A way to reduce the transmission of influenza to vulnerable people or a not so effective lever? The outbreak of the epidemic and its strong impact on hospitals has relaunched in France the sensitive question of a possible vaccination obligation for caregivers.
For Health Minister Yannick Neuder, we must "ask ourselves the question of whether there is a vaccination obligation for healthcare workers", given the repercussions of a more severe flu this season, in order to prepare for autumn 2026, as he declared on France Info on Friday.
The requirement to be vaccinated against influenza had been in the law since 2005, but was suspended by decree in 2006, the High Council for Public Hygiene judging that it "risked undermining the adherence of professionals".
Since then, the anti-Covid vaccination required of caregivers under penalty of suspension during the pandemic, from autumn 2021 to spring 2023, has created significant tensions.
Strongly recommended by the authorities, influenza vaccination remains a minority among health professionals in France. Although the current proportion is not known, it was around 22 to 25% in previous seasons, a third of the objective of at least 75% set by the World Health Organization.
At the Assistance Publique-Hôpitaux de Paris, only 19% of caregivers have been vaccinated against the flu this season, according to the general director Nicolas Revel. Head of emergencies at the Delafontaine hospital (Seine-Saint-Denis), Mathias Wargon was upset to not count "even 10%" in his teams, saying he had "already heard nurses say: +If it were important, it would be mandatory+".
Four vaccines are currently mandatory for hospital and nursing home staff: diphtheria, tetanus, polio and hepatitis B.
During a trip to the Cochin hospital in Paris a week ago, Mr. Neuder had already estimated that "the question will arise" of a possible return of compulsory vaccination of caregivers against influenza.
If we must first ensure that each establishment promotes "all the conditions of access to vaccination" for caregivers, "we must not have any taboos", according to this cardiologist, who has tasked the High Authority of Health with "taking stock".
– “In the land of Pasteur” –
In the summer of 2023, this health authority considered that the "low coverage legitimately raises the question of compulsory vaccination" for caregivers against influenza, but did not recommend it.
To justify her position, she mentioned "the inconsistent effectiveness of influenza vaccination over the years" (from 40 to 75%, editor's note), and considered large-scale studies necessary to "verify and quantify the impact of the implementation of compulsory vaccination for health professionals on the burden of nosocomial influenza".
"We are not in a pandemic emergency here. Can't we demand scientific evidence?", epidemiologist Antoine Flahault, from the University of Geneva, said on X on Tuesday, for whom the obligation to vaccinate caregivers is "not conceivable in the absence of scientific proof of a reduction in the risk of influenza" transmitted in a hospital environment.
Conversely, the Academy of Medicine has been advocating for years for annual vaccinations against influenza and Covid to be mandatory for caregivers, considering that, "far from being an attack on individual freedom", they "do honor to their profession".
And for a long time, in France as in other countries, doctors have generally been more vaccinated than nurses, who have themselves been more vaccinated than nursing assistants.
"This 'professional gradient' is regularly analyzed solely with a view to better scientific training for doctors, but it is much more complex," sociologist Hugo Touzet, who participated in a study on "the human and social aspects of vaccination in France since Covid-19," told AFP.
Thus, "the deterioration of working conditions for nurses in hospitals - when they do not feel recognized, poorly paid - can generate mistrust towards health authorities and/or their hierarchy, which can affect their perception or their adherence to vaccines," he explained.
"Beyond an obligation, (...) what is very important is that we take up the issue of vaccination in our country," according to the head of AP-HP. For the Minister of Health, in the "country of Pasteur", there is still "a need for educational measures."
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