COVID-19

Santé publique France issued an alert in early January and published an initial case definition for Covid-19 on January 10, 2020, as part of a specific surveillance effort established in collaboration with our partners. On January 13, the agency established an operational center responsible for the health crisis response, bringing together all relevant personnel across the country to work on what would later be defined as the Covid-19 program. This program is structured around eight main functions. Their role:

• organizing the epidemiological surveillance system,

• to train mediators in contact tracing,

• developing communication and prevention tools,

• assessing risk and contributing to scientific expertise,

• deploying the health reserve and managing the pharmaceutical facility’s strategic stockpiles.

1. Operational Coordination and Management and Liaison Officer

To ensure internal and external visibility of the actions carried out by Santé publique France, the operational coordination and management function is responsible for tracking the handling of requests, their assignment to the various relevant functions and/or departments, their follow-up, their traceability, and the progress of the response.

This function participates in risk analysis for the agency in terms of organization and coordinates the agency’s preparation for parliamentary inquiries, in particular. It also organizes feedback sessions to improve the agency’s resilience and ensure its renewal. In conjunction with scientific management, it facilitates inter-departmental and interregional scientific coordination to ensure the smooth flow of information within the agency. Additionally, to facilitate communication with our partners, the liaison officer maintains direct contact with the supervisory authorities and ensures the flow of information to better organize the handling of requests.

2. Monitoring, Data Production, Reporting, and Indicators

To monitor the evolution of the COVID-19 pandemic and provide real-time updates to both decision-makers and the general public, Santé publique France, in collaboration with its partners, has automated a new national system for collecting screening data as of May 13, 2020, in which all results of virological tests (and antigenic tests since December 8) conducted by city laboratories and those of hospitals are systematically recorded.

In parallel with epidemiological data, a psycho-behavioral surveillance system, CoviPrev, has been established, with data collection initially conducted on a weekly basis and later on a monthly basis.

Based on data collected through various information systems, Santé publique France produces a daily epidemiological report that is sent to the crisis center of the Ministry of Health. Key figures are updated daily on our website. Weekly national and regional epidemiological reports are published to track, on the one hand, the circulation of SARS-CoV-2, morbidity, and mortality associated with COVID-19, and on the other hand, the impact of this circulation on the healthcare system (hospital bed occupancy rates).

This flexible system is adapted in a responsive manner to each stage of the epidemic and has continuously contributed to scientific expertise. It is a comprehensive, multi-source system that routinely measures 83 indicators, enabling the monitoring of SARS-CoV-2 circulation and its main variants, as well as associated syndromes such as nosocomial infections, pediatric multisystem inflammatory syndrome (PIMS), etc., and thereby the identification of areas of concern and particularly vulnerable populations. These indicators include, for example, the proportion of people hospitalized, admitted to emergency departments, or deceased, etc., with a COVID-19 diagnosis, by age group and gender.

In publishing these results, Santé publique France has adopted a policy of transparency by communicating systematically 7 days a week: the main indicators are made available as open data on Géodes in the form of tables, summaries, and interactive maps that allow users to track the evolution of the pandemic at various geographic levels—from the national to the municipal level—providing visibility into the situation that closely reflects individual realities. Since then, Géodes has recorded over 31 million visits, and nearly 110 million pages have been viewed, demonstrating the French public’s interest in daily, transparent communication regarding epidemic surveillance.

3. Expertise, assessment, and coordination at the regional level

In support of the ARS (Regional Health Agencies), Santé publique France ensures the contextualized monitoring of all indicators, risk assessment at the local level, and support for Level 3 investigation and contact tracing (cluster control).

Santé publique France’s regional units have conducted monitoring in close collaboration with on-the-ground stakeholders, tailored to regional challenges—whether in the context of producing epidemiological indicators, evaluating local measures to curb the epidemic, or monitoring the vaccination campaign. They work closely with local authorities to ensure alignment between local situations and national guidelines. The expertise developed at the regional level is essential for highlighting the specific challenges facing each region, and even each department, and enables decision-makers to respond more effectively to potential critical situations regarding the epidemic’s dynamics.

Finally, our regional units maintain close communication with local partners to ensure widespread information sharing.

4. Knowledge, Studies, Expertise

Santé publique France has initiated or participated in the implementation of several studies on the topic of COVID-19, thereby putting its expertise to work in generating knowledge about the disease, its modes of transmission, and its impact on the general population or specific groups (self-employed workers, children, people in extreme precariousness, men who have sex with men, etc.).

