ABSTRACT
Vaccination has been identified many decades ago as an effective means to prevent several diseases. However, in France, there is an emergence of vaccine hesitancy, that has caused a reduction of vaccination coverage rates. This issue reduces the effectiveness of the immunization process, and represents a real threat to public health that should be urgently addressed. The purpose of this review is to present actions that have been taken to fight against vaccine hesitancy and thus enhance vaccine uptake. The results indicate that different strategies have been proposed to reach this goal, mainly by vaccination campaigns. These findings highlight the strong implication of national health authorities and the medical staff of hospitals and health-care centers. However, actions implemented should be part of a long-term approach, and further studies are required to identify the most effective strategies to address vaccine hesitancy.
Introduction
Vaccination is considered as one of the greatest advances in health in the 20th century.Citation1 It is known as the most effective means to prevent diseases, with an interesting cost-effectiveness ratio, and has notably led to the eradication of diseases such as smallpox and poliomyelitis, but has also lessened the burden of Haemophilus influenza type b (Hib) and measles.Citation2 Despite this huge success, the coverage rates in some European countries are currently insufficient to ensure herd immunity, as vaccination rates are below the coverage threshold of 95% recommended by the World Health Organization (WHO) for some vaccines.Citation3
The negative perceptions towards vaccination have increased over the past two decades, and have led to an emerging concern named vaccine hesitancy (VH). The Strategic Advisory Group of Experts on Immunization (SAGE Group) has given the following definition of VH: “Vaccine hesitancy refers to delay in acceptance or refusal of vaccines despite availability of vaccination services. Vaccine hesitancy is complex and context specific varying across time, place and vaccines. It includes factors such as complacency, convenience and confidence”.Citation4 Vaccine hesitant people can be represented by people who refuse or delay vaccination, but also by those who accept them with uncertainty regarding their safety or efficacy.Citation5 VH may not concern all vaccines,Citation6 and includes various determinants that are sometimes linked. These factors can be divided in two main categories: socio-demographic factors (age, gender, level of education, type of work, beliefs, culture, traditions) and non-socio-demographic factors (access to hospitals, financial and non-financial barriers such as lack of time, workload). The latter can be clustered together in the 5A taxonomy which includes access, affordability, awareness, acceptance and activation.Citation7 Doubts about vaccine effectiveness and fear of side effects are the main reasons that explain VH; people express doubts, due to a context of “individual's rights” and a requirement for high quality of drugs.Citation8 According to an international study that measured confidence in vaccination among the general public in 67 countries, France was the country in which people were most doubtful about vaccine safety.Citation9 Worries about vaccine safety and fear of side-effects, along with the perception of a low importance of a given vaccine, are among the frequent reasons explaining a low immunization rate among children.Citation10 In addition, some physicians and parents (known as vaccine hesitant parents, VHPs) consider children as already receiving too many vaccines.Citation11 Importance of vaccination is more often reported in the elderly, who are generally more favorable to vaccination as they personally experienced serious diseases as children, and are thus aware of the impact that vaccination can have on the prevention of these diseases.Citation12
VH can lead to difficulties in eradicating life-threatening infectious diseases, resulting in an increase of case fatality rates and critical complications that are associated with outbreaks and a growth in healthcare expenditures.Citation13 Addressing it is therefore important to continuously improve health-related quality of life of the general population.
The present review aims to summarize all the actions and strategies that have been implemented to address VH issue in France, and more broadly, to enhance vaccine acceptance.
