Background: As part of the ongoing debate in France regarding the scaling back of tuberculosis vaccination policy, we estimated the epidemiological impact of three possible scenarios for primary BCG vaccination: maintaining widespread vaccination of children, targeting children at risk, and completely discontinuing vaccination. Methods: Using data from mandatory tuberculosis reporting, we estimated the number of cases currently prevented each year by BCG vaccination, corresponding to the excess cases that would be observed if vaccination were discontinued. The proportion of these cases occurring among at-risk children was estimated using data from a study conducted in the Île-de-France region in 1997. The proportion of these children in the total population of children living in France was estimated based on data provided by INSEE and INED. Results: Under the scenario most favorable to vaccination, up to 800 additional cases of tuberculosis would occur each year if all BCG vaccination activities were discontinued. Restricting vaccination to at-risk children would result in approximately 200 additional cases per year, assuming that vaccination coverage in this population is maintained at its current level. Vaccinating less than 15% of each annual cohort of children would therefore prevent approximately three-quarters of the cases currently occurring. Conclusion: BCG vaccination of only at-risk children appears to be an efficient option. However, the actual effectiveness of such a strategy will depend on the ability to maintain high vaccination coverage in this population, in the context of, on the one hand, the repeal of mandatory vaccination, and on the other hand, the imminent discontinuation of the multi-puncture BCG vaccine, the technique used for the vast majority of primary vaccinations. Beyond epidemiological and economic considerations, the decision must take into account the operational, social, and ethical challenges posed by a BCG vaccination strategy targeting at-risk populations consisting primarily of children of foreign origin.