Thus, studies focusing on sociodemographic factors, individual behaviors, and practices associated with SARS-CoV-2 infection, as well as those analyzing the relationship between COVID-19 and environmental conditions (such as the analysis of the pandemic in relation to climate change), have enabled a better understanding of how the virus spreads.

In addition, studies have been conducted to document the impact of the pandemic and its management on the mental health of the French population, more broadly on health and healthcare utilization among the general population or specific subgroups (older adults, pregnant women, young people, etc.), on social health inequalities (in terms of morbidity or excess mortality), on changes in working conditions during lockdown, or on the adoption of risky behaviors (alcohol, tobacco, and psychotropic substance use, changes in addiction patterns, etc.) as well as changes in physical activity, sedentary behavior, and diet.

Some of this research is conducted exclusively by Santé publique France, while other studies are carried out in collaboration with various partners (Inserm, universities, CNAM, etc.), and all contribute to generating knowledge about the virus, its modes of transmission, and its impact on various aspects of French people’s lives (particularly professional, social, and medical). In addition, international epidemiological monitoring allows us to track the evolution of the situation worldwide and provide decision-makers with data for international comparisons of the measures implemented.

Finally, throughout the crisis, Santé publique France has maintained close ties with several modeling teams with whom joint work has been conducted, helping to inform decision-makers about the epidemiological situation.

5. Prevention, Health Promotion, and Social Marketing

Based on the observation that the spread of the epidemic is linked to individual behaviors, Santé publique France developed tools to prevent virus transmission through the adoption of preventive measures, including materials for healthcare professionals and the general public (posters, flyers, TV spots, and radio spots), available for download via the catalog. Videos to support the public in managing this crisis have also been developed, along with materials to promote continuity of care.

To best meet everyone’s needs, materials and tools tailored to vulnerable populations have addressed the specific challenges of health literacy and health inequities. In addition, to prevent risky behaviors linked to increased vulnerabilities during the health crisis—particularly during lockdown periods—the helplines (Drogues Info Service, Tabac Info Service, Alcool Info Service, and Joueurs Info Service) quickly adapted to inform, support, listen to, and address the specific needs that emerged during this period.

Thus, Santé publique France directly applies its expertise—and more broadly, the new knowledge generated—to practical applications, particularly in terms of health promotion, thereby ensuring a public service offering grounded in scientific knowledge.

6. Management of Strategic Purchases and Stocks and Interventions by the Health Reserve

At the request of the Ministry of Health, Santé publique France purchased, imported, stored, and distributed masks, equipment, and health products to protect the French public and their healthcare professionals. Spread across the country, numerous logistics hubs facilitated the storage of 4 billion masks and, more broadly, all personal protective equipment, as well as tests, hospital equipment, and supplies such as ventilators and intensive care medications, followed by millions of vaccines received to ensure their redistribution to healthcare facilities.

Furthermore, starting in January, the Health Reserve provided medical monitoring for French nationals returning from China. Beginning in March, it deployed additional staff to healthcare and medical-social facilities, as well as to other institutions such as the Regional Health Agencies (ARS) in mainland France and the overseas territories.

It enabled these facilities to cope, in particular, with the various surges in hospital admissions that occurred following spikes in incidence rates, according to local needs. Thanks to the nationwide mobilization of numerous professionals, this has amounted to more than 40,000 mission days carried out across 16 regions to date.

7. Vaccination Strategy

Santé publique France is strongly committed to combating the spread of the COVID-19 pandemic and, in this regard, is particularly involved in the national vaccination strategy at various levels. To this end, the agency has made its scientific expertise, operational capabilities, and communication tools available to decision-makers to plan, organize, and support the COVID-19 vaccination campaign.

It has thus participated in developing scenarios to define the vaccination strategy and the selection of priority vaccination targets, taking into account the projected timeline for dose availability, the definition of organizational procedures for vaccination and vaccine distribution based on their packaging, as well as the associated logistics. Measuring uptake of the COVID-19 vaccine has made it possible to identify the main factors driving refusal of future vaccines, track trends, and propose an information strategy to ensure broad vaccination coverage.