Background
Vaccination coverage rates (VCR) are not satisfactory in France. One of the factors explaining this situation is VH.Citation14 Mistrust and questions about vaccination can be attributed to many factors. First, vaccination is a victim of its success; the fact that many vaccine preventable diseases (VPDs) have been eradicated since the introduction of vaccines has led to the perception of vaccination as unimportant. However, the maintenance of VCR remains necessary to tackle infections due to the propagation of germs coming from regions were they are still circulating.Citation15 The internet also plays an important role in fueling vaccine controversies, and generating hesitant behaviors towards vaccination.Citation16 Online tools allow vaccine-related rumors to spread rapidly all over the world,Citation17 but the information is sometimes published without scientific validation.Citation18 Moreover, before vaccination, people often search for information on the internet,Citation19 and sometimes seek for information in accordance with their beliefs.Citation20 Yet, positive messages regarding vaccination are not often shared in the media, but people can be more tempted to share doubts if they have experienced adverse effects that they attributed to vaccines.Citation21 Vaccine-related controversies have emerged in France since the beginning of the 1990s, and started with controversies regarding the presence of adjuvants in vaccines, and the supposed link to macrophagic myofasciitis.Citation22 The same period saw the onset of controversies related to the hepatitis B vaccine (HBV), which was alleged to be associated with multiple sclerosis. Concerns focused on adjuvants (thimerosal and aluminum hydroxides) contained in the vaccine.Citation23 However, several years later, safety data are reassuring and show a favorable benefit/risk ratio for HBV.Citation24 Controversies also affected the meningococcal C vaccine (Men C), due to quality issues observed in some syringes. However, after assessment, the French Medicines Agency later confirmed that there was no health risk due to this for the children who received the vaccine.Citation25 The human papillomavirus vaccine has also been the subject of controversies, because of the alleged association with auto-immune diseases, but a study recently concluded that such a link does not exist.Citation26 The influenza vaccination campaign management during the H1N1 pandemic of 2009–2010 has also affected confidence in vaccination, as it resulted in a reduction in vaccination rates for seasonal influenza vaccination.Citation8,Citation27 During the pandemic, the majority of the population doubted the safety of the vaccine owing to its rapid marketing and consequent poor evaluation of adverse effects.Citation6 Since then, vaccination rates against seasonal influenza dramatically dropped in WHO member European countries.Citation28 This context of hesitancy is associated with the resurgence of epidemics, as it has recently been the case for measles.Citation29 Another main obstacle to vaccination is the coexistence of mandatory and recommended vaccines in the immunization schedule; recommended vaccines can be in fact considered less important .Citation30 Moreover, the vaccination process is sometimes acknowledged as complex, as many steps are required before vaccination,Citation31 and repetitive vaccine shortages currently observed are responsible for mistrust in pharmaceutical firms and health authorities.Citation32
This context urged health authorities and medical staffs in some care centers to implement approaches with the aim of resolving the issue of VH.
Search strategy
To identify relevant articles from the literature, a search was performed by the author, in May 2017, and using the following electronic databases: MEDLINE/PubMed, Web of science, International pharmaceutical abstracts, Pascal and Francis, Banque de données en santé publique (BDSP), ScienceDirect, and Embase. As the beginning of the controversies about vaccines in France started in the 1990s,Citation22 the databases were searched for English and French articles published from 1990 up to May 2017. The search was performed using keywords combined with the Boolean search operators. The vocabulary thesaurus of the databases were also used if available (Mesh in PubMed, Emtree in Embase, thesaurus of the BDSP). Selection criteria for articles was: focusing on any mean to promote vaccination in mainland France, including educational programs and immunization programs. Key words used are presented in.. Additional research through the Google search engine was also performed with the phrase “hésitation vaccinale France”.
Table 1. Key words used for the research.
Review results
Overview of study characteristics
Of 7693 articles screened, 16 articles qualified for inclusion. The search performed through Google allowed for the inclusion of six guidelines published by national health authorities and medical associations. The process for inclusion and exclusion of articles is shown on the flow diagram reported in . Different means have been used to promote vaccination (). Most have consisted in the deployment of vaccination campaigns. Guidelines regarding main recommendations published by national health authorities and medical associations are presented in .
Figure 1. Flow chart diagram of study inclusion and exclusion.
Table 2. Summary of published articles on strategies to address vaccine hesitancy in France.
Table 3. Summary of main recommendations from health authorities and medical associations on strategies to address vaccine hesitancy in France.
Vaccination campaigns against Men C
Many campaigns targeting serogroup C of Neisseria meningitis were implemented, owing to the high number of Men C cases in the Auvergne and South-Western administrative regions of France. The target population was mainly constituted of young adults and persons in close contact with the at-risk population. Various means were used to conduct the campaigns. In the Clermont-Ferrand city administrative area (located in the Auvergne region), vaccination was performed by school and university medical teams, reinforced by other physicians. Information was given to the public via the local and national press. On February 7, 2002, more than 80% of the target population were vaccinated.Citation33 The Men C campaign conducted in the South-West region was also successful; no case of meningococcal disease (MD) occurred in the 0–18 years old,Citation34 and the vaccine was broadly well tolerated.Citation35
Vaccination campaigns targeting precarious populations
Precarious populations were part of immunization strategies, in different regions of the country. Due to the 2008 to late 2011 Measles Mumps Rubella (MMR) outbreak in Europe, the humanitarian organization Medecins du monde led a vaccination campaign targeting the Roma population living in shantytowns, in many areas.Citation36,Citation37 Roma people were targeted because they mostly come from Bulgaria and Romania where as in France, the number of cases of measles was elevated. Nevertheless, the instability of this population, their eviction, and other health concerns that occurred during the immunization period made it difficult to reach adequate VCR.
National immunization campaign against H1N1 pandemic
Negative outcomes were reported for the national influenza immunization campaign during the occurrence of the H1N1 influenza pandemic as low immunization rates were observed.Citation38 Vaccination performed by mobile teams failed to strengthen vaccine uptake. Moderate success was reported in infants, but poor success was reported in adults and elderly.
