VACCINATION AGAINST

COVID-19

Favourable overall results,

persistent disparities

Public thematic report

December 2022

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Executive summary

The Covid-19 vaccination campaign must be analysed in the light of its unprecedented

nature. Given the early availability of the first, often innovative, vaccines, it began within months

of the pandemic becoming global. After a slow start due to logistical and organisational

difficulties, the programme has been continuously adapted to take into account the gradual

availability of vaccines, the difficulties in deploying them throughout the country during the first

few months and the successive waves of the epidemic.

Main stages of the vaccination campaign

9 July 2020

:

joint opinion of the analysis, research and expertise committee (CARE), the Covid-

19 scientific committee and the Covid-19 vaccine committee on a vaccination strategy.

22 July 2020

:

anticipation of possible vaccination scenarios and preliminary recommendations on

target populations from the French National Authority for Health (HAS).

27 November 2020

:

preliminary recommendations from the HAS for a five-phase vaccination, in

the context of the initial knowledge of the conditions for handling vaccines and their gradual availability.

3 December 2020:

announcement of a vaccination strategy by the Government prioritising the

protection of the most vulnerable and the health system.

End of December 2020

:

market authorisation for the Pfizer vaccine (21 December) and launch of

the vaccination campaign in nursing homes (27 December).

Early January 2021

:

Government announcement of an acceleration in the pace of vaccination, by

anticipating the eligibility of people over 75 years of age for vaccination from 18 January 2021;

establishment of vaccination centres; marketing authorisation for the Moderna vaccine.

February 2021:

market authorisation for the AstraZeneca vaccine; start of vaccination by city

medicine.

March 2021:

Expansion of prescribing skills for vaccinators (pharmacists, midwives, then nurses);

launch of vaccination in pharmacies.

May 2021:

end of vaccine shortage, successive expansion of vaccination targets; from 31 May

2021, all adults can be vaccinated.

15 June 2021

:

all people aged 12 and over become eligible for vaccination.

12 July 2021

:

announcement by the President of the Republic of the expansion of the health pass

and of the vaccination obligation of healthcare professionals and the medico-social sector.

September 2021:

start of the booster campaign.

End of December 2021

:

opening of vaccination to children aged 5 to 11.

March and April 2022

:

respective openings of the second booster campaign for people over 80

and for those 60 and over, followed by a gradual expansion of the population of eligible people.

Targeted from its start, in December 2020, at the population groups most exposed to

severe forms of Covid-19, in particular residents in nursing homes, the vaccination was made

progressively, but rapidly, accessible to the entire population aged 12 and over from spring

2021.

The content of the vaccination has itself gone through three phases: the initial scheme,

consisting of two first doses; the first booster campaign which supplements it; and the

expansions, at the end of 2021 for children aged 5 to 11 and in the spring of 2022 for the

second booster dedicated primarily to the elderly.

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Solid results on the initial two-dose vaccination scheme

By the beginning of September 2022, approximately 79% of the French population had

received the initial vaccination. This level exceeds that of several large countries (such as

Germany), some of which began vaccination earlier than France (United States and United

Kingdom), while being less favourable than that of southern European countries (Portugal,

Spain and Italy).

Coverage rate (initial two-dose scheme) by country (in % of total population)

Source: Our World in Data (Owid)

–

Court of Accounts calculations and graphs

–

data halted between

19 and 30 August 2022 depending on the country

However, in order to be properly assessed, the number of people who received the initial

two-dose vaccination must be related only to the population eligible for vaccination. Using

adults and adolescents aged 12 and over as a reference, 90.6% of the eligible population

received two doses of vaccine.

The objective of almost complete vaccination coverage of the population, excluding

children, on the initial scheme, is therefore not far from being achieved. Similarly, by the

beginning of September 2022, at least 90% of those eligible for the first booster had done so;

this rate takes into account an estimate of those infected who did not need the booster.

Non-vaccinations are therefore lower than the most publicised rates of initial vaccination

and first booster in the general population (close to 79% and 60% respectively) might suggest.

Although the refusal to vaccinate has been widely publicised in the media, a large proportion

of the French population has been vaccinated, either spontaneously or by being encouraged

to do so by the health and vaccination pass, as in several other European countries.

