12  2.1.3 Conclusion  Lot 5. Vaccine effectiveness against COVID-19 and seasonal influenza among patients presenting to  primary care physicians in EU/EEA  Lot 4. Vaccine effectiveness and impact of COVID-19 vaccines through routinely collected exposure and  outcome data using health registries  frequent group to experience severe outcomes of COVID-19, including death, and have therefore been  prioritised for vaccination. Vaccine prioritisation has also involved those working in long-term healthcare  facilities, including staff, due to their frequent contact with vulnerable residents. Studies performed in  long-term care facilities can be therefore be useful for understanding whether the vaccines can reduce  symptomatic COVID-19 infection, severe COVID-19, deaths due to COVID-19, and transmission of SARS- CoV-2.  Currently, vaccination is targeting specific groups of the population like elderly and healthcare workers but  should in the short-term be expanded to all adults as routine vaccination. Throughout the EU/EEA, a majority of countries have available digital solutions 9 for the recording of  individual vaccination data that are being also used currently to record exposure to COVID-19 vaccines.  These solutions may allow a continuous assessment of the vaccine effectiveness and impact against  respiratory infections caused by SARS-CoV-2, including by linkage of individual vaccination data with health  outcome data.  Seasonal influenza and COVID-19 pose a significant burden of disease on European populations. Influenza,  due to its seasonal epidemic peaks causes significant healthcare pressures on primary care facilities. As of  February 2021, it is difficult to estimate what the future epidemiology of COVID-19 will be, but it is possible  that continuous or seasonal circulation of the virus will continue for years to come. The majority of  individuals infected with either influenza or SARS-CoV-2 recover after a brief respiratory or systemic illness,  and do not need admission to healthcare facilities. The propensity for seeking primary care consultations  is dependent on availability of services, available treatment, potential parallel pathways to care, as  established for COVID-19 and healthcare seeking behaviour. Most efforts to assess vaccine effectiveness  for seasonal influenza have been based on study sites that are included in various influenza sentinel  surveillance systems. The EU/EEA disease surveillance systems originally designed for influenza have been  adapted to capture information on COVID-19. ECDC has since 2007 commissioned annual influenza vaccine  effectiveness studies against seasonal influenza. There is a need to complement the existing efforts to  estimate seasonal influenza vaccine effectiveness in primary care with integration of both seasonal  influenza and COVID-19 VE assessments, which will allow for estimation of the impact the vaccines on mild  disease. In the light of the above, ECDC plans to support the assessment of effectiveness of vaccines against COVID- 19 by establishing or enhancing an infrastructure and by conducting studies in the EU/EEA Member States  and EU candidates and potential candidates in Western Balkan region 10  among different settings. In the  settings where the infrastructure can benefit from ongoing and previous efforts (SARI surveillance, primary  care) influenza vaccine effectiveness will also be evaluated. Studies on the impact of interventions such  as vaccination programmes will complement the vaccine effectiveness studies to inform decision making.  9  https://www.ecdc.europa.eu/sites/portal/files/documents/immunisation-systems.pdf  $^{10}$Western Balkans, i.e. Albania, Bosnia and Herzegovina, Montenegro, Serbia, North Macedonia, and Kosovo (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).