed the “common calendar of vaccinations and immunizations throughout life,” further emphasizing its comprehensive approach. As of 2025, the CISNS calendar covers immunizations against eighteen pathogens, demonstrating the program’s broad reach. The U.S. is increasingly adopting similar strategies, focusing on adult vaccinations and maternal immunizations to protect both mothers and infants.

While the Ministry of Health and CISNS provide national recommendations, Spain’s autonomous communities retain the authority to establish their own vaccination calendars. this allows for regional adaptation based on local epidemiological conditions, though it can also lead to variations in vaccine coverage across the country. This decentralized model presents both opportunities for tailored public health interventions and challenges in ensuring equitable access to vaccines.

lessons for the U.S.: Overcoming Challenges and Building Trust

Spain’s 50-year vaccination journey provides valuable lessons for the U.S. public health system. the U.S. can learn from Spain’s consistent adaptation to new scientific evidence and emerging health threats. The COVID-19 pandemic highlighted the importance of a flexible and responsive immunization infrastructure, a lesson that resonates strongly in both countries.

One key takeaway is the importance of addressing vaccine hesitancy. In the U.S., pockets of resistance to vaccination persist, often fueled by misinformation and distrust in public health authorities. Open communication, community engagement, and culturally sensitive messaging are crucial for building trust and promoting informed decision-making.

Another critical area is ensuring equitable access to vaccines. Disparities in immunization rates persist across different socioeconomic groups and geographic regions in the U.S. Addressing these inequities requires targeted interventions, such as mobile vaccination clinics, community partnerships, and financial assistance programs. Learning from Spain’s experience with decentralization, the U.S. can strive to balance local autonomy with national coordination to achieve consistent vaccine coverage across all communities.