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Mandatory vaccination of infants in France: Is that the way forward?
Henri Partouche1,2, Serge Gilberg1,2, Vincent Renard1,3
1a Conseil Scientifique du Collège National des Généralistes Enseignants (CNGE) , Paris , France.
Insights
Mandatory infant immunization in France is not sustainable. Patient-centered communication and primary care approaches are more effective for increasing vaccine coverage and addressing hesitancy.
Area of Science:
- Public Health
- Immunization Policy
- Vaccine Hesitancy
Background:
- France expanded mandatory infant immunizations from 3 to 11 diseases in January 2018.
- Infant immunization coverage (IC) rates in France (2017) were generally high, except for measles, mumps, rubella (MMR) and meningococcus C.
- Existing high IC rates suggest mandatory expansion may not be the most sustainable approach.
Purpose of the Study:
- To evaluate the sustainability of France's expanded mandatory infant immunization policy.
- To explore alternative strategies for improving vaccine-preventable disease control and vaccine acceptance.
Main Methods:
- This paper presents an opinion based on analysis of existing data and literature on immunization coverage and vaccine hesitancy.
- It reviews the impact of mandatory policies versus communication and advisory strategies.
Main Results:
- Mandatory immunization may achieve infant MMR IC targets but doesn't address adult susceptibility for herd immunity.
- The impact of mandatory policies on vaccine hesitancy is uncertain and may conflict with patient autonomy.
- Health professional advice and communication programs are shown to improve vaccine acceptance.
Conclusions:
- Expanded mandatory immunization is not a sustainable solution for vaccine-preventable diseases.
- Effective strategies include enhanced communication, resources for health authorities, reducing missed opportunities, and increasing access.
- A patient-centered approach within primary care is recommended to sustainably reduce vaccine hesitancy.
Abstract:
In this opinion paper, the authors argue that the extension of mandatory immunization of infants up to two years of age from three diseases (diphtheria, tetanus, poliomyelitis) to 11 diseases, introduced in France in January 2018, is not a sustainable response to the challenge of controlling vaccine-preventable diseases. In France in 2017, infant immunization coverage (IC) rates were sufficiently high or increasing (hepatitis B), except for measles, mumps and rubella (MMR) and meningococcus C disease. Even if vaccination obligation makes it possible to achieve the MMR IC objectives among infants, communication programmes and supported advice from GPs are essential for the catch-up of susceptible adults to obtain herd immunity. The impact of mandatory immunization on hesitancy remains uncertain, and it contradicts the evolution of the patient's role in the governance of his own health and the principle of autonomy. Numerous studies have shown that interventions and advice from health professionals improve vaccine acceptance. To correct the poor implementation of some vaccination programmes by health professionals, strong communication and resources from health authorities are needed, rather than a retreat towards obligation. Reducing missed opportunities and increasing access to immunization are essential objectives. Finally, an immunization policy based on primary care and a patient-centred approach to each vaccination are more likely to reduce vaccine hesitancy, sustainably.
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