Furthermore, to monitor and evaluate these strategies, Santé publique France, in partnership with the Health Insurance Fund, helped establish a national vaccination information system on January 4, 2021, which collects all data entered by healthcare professionals participating in the vaccination campaign (number of pre-vaccination consultations, number of people vaccinated, etc.). This data enables the monitoring of vaccination coverage. In addition, an assessment of vaccine efficacy is currently being developed in partnership with European projects. Finally, in accordance with the provisions of Article L.1413-4 of the Public Health Code, the agency has carried out the functions of purchasing, storing, and distributing vaccines and related health products.

8. Communication and Outreach

To provide information on the pandemic as early as possible, Santé publique France published on its website all information and news related to COVID-19 (links to the COVID-19 Coronavirus Information Hotline, presentations of daily epidemiological reports, information and guidelines regarding new variants, etc.). Three communication phases were thus implemented, covering the periods before, during, and after lockdown, and were structured as follows: “Coronavirus Alert,” “Coronavirus Warning,” and “The Coronavirus Is Still Circulating.”

The strategy proposed by Santé publique France was to inform the public and direct them to the Ministry of Health and government information websites. To this end, Santé publique France produced radio spots, videos, and a series of widely distributed posters. For the lockdown period, 10 short “My Daily Life” videos were produced to support daily life; by June 2020, these had been viewed millions of times.

The agency also produced and made available materials for healthcare professionals and the general public, with a particular focus on making information accessible to vulnerable populations and migrants (posters in various formats, downloadable video and audio spots translated into 24 languages to inform, prevent virus transmission through preventive measures, and protect oneself and others). The agency also makes information on vaccination practices available to everyone on its Vaccination Info Service website, which is regularly updated to reflect current developments.

Finally, throughout this year, Santé publique France has carried out extensive work that has resulted in numerous outputs, whether intended for decision-makers (memos for the ministry), the scientific community (publications in French and international journals), or the general public (on the agency’s website as well as at press conferences). For example, since September 3, 2020, a weekly briefing has been held with the media every Friday. To date, the agency has issued 34 press releases and 3 press kits with the aim of providing the most comprehensive information possible to everyone. Finally, to contribute to expanding knowledge on the health crisis, numerous articles have been published or are in the process of being published. In addition, Santé publique France publishes articles in its peer-reviewed journal, the Weekly Epidemiological Bulletin (BEH), written by authors both within and outside the agency, covering various aspects related to COVID-19.

Non-COVID-19 Topics

Social marketing campaigns aimed at reducing addictive behaviors, contributions to knowledge about infectious and chronic diseases, and cross-sector collaboration with various stakeholders in the health sector—all of these initiatives have left their mark on 2020 and are paving the way for lasting improvements in the health of the French population.

Infectious Diseases

World AIDS Day on December 1

To mark World AIDS Day on December 1, 2020, Santé publique France published updated data on HIV/AIDS as well as data on bacterial STIs. An issue of the BEH and an issue of the Public Health Bulletin dedicated to new research, surveillance data, and the impact of COVID-19 on HIV and bacterial STI testing, as well as regional bulletins, were also published. These publications serve as an opportunity to reiterate the importance of intensifying screening for HIV and other STIs, as well as to guide HIV screening policies and initiatives.

Publication of 2019 Data on Antibiotic Use and Resistance

To mark World Antimicrobial Awareness Week and European Antibiotic Awareness Day, Santé publique France and its partners have published 2019 data on antibiotic consumption and resistance. An infographic is also available. Two pillars for effectively combating antibiotic resistance have been identified: preventing infections and limiting the transmission of bacteria and resistance genes, and using antibiotics wisely (the right ones, when needed).

Studies on vaccination coverage among healthcare professionals in healthcare facilities and nursing homes, 2018–2019 season

Vaccination is one of the priorities of the National Health Strategy. In France, healthcare workers are subject to specific vaccination recommendations. Santé publique France, in collaboration with CPias Nouvelle Aquitaine, which oversees the National Mission to Support Actions for the Prevention of Healthcare-Associated Infections (Mission Matis), conducted two studies in 2019: the first in healthcare facilities and the second in nursing homes. The initial results of these studies on influenza vaccination coverage among healthcare professionals in long-term care facilities and healthcare facilities for the 2018–2019 season were released in October 2019. The results on vaccination coverage against measles, pertussis, and chickenpox among healthcare professionals in healthcare facilities were released in November 2020.