Immunization programs targeting children
Specific actions also targeted children, with the implementation of the “cocooning” strategy to prevent young infants from getting pertussis. This approach resulted in the increase of VCR in both mothers and fathers of newborn infants.Citation39,Citation40
Vaccination campaigns for medical staff
Vaccination campaigns targeting medical staffs increased VCR, in the cities of Clermont-Ferrand and Nice. Organization of meetings with the medical staff, prior the start of the campaigns, to deliver scientific messages on the importance of vaccination and remove doubts by answering to queries, resulted in improvement of vaccine uptake, and contributed to develop a positive attitude towards vaccination.Citation41,Citation42
Tools to promote vaccination for the elderly
A tool called Vaxisenior and designed for use by physicians was created to promote vaccination in the elderly. It consisted of slides collected into a CD. Slides contained generalities on immunization, importance of vaccination, and the national immunization schedule. The tool was made for physicians.Citation43,Citation64
Discussion
Vaccination programs launched in France so far show encouraging results, but VH remains a complex issue that is difficult to tackle, as no effective strategy has shown striking evidence to address itCitation65 multiple strategies are however acknowledged by some authors as having potential impact to counter VH.Citation22
No previous study reviewing all the methods launched in France to address VH has been published to date. To the best of my knowledge, this is the first review focusing on that point. Vaccination campaigns were the means most used to promote vaccination, but complementary actions, such as developing educational tools to promote immunization, meetings with the delivery of scientific messages and exchanges to facilitate vaccination were also implemented. To improve the overall VCR, specific actions towards general practitioners (GPs) can be implemented, as they have a close contact with patients regarding health matters; Physicians are seen as models for their patients, through their own health behaviors.Citation45 Vaccination acceptance of healthcare providers (HCPs) can be improved if they are well informed about the benefits and importance of vaccination, not only for them, but also for patients they are in charge of. In that regard, initial training and continuing education appear important.Citation18 As some physicians may have questions related to the immunization process, a platform on which they can rely on in such cases can be proposed. This is already the case in Switzerland, with the academic network INFOVAC.Citation46 Furthermore, to simplify the immunization process, HCPs other than physicians can be empowered for vaccination.Citation47,Citation31 The Social Security Financing Act published on December 24, 2016, referred to the possibility for pharmacists, on a three-year experimental basis, to administer the seasonal influenza vaccine to adults. This experimentation started in two regions in early October 2017. The first results are satisfactory.Citation48
Facilitating access to vaccination is also a key element,Citation46 with the extension, for instance, of vaccination at more convenient business hours (weekends and evenings). Vaccination can also be considered in “non-traditional” settings such as nursing homes, home visits, childcare centers,Citation49 and can be carried out in environments such as schools, university preventive medicine settings, or occupational settings for workers. Two vaccination campaigns have targeted the Roma population living in France. Nevertheless, improvement of VCR was not observed but this strategy underlines the need to target precarious populations who are often far from the prevention mechanisms.Citation37
Availability of vaccines is necessary to ensure a rapid access to vaccination services and facilitate public adherence to vaccinationCitation50; but there are recurrent vaccine shortages. The reasons for these shortages vary,Citation32 and need appropriate communication campaigns. Establishing stocks of some important vaccines may help address supply pressures.Citation50 To increase availability of new vaccines the research and the industrial production of vaccines must be enhanced.Citation31,Citation51
Underscoring the importance of vaccination for the elderly to their relatives and caregivers is a way to optimize vaccination rates in this population.Citation44 French health authorities can rely on recommendations published by the European geriatric societies to improve VCR rates in this subgroup. Regarding pediatric immunization, fear of pain is known to be one of the main barriers to vaccination most often reportedCitation52; thus, injection pain should be appropriately managed.Citation1 To this end, pre-administration of topical anesthetics, distraction, or the feeling of protection expressed by parents can be helpful.Citation22 For parents with high workload who could more often forget to update the immunization status of their children, the use of postal and telephone reminders appears to be the most effective means to enhance pediatric vaccine uptake.Citation53 The use of SMS reminders can also be part of the strategies employed.Citation54
To simplify access to vaccine-related information, a toll-free phone number, established to provide vaccine-hesitant persons with any information they may require prior to vaccination can be useful.
This is already the case for many other health matters such as infectious disease caused by Human Immunodeficiency Virus (HIV), hepatitis, asthma, allergies, and drug addiction.
