It is true that “mistrust” of vaccination—which encompasses a range of attitudes on the spectrum between pro- and anti-vaccination—is difficult to measure: various studies have provided estimates for specific populations such as the elderly or parents of young children, but there is no standardized indicator to use as a measure in the general population.

One way to address this hesitancy is not to ask the population about their mistrust, but instead whether they accept the principle of vaccination. Acceptance of this principle has been monitored for more than 20 years through the Santé publique France Health Barometer using the question: “Are you in favor of vaccination in general?”.

This system of repeated surveys draws on large samples (generally between 15,000 and 25,000 respondents) that are rigorously selected (probability sampling). The Santé publique France Health Barometer allows us to monitor changes in the health-related habits and opinions of the French population, both in mainland France and, for the past decade or so, in the overseas departments and regions. The results of these surveys help us evaluate our preventive measures and adapt our messaging and information campaigns. This means that the data collected is valuable to all those involved in public health and, in this case, in promoting vaccination.

Overall vaccination acceptance decreased from 89.9% in 2005 to 61.2% in 2010, following the 2009 influenza pandemic.

Acceptance subsequently increased (78.8% in 2014), then fluctuated over the following years, and increased again in 2020 (80.0%) and 2021 (82.5%). The latest data, not published in this article, show a sustained increase, with acceptance reaching 84.6% in 2022. This means that a rise in vaccination acceptance was observed during the COVID-19 crisis.

Regardless of the year, acceptance was higher among people with higher incomes, those with higher levels of education, and those who did not live alone. In 2021, for the first time, acceptance was higher among adults aged 45 and older (particularly those aged 65 and older, with 85.9% acceptance) than among 18–24-year-olds, and it was higher among retired people than among working people; these groups were largely those who benefited the most from the COVID-19 vaccination.

The overall increase in acceptance in recent years should not obscure the trend of growing differences in acceptance across social and economic strata. In 2021, acceptance was low among people with the lowest levels of income and education, and well below the rates seen for these groups before 2009.

The article showed that not only has vaccine uptake failed to return to the levels observed prior to 2010, but also that in 2021 the gap between those with the lowest incomes and those with the highest was wider than it was before 2010. To sustain the increase in vaccine uptake by reducing social inequalities in health, the priority is to develop vaccination promotion strategies that take the social gradient into account.

During European Immunization Week 2023, numerous strategies were launched targeting the least affluent populations, such as catch-up vaccination appointments, promotion of hepatitis B vaccination, vaccination status checks, raising awareness about human papillomavirus (HPV) vaccination, and vaccination promotion in general.

Furthermore, Santé publique France has developed numerous resources on vaccination, providing information that is easy to understand and accessible to the general public. For example, the “vaccination-info-service” website has been developed in two versions: one for healthcare professionals and another for the general public that features clear, illustrated summaries of information. To reach as many people as possible, the agency also produces resources targeted at more specific populations. Videos on some of the diseases that vaccination can prevent (measles, hepatitis, chickenpox, whooping cough, etc.) have been published in French Sign Language, and several brochures have been adapted into an “easy-to-read” format.

The HPV vaccination campaign, which just began in secondary schools in September 2023, is part of the same approach. The campaign aims to improve low HPV vaccine coverage, but also to increase HPV vaccine acceptance by reducing social inequalities in access to care and prevention services.

In addition, the Provence-Alpes-Côte d’Azur (PACA) Regional Office (Regions Division) of Santé publique France collaborated with the PACA Regional Health Observatory to conduct a study on vaccination hesitancy among pregnant women. This study demonstrated the impact of an educational strategy involving motivational interviews in maternity wards to boost confidence in vaccines (see Box – Motivational interviews to reduce vaccine hesitancy among mothers).

These examples demonstrate our ongoing efforts to identify and evaluate promising interventions aimed at increasing vaccine acceptance among the population, as well as our work to address the growing disparities observed between people from different socioeconomic groups.