What We Do
Vaccination is the most effective public health measure in the fight against infectious diseases. With the exception of water sanitation, no other intervention has had as great an impact on reducing mortality and promoting population growth. Yet vaccination no longer enjoys unanimous public support.
In this context, Santé publique France conducts evaluations of France’s vaccination policy, such as monitoring vaccination coverage and the impact of vaccination on the dynamics of the diseases targeted by vaccination. In addition to monitoring vaccine-preventable diseases, it also produces data on perceptions and practices regarding vaccination, as well as on public acceptance. All of these activities take on particular significance in the implementation of social marketing initiatives aimed at increasing public acceptance of vaccination, and more specifically in supporting and evaluating the impact of the law on mandatory vaccination for children aged 0 to 2 years.
Thus, Santé publique France’s mission is to support and evaluate public policy by implementing:
vaccination promotion;
monitoring changes in public perception of vaccination among the general population and healthcare professionals;
epidemiological surveillance of vaccine-preventable diseases;
its participation in expert assessments of vaccination policies at the national and European levels;
initiatives to promote vaccination.
Epidemiological surveillance of vaccine-preventable diseases and vaccination coverage
Santé publique France evaluates and monitors vaccination coverage in France:
For young children (0–24 months): children’s health certificates
At age 2, vaccination coverage is monitored through the analysis of 24-month health certificates. The certificate is completed for each child by the physician during the mandatory infant examination at 24 months. This certificate includes a “vaccination” section in which all vaccinations administered must be recorded. The physician conducting the examination or the family sends this duly completed certificate to the physician in charge of the departmental maternal and child health (PMI) service, in a confidential envelope. The departmental PMI services transmit the data files to the Directorate of Research, Studies, Evaluation, and Statistics of the Ministry of Health (Drees).
Drees compiles and validates these files and then calculates weightings. The files containing vaccination and sociodemographic data are then sent to Santé publique France for verification of vaccination data and analysis. Since 2004, the data provided to Santé publique France has consisted of anonymized individual records indicating vaccination status as well as certain sociodemographic data specific to each child.
The analyses concern vaccinations to be administered before the age of 2 and listed on the 24-month certificates, namely:
the two doses before 6 months of age and the booster at 11 months for the vaccine against diphtheria, tetanus, polio, pertussis, Haemophilus influenzae type b, invasive pneumococcal disease, and hepatitis B
the single dose of BCG vaccine recommended at birth (or starting at 1 month of age since 2017) for children considered at risk for tuberculosis, particularly those residing in the Île-de-France region and French Guiana,
the two doses of the vaccine against measles, rubella, and mumps, recommended at 12 months and between 16 and 18 months, respectively.
Health certificates, completed by doctors, serve as a valuable tool for assessing infant vaccination coverage, enabling the tracking of historical trends and the conduct of annual comparisons. Furthermore, these so-called “routine” vaccination coverage rates are collected annually through a permanent mechanism integrated into the healthcare system’s operations. These data are available at the departmental level, allowing for the study of spatial variations in vaccination coverage.
This data source, however, has limitations. There is a long delay between the vaccination and the availability of the information: it takes approximately 16 months for the data to be disseminated after the health certificate is completed, due to the various stages of data entry at the departmental level, followed by data transfer and processing at the national level. Thus, the vaccination coverage data published by Santé publique France in 2019 are derived from 2017 health certificates and pertain to children born in 2015. Furthermore, this system is slow to respond to changes in the vaccination schedule: any change requires the printing of new certificates, their distribution, and their subsequent use. This explains, for example, the absence of data from this source for the meningococcal C vaccine, even though this vaccine was introduced into the vaccination schedule in April 2010. Finally, departmental participation in this data reporting is insufficient and declining in certain regions: in 2017, 89 departments reported data from the 24-month certificates. Regional estimates were produced in 2019 only when (1) data were available for all departments in the region or (2) the departments for which data were missing represented no more than 20% of the region (based on 2014 birth counts). Furthermore, the departmental services that manage health certificates do not receive health certificates for all children. In total, the certificates whose information is collected and transmitted at the national level cover less than 30% of children in the age group.
It should be noted that vaccination data contained in the 9-month health certificates are also analyzed, although these data are of less interest for monitoring vaccination coverage.
For older children and adolescents (ages 2–15): depending on the vaccine types: data from the school survey cycle and data from the SNDS (National Health Data System) for reimbursed vaccines
These data are collected through a survey cycle resulting from a collaboration between the Ministry of Health and the Ministry of National Education. In this survey cycle, which began in 2000, a survey is conducted alternately among children in the final year of preschool (GSM, age 6), the second year of elementary school (CM2, age 11), and the ninth grade (age 15). The most recent data analyzed pertain to the GSM survey conducted in 2012–2013. Initially conducted every three years (i.e., one survey every three years at each level), the frequency was reduced in 2012 (to one survey every six years at each level). Data collection is carried out in each school selected by random draw by nurses and doctors from the French Ministry of National Education. Data entry into a national database is coordinated by the Directorate for Research, Studies, Evaluation, and Statistics (DREES) of the Ministry of Health. The vaccination and sociodemographic data from this database are then transmitted to the Respiratory Infections and Vaccination Unit of Santé publique France for analysis.
These surveys serve as an important estimation tool for older children, particularly because they focus on key periods of child development (entry into elementary school, preadolescence, and adolescence). However, the sample size does not allow for estimating regional coverage rates, except for the GSM surveys.
