Development of the vaccine policy in France

The development of the vaccine policy takes account of the technical projections in this field (many these last years in particular thanks to biotechnologies), of the evolution of the epidemiologic characteristics of the diseases in France, but also in the foreign countries (because of the multiplication of international displacements), of the international recommendations (in particular of WHO), of the evaluation of the benefit-risks ratio of vaccinations, the organization of the system of care and prevention.

To carry out its missions, Ctv-cshpf is based on a multi-field expertise (infectiology, pediatry, immunology, microbiology, epidemiology, public health, pharmacoepidemiology, general medicine, occupational medicine) supplemented that of the agencies (AFSSAPS, InVS), national centers of reference for the transmissible diseases. Its technical secretariat is ensured by the Directorate-General of Health (DGS). In addition, other authorities intervene in the procedure of marketing of a vaccine: commission of marketing authorization, the commission of transparency, the economic committee of the drug for the fixing of the price.

Implementation of the vaccine policy

Diffusion of the vaccine recommendations
They are formalized in the vaccine calendar, published in the Official Bulletin of the Ministry in charge of health. This calendar is very widely diffused with the professionals of health via the national Institute of prevention and education for health (INPES, old CFES), within the framework of the promotion campaigns of vaccination in connection with the organizations of social protection.

Promotion campaigns of vaccination
They can relate to vaccination in general, but also to be targeted on certain vaccinations (measles-mump-rubella, influenza…). They are financed by the national Fund of prevention, education and information for the health (FNPEIS) of the National Case of Sickness insurance of the Persons Employed (CNAMTS) and carried out by the INPES. They are addressed to general public, either directly by messages using the various media (newspaper industry, television…), or indirectly by relays [ services of promotion of health in favour of the pupils of national Education, services of mother and infant welfare (SME) of the general Councils… ] and by the doctors who are specific recipients of documents (scientific Letter of Vaccination, for example). Various supports (booklets, plates, posters) are regularly published and are available on request) to the INPES.

The realization of vaccinations
The large majority of vaccinations is carried out by the liberal doctors, generally general practitioners or specialists (pediatrists).
In each department, obligatory vaccinations, but also of vaccinations recommended must be able to be carried out free by the departmental services of vaccination or the services of SME. The list of these centers can be obtained from the general Councils or from the town halls.

On the level of each department are organized:

- the services of vaccinations, concerning the General Council, ensure the organization of it. The departments directly propose meetings of free vaccinations or in collaboration with the communes or other organizations. If the texts in force refer to obligatory vaccinations, the most recent vaccines being the subject of a simple recommendation are frequently integrated into the departmental devices.

- services of mother and infant welfare: the law of December 18, 1989 relating to the mother and infant welfare defines the missions of this service. It organizes premarital, antenatal and postnatal consultations, consultations and medico-social actions of prevention in favour of the children of less than 6 years.Vaccinations are ensured during the consultations of infantile protection (article R. 2112-3 of the code of the public health). In addition, the centers of consultations of planning inform their patients and the rubella vaccinations propose to them and hepatitis B at the time of the visits for a contraception or trackings of sexually transmitted diseases.
The service of SME collects and treats the epidemiologic data provided by the certificates of health during the obligatory examinations of the mother and the child. The certificates of health of the twenty-fourth month and the medical check-ups at four years in nursery school are regularly used for the evaluation of the vaccine covers.

- other services contribute to the realization of vaccinations:services of promotion of health in favour of the pupils, services of occupational medicine, centers of vaccination for the travellers…

The assumption of responsibility of vaccinations
Any person can profit free from obligatory vaccinations, as well as certain vaccinations recommended, in the departmental services of vaccination. The services of SME practise free the vaccinations obligatory and recommended in nourrissons.
Obligatory vaccinations for certain professions or the students in these professions are with the load of the employer or the school establishment. They can then be carried out by the services of occupational medicine, of the medicine of prevention (school medicine or academic).

Obligatory and unquestionable vaccinations of those which are recommended are dealt with by the schemes of health insurance, the rate of refunding is 65 %. the principle of the assumption of responsibility by the health insurance of vaccinations to the title of the legal services was determined by the law n° 95-14 of February 4, 1995. The request for inscription to the list of the refundable specialities by the sickness insurance must be made by the producing laboratory. The list of the vaccinations dealt with is drawn up by decree, after opinion of the Commission of the transparency. The public price of the vaccine is then fixed after opinion of the economic Committee of the drug. The vaccinations currently dealt with are those against the whooping-cough, the diphteria, hepatitis B, the infections with  Haemophilus influenzae  B, the mumps, the poliomyelitis, measles, rubella, tetanus, tuberculosis, the invasive infections with pneumococci and méningocoques (within the framework of the recommendations of the CSHPF).

The vaccine against the influenza is proposed free with certain groups of population by the sending of a good (social policy-holders as from 65 years like with the policy-holders presenting certain pathologies of long duration).

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