Chronic diseases

Regional prevalence indicators for diabetes complications (Géodes)

To mark World Diabetes Day, Santé publique France is making available on Géodes the prevalence rates of pharmacologically treated diabetes from 2010 to 2019, at the departmental level. New indicators regarding the occurrence of diabetes-related complications and the frequency of recommended follow-up tests are also available for the years 2010, 2013, 2016, and 2019 at the regional level.

Survival of people with cancer: new estimates for the period 1989–2018 in metropolitan France

Santé publique France, the Biostatistics and Bioinformatics Department of the Hospices Civils de Lyon, the Francim cancer registry network, and the National Cancer Institute have published the first results of survival estimates for people with cancer in metropolitan France between 1989 and 2018, including, for the first time, estimates of survival 20 years after a cancer diagnosis.

Prevention and Screening Coverage for Cervical Cancer

According to the WHO, cervical cancer is the only cancer that can be eliminated through two complementary interventions: HPV vaccination (primary prevention) and screening, which detects precancerous lesions and treats them before they develop into cancer (secondary prevention). In this context, Santé publique France has published new estimates of cervical cancer screening coverage for 2016–2018 and a methodological guide for implementing the evaluation of the organized screening program for this cancer, which has been underway since 2018. Furthermore, the screening protocols for cervical cancer in women aged 30 to 65 have changed. The French National Authority for Health (HAS) recommends that the HPV test, which is more effective for these women, replace the Pap test, which remains the recommended screening method for women aged 25 to 29. Santé publique France, the HAS, and the INCa have developed a “Questions and Answers” document to provide women with further details.

Launch of Studies/Surveys

ESPA November 13 Survey, Phase 2

In November 2020, Santé publique France launched the second phase of the November 13 ESPA survey to assess, five years after the attacks, the evolution of the psychological trauma and the use of support services.

Entred 3

Santé publique France, in partnership with the Health Insurance Fund, the Social Security for the Self-Employed, the French National Authority for Health (HAS), and the French National Agency for Medicines and Health Products Safety (ANSM), has launched the third edition of the Entred study (National Representative Sample of People with Diabetes), involving 13,000 people with diabetes in mainland France and the overseas departments. This national study on diabetes aims to better understand the needs and care of people with diabetes in France. The goal is to improve the quality of care and, consequently, the health and quality of life of these individuals.

Lubrizol: Launch of a study to assess the health and quality of life of the population following the industrial fire in Rouen

Following the fire at the Lubrizol and NL Logistique warehouses in September 2019 in Rouen, Santé publique France launched a health and quality of life study titled “A Study Listening to Your Health.” Conducted in 122 municipalities in Seine-Maritime, this survey is part of a series of epidemiological studies established by Santé publique France to assess the overall medium- and long-term health impact of this large-scale industrial accident: the “Santé Post Incendie 76” initiative.

Launch of the Health Barometer in Saint Pierre and Miquelon

In September, Santé publique France launched its “Health Barometer” for the first time in Saint-Pierre-et-Miquelon.

Addictions

Results of the Gambling Barometer

For the third time, following surveys conducted in 2010 and 2014, the 2019 Santé publique France Barometer included a section dedicated to gambling practices among the French population. Conducted among a sample of approximately 10,000 individuals over the age of 18, this survey estimated the prevalence of these activities by describing player profiles, reporting on trends, and addressing the issue of problem gambling

Tobacco: Results of the Barometer on Secondhand Smoke

New data from the Santé publique France Barometer published in February show that French people’s exposure to secondhand smoke is decreasing at home but remains stable in the workplace, even though regulations prohibit it. In this context, Santé publique France has launched a campaign to promote the remote support service Tabac info service among the general public and in workplaces.

Tobacco: World No Tobacco Day - BEH prevalence

To mark World No Tobacco Day on May 31, Santé publique France published, as it does every year in the BEH, new data on smoking prevalence in France.

Tobacco: #Moissanstabac 2020 Edition - Types of Tobacco Consumed

The 5th edition of #Moissanstabac, designed and led by Santé publique France in partnership with the Ministry of Solidarity and Health and the Health Insurance Fund, took place this year under exceptional circumstances, amid the implementation of the second lockdown, which was necessary to curb the spread of the COVID-19 epidemic. Under these particular circumstances, 126,000 smokers decided to sign up for #MoisSansTabac to quit smoking.

At the start of the challenge in November, Santé publique France published new data on smoking in France from the 2018 Santé publique France Health Barometer. What are the different types of tobacco smoked by the French? What is the public’s opinion on increasing tobacco taxes? Have successive price hikes had an impact on the French public’s motivation to quit?