Considering that trust in institutions is significantly associated with low VH, it is important to implement actions in order to restore the confidence in health policies. To avoid the feeling that governments are influenced by the pharmaceutical industry, transparency regarding the conflicts of interests of those involved in vaccination policy should be clearly provided to the public.Citation31,Citation18 The “Bertrand Law” published in May 2013 requires pharmaceutical companies to disclose all relationships that they might have with all stakeholders engaged in health matters, including vaccination. Measure such as this, which is already effective, can help build and sustain general confidence. Some guides are available to help governments reestablish confidence in health institutions among HCPs. The guide from the European centre for disease prevention and control,Citation17 the “Communicate to vaccinate” guide,Citation55 and the Tailoring Immunization Programs guideCitation56 have been published for this purpose. The latter underlines the importance of segmenting the population to define subgroups at risk of developing VH. In this way, different groups can be constituted (adolescents, parents, the elderly, at-risk patients with chronic diseases, people living with toddlers) to set up suitable action plans.Citation49
As mandatory vaccines are sometimes perceived as a restriction of individual liberty, suggestions have been made to transfer the current mandatory vaccines to the list of recommended vaccines.Citation18 It should be noted, however, that such an action with tuberculosis vaccine has resulted in a decrease of VCR in the new targets of the vaccine.Citation57 The possibility of such a reaction should be thoroughly evaluated. The issue is emphasized by the existence of vaccines that combine mandatory and recommended ones: they were most used to respect mandatory schedules for infants, especially for diphtheria tetanus and poliomyelitis (DTP) vaccine which was the unique mandatory immunization in France until January 2018. A solution to this issue was brought by the French ministry of health, which decided to extend immunization obligation to 11 vaccines, including the DTP vaccine, for infants born as of January 1st, 2018. The 11 vaccines should be administered during the first 18 months of life.Citation67
A new immunization schedule for toddlers with fewer doses of vaccines began to be implemented in France in April 2013 for diphtheria, tetanus, poliomyelitis, pertussis and invasive infections due to Hib.Citation66 This schedule consists of 2 primary doses of vaccine followed by a booster dose (2+1 schedule), replacing the 3+1 schedule. However, it is difficult to confirm whether this simplified schedule has affected VCR for infants as VCR have increased only for some vaccines.Citation58 The impact of new mandatory immunization schedule for infants on VCR is now to be assessed.
As specified by the WHO, convenience is one of the determinants of vaccine hesitancy.Citation4 Its refers to many factors that may have an effect on vaccine uptake, and includes “ability to understand (language and health literacy)”.Citation12 Health literacy is defined as the “specific capacity to retrieve, understand, apply and use medical information, interacting with the health system”.Citation59
Those with insufficient health literacy can have less healthy behaviors, as they have difficulties in understanding and using health information provided to them to make appropriate health decisions.Citation60 Evaluation of health literacy has already been done in France for diabetes.Citation61,Citation62 Nevertheless, the more specific evaluation of vaccine literacy should be conducted and its results taken into account to implement adequate interventions aiming to strengthen vaccination advocacy. Improving vaccine literacy skills can have a positive impact on immunization rates.
Because people increasingly rely on social media, online tools can be used to promote vaccination.Citation21 However, in such case, the content needs to be well monitored,Citation49 and the language used should be clearCitation1;the delivery of scientific information to the public is an indispensable way to reduce the impact of vaccine controversies.Citation63
This review aimed to be exhaustive, as it has included multiple strategies implemented in different areas of France to fight against VH and thus enhance vaccine uptake. Although it clearly demonstrates the use of various means to address VH, leading to great results for most studies, some limitations are to be considered. First, only vaccination programs conducted in mainland France were included, due to the application of the principle that action plans launched in French overseas departments and territories are likely to be the same, as the same national health policies apply. However, this bias, even if of minor importance, could have generated missing data. Additionally, three articles on the BDSP were not be accessible, as the link was non-functional. However, as a relative high number of articles and guidelines were included in the review, it can be considered that they represent well the methods launched to address vaccine hesitancy issue in mainland France.
Second, most of the strategies concerned only specific subgroups of the population (e.g., HCPs working in hospitals, patients attending infectious diseases centers). As these patients represent a minority of the population, such findings may not accurately reflect the impact of these strategies on the general population.
Lack of access may have a negative impact on vaccination uptake with the potential to increase VH. For this reason, strategies launched to enhance vaccine uptake were included in the review, because such approaches can indirectly contribute to reduce VH among the population. These data could help health authorities in considering more immunization programs focusing on enhancing global vaccine uptake to effectively address VH.
However, Addressing VH issue requires interventions and actions implemented on a regular basis, and needs collaboration between the main actors of the immunization process, including health authorities, HCPs and patients. Qualitative studies may be of great help in understanding determinants of vaccine uptake at the individual level, as this can lead to creating tailored interventions for at-risk groups.
Conclusion
Several actions have been implemented to address the issue of VH in France. Supplying vaccine-hesitant people with appropriate information seems insufficient to overcome their hesitancy; further studies are therefore needed to identify the most effective strategies to address VH. Moreover, action plans previously launched should be part of a long-term approach.
Disclosure of potential conflicts of interest
No potential conflicts of interest were disclosed.
Acknowledgments
The author thanks Philip Robinson (DRCI, Hospices Civils de Lyon) for help in manuscript preparation.
