A 3 2 3 -A 6 3 6 at local level; inadequate data collection and follow-up process at later stages of life; poor awareness of immunisation schedule by health care practitioners (HCPs); lack of structural and operational policies to promote and deliver vaccination at later stages of life; infrequent interactions with the health care system during adult-hood; limited and inconsistent information dissemination by HCPs and government; negative messages on vaccination through media; complacent public attitude towards the risk posed by vaccine preventable diseases. ConClusions: Three main domains of barriers exist: low institutional facilitation to recommend lifespan immunisation as part of NIP; inadequate mechanisms at regional and local level to facilitate citizen access to immunisation / vaccination; low patient demand for immunisation at older stages of life. To overcome these barriers a broad-ranging approach based on awareness is required, which includes providing comprehensive pharmacoeconomic evidence to policy makers and payers, developing information tracking systems that enable follow up, and HCP education to facilitate information dissemination.

approach to costing and uptake among populations considered. CONCLUSIONS: Rx-to-OTC switches are a real opportunity to realise savings for budget holders and productivity gains for employers. More robust economic models are required to estimate the impact of the switches in Europe.