Shaping pneumococcal vaccine policy in France: evidence from literature review and dynamic modelling
Abstract
Invasive pneumococcal disease (IPD) remains a major public health burden in France, disproportionately affecting infants and older adults. Despite longstanding pneumococcal conjugate vaccine (PCV) programmes, serotype replacement continues to drive transmission. The availability of higher-valency PCVs (PCV20, PCV21) therefore calls for robust, context-specific population evidence. The French National Authority for Health applied a WHO‑aligned evidence‑to‑recommendation framework combining systematic literature review, expert input and a dynamic transmission model calibrated on national surveillance data (2001–2024). The model captures serotype replacement and indirect protection, enabling comparison of paediatric (PCV13/15/20) and adult (PCV20/21) strategies over 3–10‑year horizons. The literature review identified six paediatric PCV20 clinical trials and sixteen epidemiological and economic modelling studies. Randomized trials were at low risk of bias (ROB‑2), except for one non‑comparative study, and demonstrated non‑inferior immunogenicity of PCV20 and PCV21 versus established comparators. The model accurately reproduced long‑term serotype‑specific IPD trends in France over two decades. The most efficient strategy combined PCV20 in children and PCV21 in adults, projecting a 6% reduction in IPD incidence, severe sequelae and mortality over five years. Paediatric vaccination mainly contributed through indirect effects by reducing carriage and transmission. Explicitly accounting for serotype replacement was critical to differentiating strategies and their time‑dependent impact, consistent with other models, while outcomes depended on the French epidemiological context. Overall, integrating systematic review and dynamic modelling within a multi‑criteria evidence‑to‑recommendation framework provides decision‑relevant evidence to support a simplified pneumococcal vaccination programme in France based on one paediatric and one adult vaccine.
Key messages: • In France, IPD still heavily affects infants and older adults. Modelling shows higher-valency PCVs can better reduce disease burden, even as serotype replacement sustains transmission.
• Dynamic, context-specific modelling supports PCV20/21 use, capturing indirect effects and serotype shifts, and projecting greater population impact, with the largest benefits in older adults.
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- Invasive Pneumococcal Disease Presenting with Pyogenic Spondylitis in a Patient on Chronic Hemodialysis Who Previously Received a Pneumococcal Vaccine
- Recommendations for Adult Pneumococcal Vaccination in Korea: 2026 Update Incorporating the 21-Valent Pneumococcal Conjugate Vaccine.
BibTeX
@article{pini2026shaping,
title = {{Shaping pneumococcal vaccine policy in France: evidence from literature review and dynamic modelling}},
author = {M Pini and D Thorrington and A Maurin and L Temime and L Opatowski and D Smith and S Cauchemez and D Levy-Bruhl and A Lasserre and JC Lafarge},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.464},
url = {https://doi.org/10.1093/eurpub/ckag169.464},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Shaping pneumococcal vaccine policy in France: evidence from literature review and dynamic modelling
AU - M Pini
AU - D Thorrington
AU - A Maurin
AU - L Temime
AU - L Opatowski
AU - D Smith
AU - S Cauchemez
AU - D Levy-Bruhl
AU - A Lasserre
AU - JC Lafarge
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.464
UR - https://doi.org/10.1093/eurpub/ckag169.464
AB - Invasive pneumococcal disease (IPD) remains a major public health burden in France, disproportionately affecting infants and older adults. Despite longstanding pneumococcal conjugate vaccine (PCV) programmes, serotype replacement continues to drive transmission. The availability of higher-valency PCVs (PCV20, PCV21) therefore calls for robust, context-specific population evidence. The French National Authority for Health applied a WHO‑aligned evidence‑to‑recommendation framework combining systematic literature review, expert input and a dynamic transmission model calibrated on national surveillance data (2001–2024). The model captures serotype replacement and indirect protection, enabling comparison of paediatric (PCV13/15/20) and adult (PCV20/21) strategies over 3–10‑year horizons. The literature review identified six paediatric PCV20 clinical trials and sixteen epidemiological and economic modelling studies. Randomized trials were at low risk of bias (ROB‑2), except for one non‑comparative study, and demonstrated non‑inferior immunogenicity of PCV20 and PCV21 versus established comparators. The model accurately reproduced long‑term serotype‑specific IPD trends in France over two decades. The most efficient strategy combined PCV20 in children and PCV21 in adults, projecting a 6% reduction in IPD incidence, severe sequelae and mortality over five years. Paediatric vaccination mainly contributed through indirect effects by reducing carriage and transmission. Explicitly accounting for serotype replacement was critical to differentiating strategies and their time‑dependent impact, consistent with other models, while outcomes depended on the French epidemiological context. Overall, integrating systematic review and dynamic modelling within a multi‑criteria evidence‑to‑recommendation framework provides decision‑relevant evidence to support a simplified pneumococcal vaccination programme in France based on one paediatric and one adult vaccine. Key messages: • In France, IPD still heavily affects infants and older adults. Modelling shows higher-valency PCVs can better reduce disease burden, even as serotype replacement sustains transmission. • Dynamic, context-specific modelling supports PCV20/21 use, capturing indirect effects and serotype shifts, and projecting greater population impact, with the largest benefits in older adults.
SN - 1101-1262
SN - 1464-360X
ER -