References
- MacDonald, N. E., Smith, J., Appleton, M. Risk perception, risk management and safety assessment: what can governments do to increase public confidence in their vaccine system? Biologicals: Journal of the International Association of Biological Standardization. 2012;40(5):384–8. doi:10.1016/j.biologicals.2011.08.001
- Goulenok, T. Vaccination anti-pneumococcique chez l'adulte : comment améliorer la couverture vaccinale ? Journal Des Anti-Infectieux. 2014;16(2):89–98. doi:10.1016/j.antinf.2014.01.007
- WHO. Guide to tailoring immunization programmes. 2017, March 18. Retrieved from http://www.euro.who.int/en/health-topics/communicable-diseases/poliomyelitis/publications/2013/guide-to-tailoring-immunization-programmes
- WHO | Addressing Vaccine Hesitancy. 2016, June 7. Retrieved March 29, 2017, from http://www.who.int/immunization/programmes_systems/vaccine_hesitancy/en/
- Peretti-Watel, P., Verger, P. L'hésitation vaccinale : une revue critique. J. Des Anti-Infectieux. 2015;17(3):120–4. doi:10.1016/j.antinf.2015.07.002
- Ward, J. K. Rethinking the antivaccine movement concept: A case study of public criticism of the swine flu vaccine's safety in France. Soc. Sci. Med. (1982). 2016;159:48–57. doi:10.1016/j.socscimed.2016.05.003
- Thomson, A., Robinson, K., Vallée-Tourangeau, G. The 5As: A practical taxonomy for the determinants of vaccine uptake. Vaccine. 2016;34(8):1018–24. doi:10.1016/j.vaccine.2015.11.065
- Loulergue, P., Floret, D., Launay, O. Strategies for decision-making on vaccine use: the French experience. Ex. Rev Vaccine. 2015;14(7):917–22. doi:10.1586/14760584.2015.1035650
- Larson, H. J., Figueiredo, A., de Xiahong, Z., Schulz, W. S., Verger, P., Johnston, I. G., Cook AR, Jones NS. The State of Vaccine Confidence 2016: Global Insights Through a 67-Country Survey. EBioMedicine. 2016;12:295–301. doi:10.1016/j.ebiom.2016.08.042
- ECDC. Conducting health communication activities on MMR vaccination. 2010. Retrieved from https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/1008_TED_conducting_health_communication_activities_on_MMR_vaccination.pdf
- Williams, S. E. What are the factors that contribute to parental vaccine-hesitancy and what can we do about it? Human Vaccine. Immunother. 2014;10(9), 2584–96. doi:10.4161/hv.28596
- SAGE group. Report of the SAGE working group on vaccine hesitancy. 12 November 2014. 2014, November 12. Retrieved from http://www.who.int/immunization/sage/meetings/2014/october/SAGE_working_group_revised_report_vaccine_hesitancy.pdf
- Szucs, T., Quilici, S., Panfilo, M. From population to public institutions: what needs to be changed to benefit from the full value of vaccination. J Mark Access Health Policy. 2015;3(1):26965. doi:10.3402/jmahp.v3.269657
- Lévy-Bruhl, D. Hésitation vaccinale: données françaises. 2016, July 6. Retrieved from http://www.rencontressantepubliquefrance.fr/wp-content/uploads/2016/06/LEVY_BRUHL.pdf
- HCSP. Politique vaccinale et obligation vaccinale en population générale. Paris: Haut Conseil de la Santé Publique; 2014. Retrieved from http://www.hcsp.fr/explore.cgi/avisrapportsdomaine?clefr = 455
- Ward, J. K., Peretti-Watel, P., Larson, H. J., Raude, J., Verger, P. Vaccine-criticism on the internet: New insights based on French-speaking websites. Vaccine. 2015;33(8):1063–70. doi:10.1016/j.vaccine.2014.12.064
- ECDC. Communication on immunization-building trust. 2012;2012. Retrieved from https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/TER-Immunisation-and-trust.pdf
- Gaudelus, J., Pontual, L. Vaccins refusés ou discutés par les parents. Que faire ? Médecine Thérapeutique/Pédiatrie. 2015;18(3):119–25. doi:10.1684/mtp.2015.0568
- Moyroud, L., Hustache, S., Goirand, L., Hauzanneau, M., Epaulard, O. Negative perceptions of hepatitis B vaccination among attendees of an urban free testing center for sexually transmitted infections in France. Human Vaccine. Immunother.. 2016;0(0):1–7. doi:10.1080/21645515.2016.1264549
- Kestenbaum, L. A., Feemster, K. A. Identifying and addressing vaccine hesitancy. Pediatric Annals. 2015;44(4):e71–75. doi:10.3928/00904481-20150410-07
- Stahl, J.-P., Cohen, R., Denis, F., Gaudelus, J., Martinot, A., Lery, T., Lepetit, H. The impact of the web and social networks on vaccination. New challenges and opportunities offered to fight against vaccine hesitancy. Medecine ET Maladies Infectieuses. 2016;46(3):117–22. https://doi.org/10.1016/j.medmal.2016.02.002
- Verger, P., Collange, F., Fressard, L., Bocquier, A., Gautier, A., Pulcini, C., Peretti-Watel, P. Prevalence and correlates of vaccine hesitancy among general practitioners: a cross-sectional telephone survey in France, April to July 2014. Eurosurveillance. 2016;21(47). doi:10.2807/1560-7917.ES.2016.21.47.30406
- Balinska, M. A. Hepatitis B vaccination and French Society ten years after the suspension of the vaccination campaign: how should we raise infant immunization coverage rates? Journal of Clinical Virology: The Official Publication of the Pan American Society for Clinical Virology. 2009;46(3):202–5. doi:10.1016/j.jcv.2009.07.024
- Boazis, M. Vaccin contre l'hépatite B et sclérose en plaques : bilan des dernières études épidémiologiques. J Pharm Clin. 2003;21(4):228–35.