All ages: vaccination coverage surveys
Vaccination coverage surveys are necessary when data cannot be obtained by other means. They are conducted among specific populations (e.g., healthcare professionals in healthcare facilities, staff at facilities caring for dependent individuals, homeless children, children living in regions with specific vaccination recommendations, adults).
In these sample-based surveys, data are collected from a sample of the population. When the sample is selected by random drawing, the results can be extrapolated to the entire population. These surveys can be tailored specifically to the type of information sought and provide very comprehensive data (for example, vaccination dates for each dose received, or sociodemographic factors potentially associated with vaccination). However, they may require expertise in epidemiology and statistics to design an appropriate sampling plan and conduct a suitable analysis. They are also time-consuming and can be quite costly. Numerous survey studies have been conducted in recent years by Santé publique France in collaboration with other institutions.
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Vaccine purchases
The number of vaccine doses purchased in the private sector is compiled monthly by the Group for the Development and Production of Statistics (GERS) and transmitted to Santé publique France. These are comprehensive data on purchases made by retail pharmacies from wholesalers and pharmaceutical companies. These monthly purchases are broken down by department and by administrative geographic unit (UGA), each comprising about thirty pharmacies. They do not include information such as the age of the vaccinated person, their gender, or their birth order, which is a significant limitation. Although useful for tracking trends in vaccination activity (all other factors being equal, an increase in purchases suggests improved coverage), these data do not allow for a direct estimate of vaccination coverage due to the absence of a denominator. They have been used, for example, to indirectly track BCG vaccination coverage following the suspension of mandatory BCG vaccination in July 2007.
Vaccine Reimbursement
Santé publique France now also uses SNDS data to monitor vaccination coverage, specifically the Inter-Regime Consumption Datamart (DCIR), which contains comprehensive individual data on healthcare reimbursements by the National Health Insurance, covering beneficiaries of nearly all health insurance schemes. This data source provides both a numerator and a denominator and offers the advantage of enabling estimates of vaccination coverage at a given age down to the departmental or even sub-departmental level. As part of the creation of the National Health Data System (SNDS), the DCIR’s data retention period was recently extended to 20 years (data archived starting in 2006), enabling the construction of historical data for children.
Since 2011, these data have been used to estimate vaccination coverage against meningococcal C among individuals aged 1 to 24—the age group targeted by vaccination recommendations—as well as HPV vaccination coverage among young girls. Until 2014, meningococcal C vaccination coverage was estimated using the General Sample of Beneficiaries (EGB), a sample representing 1/97th of the DCIR. For meningococcal C vaccination coverage, estimates include children at age 2, since this valence was not included in the 24-month health certificate until 2018. This data source also allows for the production of vaccination coverage indicators in a much more timely manner than health certificates, since only 2 to 3 months are required for data consolidation and processing, versus at least 16 months for health certificates. However, SNDS data have limitations in certain departments, as vaccinations administered in maternal and child health centers (PMI) are not always included, depending on how vaccines are purchased and reimbursed. Indeed, vaccines cannot be linked to recipients when they are purchased by the departments and provided free of charge. The analyses presented correct this limitation as much as possible. For French Guiana, the data do not cover the entire territory and very likely overestimate vaccination coverage.
Information and Promotion Initiatives
To support the vaccine policy guidelines, Santé publique France is committed to:
Increasing public and healthcare professionals’ knowledge about vaccination
The dedicated website vaccination-info-service.fr, the official reference site on vaccinations, is designed to answer the most frequently asked questions on the subject, based on reliable and scientifically validated information. It includes a section specifically designed for healthcare professionals, developed in collaboration with independent scientific experts.
Distributing informational materials for the general public, healthcare professionals, or specific groups (parents, vulnerable populations, adolescents). All of these tools are available in the “Tools” tab.
Promoting vaccination among everyone
Santé publique France coordinates with the Ministry of Health the European Immunization Week, which aims to mobilize on-the-ground stakeholders on the topic through the organization of local and regional events, led by the Regional Health Agencies (ARS) and national partners
European Immunization Week (EIW)
This has been an initiative of the World Health Organization (WHO) since 2005. It now takes place simultaneously in more than 200 countries worldwide and aims to:
to remind the public that vaccination is the best protection against certain infectious diseases, and that it is important to get vaccinated and keep vaccinations up to date,
to improve vaccination coverage by raising awareness about vaccination among the public, healthcare professionals, government authorities, and the media.
To bring this event to life, a large number of stakeholders and partners come together every year in France and around the world.
Social marketing initiatives
Santé publique France also conducts communication campaigns to promote vaccination and the vaccination schedule among the general public and healthcare professionals. In 2019, Santé publique France and the Ministry of Health launched the first national campaign to promote vaccination, aimed at strengthening public confidence and helping to increase vaccination coverage.
This initiative, centered around the message “The best protection is vaccination,” was launched at the start of European Immunization Week 2019 and was featured:
In national and regional media and online through a TV spot promoting vaccination, print ads, and messages on the web and social media:
In healthcare settings via a poster and in the professional press;
In regions during European Immunization Week with information and prevention booths, known as “Vaccination Info Villages,” run by ARS teams and their partners.
Santé publique France also produces numerous resources to increase public awareness of vaccination. All of these resources are available in the “Resources” tab.
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Information accessible to everyone
Health prevention accessible to everyone