Alcohol: Publication of New Data on Alcohol Consumption with Regional and Departmental Morbidity and Mortality Indicators

In January, Santé publique France published previously unpublished data featuring a regional analysis of alcohol consumption as well as regional and departmental indicators of alcohol-related morbidity and mortality.

In addition, Alcool Info Service offers alcohol users and their loved ones help, information, support, guidance, and advice via the internet or by phone ...

Sexuality

As part of its “sexual health” program, Public Health continued its outreach efforts to various audiences.

Choosing the Right Contraception

In February, a new tool was launched on the website choisirsacontraception.fr. Its goal is to help women prepare for their contraceptive consultation and provide them with personalized information on contraception.

ASKIP on sexuality: experts answer teens’ questions about sexual health

Teens have many questions about sexuality. The educational “Askip” (“as I hear it”) videos from Santé publique France, released in November, are here to answer them: “Askip, the pill can cause infertility. Askip, you can’t get pregnant the first time” …

I practice safe sex! Or how to promote combined prevention among men who have sex with men (MSM)

Because the fight against HIV and other STIs remains a major challenge, Santé publique has continued its outreach on the topic of HIV, particularly among MSM, who remain the most affected group. Through the slogan “I practice safe sex” (referencing the name of the website dedicated to them: sexosafe.fr), the goal is to establish good prevention habits, even after lockdown: “Even after weeks without sex, STIs still have it in for me. I always reach for a condom. I practice safe sex!”

Living with HIV means, first and foremost, living

In December, Santé publique France marked World AIDS Day to remind the public that, thanks to modern treatments, an HIV-positive person can live a full and healthy life without transmitting HIV or even start a family. The aim of this campaign is to change perceptions of HIV-positive people, who are still too often subjected to discrimination in their sexual lives due to their HIV status.

Nutrition and Physical Activity

Survey Results on Children’s Exposure to Fatty, Salty, and Sugary Products

A study by Santé publique France published in June shows that more than half of the advertisements seen by children and adolescents are for fatty, salty, and sugary products (PGSS). This study quantifies children’s and adolescents’ exposure to advertising for these products and how it has changed, particularly on television, and thus enables the establishment of recommendations to limit this exposure.

“En 2-2”: the new campaign encouraging young people to eat better on a budget without sacrificing enjoyment

According to a study by the National Observatory of Student Life, nearly half of the student population reports skipping meals during a typical week of classes. During this health crisis, young people’s financial insecurity is worsening and adds to the challenges they face in adopting a healthier diet. Santé publique France approaches the management of this crisis from a holistic health perspective, which is why the agency remains committed to prevention and has launched a digital information campaign targeting 18- to 25-year-olds, with the aim of providing them with some tips to improve their diet.

BEH Special Issue: Physical Activity and Prevention in the Treatment of Chronic Diseases

On November 3, the BEH Special Issue dedicated to physical activity in the prevention and treatment of chronic diseases was published online.

Environment

Heat Wave Reports

The summer of 2020 was marked by three heat waves, one of which was particularly severe in northern France. The departments affected by at least one heat wave are home to more than 50 million residents, representing 77% of the metropolitan population. These three heat waves had significant health impacts, as documented in a public health bulletin published in October.

Results of the City and Heat Study

What are the links between urban planning, heat, and mortality? Santé publique France and the Institut Paris Région have published the results of a study conducted in 2019–2020 across 1,300 municipalities in Île-de-France.

Environmental Health: Biomonitoring Data and Exposure Studies

In July, Santé publique France published BEH No. 18-19 on biomonitoring data and exposure studies.

Signing of the Charter on Openness to Society

ANSES, BRGM, Ifremer, INERIS, INRAE, IRSN, Gustave Eiffel University, and Santé publique France have signed a charter on openness to society. Through their research, expertise, and/or scientific and technical assessment activities, these eight public institutions share a common goal: to provide a better understanding of risks as well as the means to prevent and reduce them.

Ethics

In the September 2020 issue of our quarterly journal La Santé en action, we dedicated a special feature to ethics, prevention, and health promotion.

Publications

Find all of Santé publique France’s 2020 publications in the dedicated section of our website. This includes issues of the BEH, articles of the month, and issues of *La santé en action*, such as the issue of *La santé en action* on the theme of Ethics and Professional Conduct.