- Sécurité du vaccin contre la méningite C Meningite… – MesVaccins.net. 2016, July 9. Retrieved March 30, 2017, from https://www.mesvaccins.net/web/news/9262-securite-du-vaccin-contre-la-meningite-c-meningitec-c-etait-une-fausse-alerte
- Grimaldi-Bensouda, L., Guillemot, D., Godeau, B., Bénichou, J., Lebrun-Frenay, C., Papeix, C., Labauge P, Berquin P, Penfornis A, Benhamou PY, PGRx-AID Study Group, et al. Autoimmune disorders and quadrivalent human papillomavirus vaccination of young female subjects. J Intern Med. 2014;275(4):398–408. doi:10.1111/joim.12155
- Peretti-Watel, P., Verger, P., Raude, J., Constant, A., Gautier, A., Jestin, C., Beck, F. Dramatic change in public attitudes towards vaccination during the 2009 influenza A(H1N1) pandemic in France. Eurosurveillance. 2013;18(44):20623.
- Raude, J., Fressard, L., Gautier, A., Pulcini, C., Peretti-Watel, P., Verger, P. Opening the “Vaccine Hesitancy” black box: how trust in institutions affects French GPs’ vaccination practices. Ex. Rev. Vaccine. 2016;15(7):937–48. doi:10.1080/14760584.2016.1184092
- Rougeole : 4 fois plus de cas qu'au premier quadrimestre 2016. Vers une vaccination ROR obligatoire ? 2017, June 22. Retrieved June 22, 2017, from https://www.vidal.fr/actualites/21595/rougeole_4_fois_plus_de_cas_qu_au_premier_quadrimestre_2016_vers_une_vaccination_ror_obligatoire/
- Les Français et la Vaccination : pourquoi tant d'h… – MesVaccins.net. 2016, October 4. Retrieved March 30, 2017, from https://www.mesvaccins.net/web/news/9598-les-francais-et-la-vaccination-pourquoi-tant-d-hesitation
- Comité d'orientation de la concertation citoyenne sur la vacination. Rapport sur la vaccination. 2016, November 30.
- Medqual. La lettre d'actualités N° 170. 2017, Février
- Beytout, J., Laurichesse, H Enseignements de la campagne de vaccination anti-méningococcique dans le Puy-de-Dôme. Med ET Mal Infect. 2002(6):259–60. doi:10.1016/s0399-077x(02)00368-2
- Bruhl, D. L. Campagne de vaccination contre le méningocoque C dans le Sud-Ouest: un premier bilan. Journal de Pédiatrie et de Puériculture. 2003;16(4):224–226.
- Bagheri, H., Gony, M., Montastruc, J.-L. A propos d'une campagne de vaccination contre la méningite C dans les Hautes-Pyrénées : réflexions de pharmacovigilance. Thérapie. 2005;60(3):287–94. doi:10.2515/therapie:2005038
- Laurence, S., Chappuis, M., Rodier, P., Labaume, C., Corty, J.-F. Campagne de vaccination hors centre contre la rougeole des populations précaires en période de pic épidémique, Marseille 2011. Revue d’Épidémiologie et de Santé Publique. 2013;61(3):199–203. doi:10.1016/j.respe.2012.12.017
- Laurence, Sophie, Chappuis, M., Lucas, D., Duteurtre, M., Corty, J.-F. Campagne de vaccination rougeole des populations précaires : retour d'expérience, Ambulatory Measles Immunization for deprived populations: lessons learned. Santé Publique. 2013;25(5), 553–9.
