Until 2007, BCG vaccination was mandatory for children before they entered a group setting. In July 2007, the vaccination requirement was lifted and replaced by a vaccination recommendation. BCG was recommended from birth through age 15 on a targeted basis for all children at high risk of tuberculosis, including notably all children residing in Île-de-France and French Guiana. Public health authorities specified that any negative impact of this new vaccination policy could lead to a reconsideration of this decision. In the period following this change, epidemiological surveillance showed a steady downward trend in the incidence of tuberculosis, particularly among children. In February 2025, Santé publique France informed the Ministry of Health that epidemiological indicators suggested the change in vaccination policy had no impact on the epidemiology of childhood tuberculosis beyond what was expected in the models developed in 2005. These models predicted, upon the transition to targeted vaccination, approximately 200 additional cases per year, including about 5 severe cases. In 2024, the number of reported cases in France was 4,491 (including 204 in children), representing a reporting rate of 6.5 cases per 100,000 inhabitants. The agency thus raised questions about the possible evolution of the current vaccination strategy. The Directorate General for Health (DGS), in an email dated February 26, 2025, referred the matter to the agency (referral no. 25-A-0032) requesting that the agency provide a detailed report on this issue, which would enable the DGS to refer the matter to the High Authority for Health (HAS) if necessary (Appendix I). The deadline initially requested by the DGS was renegotiated via a letter dated March 24, 2025, to allow the agency to respond by the end of 2025, in order to include in the response new estimates derived from data from the National Perinatal Survey and the Epiphane survey, which had not yet been analyzed at that time. In addition, Santé publique France also included an epidemiological impact analysis of BCG vaccination, which was not initially planned. Santé publique France’s response is structured around three main areas. The first part of this document thus presents an analysis of the epidemiological impact of the current vaccination strategy on the incidence of pediatric tuberculosis, as well as that of various alternative strategies that could be considered in mainland France. This analysis focuses on the Île-de-France region, which accounts for one-third of nationally reported tuberculosis cases and is the only region in mainland France to have recent BCG vaccination coverage data. It excludes Mayotte (analysis impossible due to the lack of vaccination coverage data) and French Guiana (analysis less relevant due to high vaccination coverage rates, exceeding 80%), territories that, moreover, account for a very small number of cases, particularly pediatric cases. The latest national data on BCG vaccination coverage and the incidence of childhood tuberculosis are presented in the second and third sections of this document, respectively.