Trust, Access, and the Division of Responsibility for Vaccine Confidence in Central and Eastern Europe: Paired Own-Country and Regional Ratings from a Multi-Stakeholder Professional Panel.

BACKGROUND/OBJECTIVES: Immunisation coverage gaps in Central and Eastern Europe (CEE) are commonly attributed to barriers of access. This study measured how the professionals who deliver immunisation services weigh competing barriers, whether their assessments differ when the referent is their own country rather than the CEE region as a whole, and how they rank candidate interventions on expected impact and near-term feasibility. METHODS: Sixty-two professionals working in twelve countries and at the European level (47 based in CEE, 39 of them in Romania) completed a cross-sectional structured survey around a multi-stakeholder meeting in Bucharest (14 May 2026). Respondents rated 15 barriers twice, for their own country and for the CEE region; rated 16 interventions for the expected impact and 12-24-month feasibility; force-ranked their selections; and assigned the lead responsibility for five system functions. RESULTS: Digital misinformation was the highest-rated barrier in every subgroup and at both geographic levels. The assessments differed by geographic referent: within respondents, trust and information barriers were rated more severe for their own country and access barriers more severe for the region (d_z = 0.52), a pattern attenuated but retained after standardising within each level; the same regional object was also described differently by respondents inside and outside CEE (d = 1.02). Across the 16 intervention-level means, the expected impact and feasibility were only weakly and imprecisely associated (r = 0.21, 95% CI -0.32 to 0.64), although, within respondents, the two were modestly correlated (r = 0.33). Continuing professional education for primary care ranked first on expected impact and led the forced-choice ranking in every subgroup. The lead responsibility was the clearest for professional training and least settled for equity monitoring. CONCLUSIONS: Barriers were assessed differently depending on whether the referent was the respondent's own country or the region as a whole. These are professionals' perceptions, not measured outcomes: access may rank low partly because the panel does not face it personally, and the findings do not place cost and structural determinants second. Regional strategies built on assumptions about neighbouring systems may misallocate attention, and the equity agenda this panel endorses rests on a monitoring function no actor owns.