- Bone, A., Guthmann, J.-P., Nicolau, J., Lévy-Bruhl, D. Population and risk group uptake of H1N1 influenza vaccine in mainland France 2009–2010: results of a national vaccination campaign. Vaccine. 2010;28(51):8157–61. doi:10.1016/j.vaccine.2010.09.096
- Decréquy, A., de Vienne, C., Bellot, A., Guillois, B., Dreyfus, M., Brouard, J. Stratégie du cocooning : efficacité d'une politique de promotion de la vaccination anticoquelucheuse des parents à la maternité d'un CHU. Arch Pediatr. 2016;23(8):787–91. doi:10.1016/j.arcped.2016.05.012
- Leboucher, B., Sentilhes, L., Abbou, F., Henry, E., Grimprel, E., Descamps, P. Impact of postpartum information about pertussis booster to parents in a university maternity hospital. Vaccine. 2012;30(37):5472–81. doi:10.1016/j.vaccine.2012.06.071
- Chamoux, A., Denis-Porret, M., Rouffiac, K., Baud, O., Millot-Theis, B., Souweine, B. Étude d'impact d'une campagne active de vaccination antigrippale du personnel hospitalier du CHU de Clermont-Ferrand. Med ET Mal Infect. 2006;36(3):144–50. doi:10.1016/j.medmal.2006.01.004
- Dunais, B., Saccomano, C., Mousnier, A., Roure, M.-C., Dellamonica, P., Roger, P.-M. Influenza vaccination: impact of an intervention campaign targeting hospital staff. Infect Control Hosp Epidemiol. 2006;27(5):529–31. doi:10.1086/504453
- Belmin, Joel, Bourée, P., Camus, D., Guiso, N., Jeandel, C., Trivalle, C., Veyssier, P. Educational vaccine tools: the French initiative. Aging Clin Exp Res. 2009;21(3):250–3. doi:10.1007/BF03324906
- Belmin, J. Improving the vaccination coverage of geriatric populations. J Comp Pathol. 2010;142 Suppl 1:S125–128. doi:10.1016/j.jcpa.2009.10.019
- Collange, F., Verger, P., Launay, O., Pulcini, C. Knowledge, attitudes, beliefs and behaviors of general practitioners/family physicians toward their own vaccination: a systematic review. Hum Vaccin Immunother. 2016;12(5):1282–92. doi:10.1080/21645515.2015.1138024
- Siegrist, C., Desgrandchamps, D., Heininger, U., Vaudaux, B. How to improve communication on vaccine issues at the national level? INFOVAC-PED: an example from Switzerland. Vaccine. 2001;20 (Suppl 1):S98–S100.
- Académie nationale de pharmacie. La vaccination: un acte individuel pour un bénéfice collectif. 2012, October 17. Retrieved from http://www.acadpharm.org/dos_public/Recommandations_SEance_vaccination_17_10_2012_VF_du_24.10_2012_Conseil.pdf
- Expérimentation de la vaccination contre la grippe en pharmacie : les premiers chiffres. (2017, June 12). Retrieved February 18, 2018, from https://www.ameli.fr/pharmacien/actualites/experimentation-de-la-vaccination-contre-la-grippe-en-pharmacie-les-premiers-chiffres
- Schmitt, H.-J., Booy, R., Aston, R., Van Damme, P., Schumacher, R. F., Campins, M., Rodrigo C, Heikkinen T, Weil-Olivier C, Finn A, et al. How to optimise the coverage rate of infant and adult immunisations in Europe. BMC Medicine. 2007;5;11. doi:10.1186/1741-7015-5-11
- Hurel, S. Rapport sur la politique vaccinale [rapport public]. 2016, January. Retrieved March 30, 2017, from http://www.ladocumentationfrancaise.fr/rapports-publics/164000033/index.shtml
- HCSP. Pour une amélioration de la politique vaccinale en France. Paris: Haut Conseil de la Santé Publique. 2012, Retrieved from http://www.hcsp.fr/explore.cgi/avisrapportsdomaine?clefr = 271
- Taddio, A., Appleton, M., Bortolussi, R., Chambers, C., Dubey, V., Halperin, S., Hanrahan A, Ipp M, Lockett D, MacDonald N, et al. Reducing the pain of childhood vaccination: an evidence-based clinical practice guideline. Can. Med. Assoc. J. 2010;182(18):E843–E855. doi:10.1503/cmaj.101720
- Harvey, H., Reissland, N., Mason, J. Parental reminder, recall and educational interventions to improve early childhood immunisation uptake: A systematic review and meta-analysis. Vaccine. 2015;33(25):2862–80. doi:10.1016/j.vaccine.2015.04.085
- Domek, G. J., Contreras-Roldan, I. L., O'Leary, S. T., Bull, S., Furniss, A., Kempe, A., Asturias, E. J. SMS text message reminders to improve infant vaccination coverage in Guatemala: A pilot randomized controlled trial. Vaccine. 2016;34(21):2437–43. doi:10.1016/j.vaccine.2016.03.065