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Comparison of vaccination rates under the initial two-dose scheme for the general

population and for the eligible population only (aged 12 and over)

Source: CNAM data

–

Court of Accounts calculations and graph

–

Data as of 4 September 2022

The cost to the French national health insurance organisation of vaccination is high in

absolute terms (€7.6 billion for 2020 to 2022, including €4.7 billion for 2020 and 2021).

This amount must be put into perspective for several reasons.

It represents about 15% of the total health insurance expenditure directly attributable to

the health crisis (about €48 billi

on in total recorded for 2020 and 2021 or forecast for 2022).

In addition, the increase in vaccination has allowed the government to reduce the need

for costly measures to restrict economic activity (loss of revenue and subsidies to businesses

and households) in order to prevent the risk of overwhelming the health system with Covid-19

patients.

Above all, vaccination has a positive impact on the health status of the population. It has

reduced the number of hospital admissions and, according to the WHO, prevented 38,700

deaths of people aged 60 and over in France (between December 2020 and November 2021).

Persistent weaknesses, expansions not finding their audience

Among adults and adolescents, vaccination rates are heterogeneous according to

territories and social conditions.

Particularly vulnerable, and as such a prime target for the vaccination strategy, the

population aged 80 and over is less well vaccinated than other adults (88% for the initial

scheme compared to 89.5%). The gap widens as age increases. It seems to reflect isolation,

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reduced mobility or the difficulty of making an appointment via the Internet, which would justify

increased intervention by private nurses in patients

’

homes.

Similarly, there have been gaps in the monitoring of people with conditions that increase

the risk of severe forms of Covid-19. This is particularly the case for people on dialysis, which

is all the less understandable as they have regular contact with the health system.

Lastly, the latest expansions of vaccination have not found their audience. The

vaccination rate for children aged 5 to 11 remains very low (less than 5% in total), which helps

to explain the vaccination gap in the general population compared to southern European

countries. As of 2 November 2022, the modest second booster figures for people aged 60 and

over (33.6% in total) are worrying, in an autumn context favourable to a resumption of the

epidemic.

Number of people vaccinated with a second booster

Source: FPS data as of 2 November 2022 and Court of Accounts graph

In the autumn of 2022, therefore, the purposes of vaccination should not be forgotten on

the grounds of satisfactory overall levels of the first two doses and their first booster.

The organisation of the vaccination campaign: lessons to be learned

The pooling of vaccine purchases by the European Union was a key factor in the Covid-

19 vaccination campaign conducted in France, in particular by preventing bidding and

crowding out between European countries. The prevention of other large-scale epidemics

would likewise require organised responses at European level.

Given their congregation in collective living areas and their state of health, residents in

nursing homes are a key target for vaccination against Covid-19. The supply of vaccines to

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nursing homes was partly based on hospital pharmacies, in derogation of the common law

circuit of wholesale distributors and pharmacies.

Vaccinations by vaccination site (cumulative over the campaign)

Source: CNAM data under data.gouv

–

Court of Accounts graph

–

data from September 2022

Note: other locations: businesses and others.

To define the vaccination policy, the government relied on the French National Authority

for Health, but also, on the grounds of urgency, on other bodies specially created for this

purpose. As a result, there is a need to clarify the procedures that will enable the HAS to carry

out all its tasks relating to vaccination in contexts of great urgency.

The vaccination against Covid-19 mobilised a large number of contributors: vaccination

centres, pharmacists, doctors and nurses. In order to ensure rapid scaling up of vaccination in

other circumstances, a pool of vaccinators (just over 128,000 for Covid-19) should be identified

beforehand. In addition, the role of each contributor should be better defined, to ensure wider

vaccination coverage of the elderly or frail by doctors and nurses.

The organisation of the vaccination campaign against Covid-19 took into account the

weight of social inequalities in access to health, in particular by developing actions to reach

out to people who are far from prevention or care (often referred to as

“go

-

to” approa

ch). Other

actions of this nature are intended to be implemented in the broader field of preventive health

care.

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The fact that the national health insurance organisation sends lists of their patients

concerned by preventive measures for the main diseases to the doctors treating them is a step

forward that should be continued.

Lastly, the roll-out of Covid-19 vaccination has been accompanied by a large amount of

public data being made available online. Access to public data on vaccination against various

diseases should be further improved.