- Willis, N., Hill, S., Kaufman, J., Lewin, S., Kis-Rigo, J., De Castro Freire, S. B., Bosch-Capblanch X, Glenton C, Lin V, Robinson P, et al. “Communicate to vaccinate”: the development of a taxonomy of communication interventions to improve routine childhood vaccination. BMC Int. Health Human Right. 2013;13:23. doi:10.1186/1472-698X-13-23
- World Health Organization. The guide to Tailoring Immunization Programmes (TIP). 2013
- Guthmann, J.-P., Fonteneau, L., Desplanques, L., Lévy-Bruhl, D. Couverture vaccinale BCG chez les enfants nés après la suspension de l'obligation vaccinale et suivis dans les PMI de France : enquête nationale 2009. Arch Pediatr. 2010;17(9):1281–7. doi:10.1016/j.arcped.2010.05.013
- Martinot, A., Cohen, R., Denis, F., Gaudelus, J., Lery, T., Lepetit, H., Stahl, J.-P. Évolution du taux de couverture vaccinale des enfants de moins de 7ans en France après publication du calendrier vaccinal 2013. Archives de Pédiatrie. 2014;21(12):1389–90. doi:10.1016/j.arcped.2014.08.001
- Biasio, L. R., Carducci, A., Fara, G. M., Giammanco, G., Lopalco, P. Health Literacy, Emotionality, Scientific Evidence Elements Of An Effective Communication In Public Health. Hum Vaccin Immunother. 2018;0. doi:10.1080/21645515.2018.1434382
- Biasio, L. R. Vaccine hesitancy and health literacy. Hum Vaccin Immunother. 2016;13(3):701–2. doi:10.1080/21645515.2016.1243633
- Debussche, X., Corbeau, C., Caroupin, J., Fassier, M., Ballet, D., Balcou-Debussche, M., Boegner, C. Littératie en santé et précarité : optimiser l'accès à l'information et aux services en santé. L'expérience de Solidarité Diabète. Médecine Des Maladies Métaboliques. 2017;11(8):739–44. doi:10.1016/S1957-2557(17)30179-7
- Debussche, X., Balcou-Debussche, M., Osborne, R. CA-090: La littératie en santé : un outil pour une meilleure accessibilité dans le diabète de type 2. Diabetes Metab. 2016;42:A59–A60. doi:10.1016/S1262-3636(16)30222-1
- Karafillakis, E., Dinca, I., Apfel, F., Cecconi, S., Wűrz, A., Takacs, J., Suk J, Celentano LP, Kramarz P, Larson HJ. Vaccine hesitancy among healthcare workers in Europe: A qualitative study. Vaccine. 2016;34(41):5013–20. doi:10.1016/j.vaccine.2016.08.029
- Belmin, Joel, Bourée, P., Camus, D., Guiso, N., Jeandel, C., Trivalle, C., Veyssier, P. Vaccination in older adults: development of an educational tool, Vaxisenior, in France. Expert Rev Vaccines. 2010;9(sup3):15–20. doi:10.1586/erv.10.29
- Dubé, E., Gagnon, D., MacDonald, N. E., SAGE Working Group on Vaccine Hesitancy. Strategies intended to address vaccine hesitancy: Review of published reviews. Vaccine. 2015;33(34):4191–203. doi:10.1016/j.vaccine.2015.04.041
- Simplification et évolution majeure du calendrier … – MesVaccins.net. 2013, April 18. Retrieved February 1, 2018, from https://www.mesvaccins.net/web/news/4037-simplification-et-evolution-majeure-du-calendrier-vaccinal-francais-2013
- Vaccination des nourrissons : quels changements en 2018 ? 2018, May 1. Retrieved February 18, 2018, from https://www.ameli.fr/assure/actualites/vaccination-des-nourrissons-quels-changements-en-2018
- HCSP. Avis relatif à la vaccination anti- Méningococcique C. Paris: Haut Conseil de la santé publique. 2016.
- Levy-Bruhl, D., Perrocheau, A., Mora, M., Taha, M. K., Dromell-Chabrier, S., Beytout, J., Quatresous, I. Vaccination campaign following an increase in incidence of serogroup C meningococcal diseases in the department of Puy-de-Dôme (France). Euro Surveill. 2002;7(5):74–76.
- Krypciak, S., Liuu, E., Vincenot, M., Landelle, C., Lesprit, P., Cariot, MA., Mézière, A, Taillandier-Hériche, E, Leroux, JL, Canoui-Poitrine, F, et al. Improvement of pneumococcal immunization coverage in older patients. Rev Med Interne. 2015;36(4):243–7.
- Baudier, F., Tarrapey, F., Leboube, G. Pilot campaign to promote vaccination: description preliminary results of a regional French program. Med Mal Infect. 2007;37(6):331–6.
- Rothan-Tondeur, M., Filali-Zegzouti, Y., Golmard, J. L., De Wazieres, B., Piette, F., Carrat, F., Lejeune, B., Gavazzi, G. Randomised active programs on healthcareworkers' flu vaccination in geriatric health care settings in France: The VESTA study. J Nutr Health Aging. 2011;15(2):126–32.