France Vaccine Schedule: Mandatory Vaccines and Boosters

France requires 11 vaccinations for all children born after January 1, 2018, making it one of the more comprehensive mandatory childhood vaccination programs in Europe. Before 2018, only three vaccines were legally required: diphtheria, tetanus, and polio. The expansion added eight more, covering diseases from measles to meningitis, and reshaped how families, schools, and healthcare providers approach immunization across the country. Beyond childhood, the French schedule includes recommended boosters for adults, new protections for pregnant women, a pioneering RSV prevention campaign for newborns, and annual vaccinations for older adults.

The Eleven Mandatory Childhood Vaccines

On December 4, 2017, French lawmakers passed a law extending childhood vaccination mandates from three to eleven. The new law applies to every child born on or after January 1, 2018. The three previously mandatory vaccines (diphtheria, tetanus, and poliomyelitis) were joined by vaccinations against pertussis (whooping cough), Haemophilus influenzae type b, hepatitis B, pneumococcal disease, meningococcal C disease, measles, mumps, and rubella.¹

The enforcement mechanism is distinctive. Parents who skip the required vaccinations are not fined. Instead, unvaccinated children cannot be admitted to collective childcare services, nurseries, or schools. This approach uses access to public services as the incentive rather than financial penalties, and it has proven effective at raising uptake rates in the years since the mandate took effect.²

How the Childhood Schedule Is Timed

Most of the mandatory vaccines in France are delivered through combination products, which means fewer injections for the child. A hexavalent vaccine, covering diphtheria, tetanus, pertussis, polio, hepatitis B, and Haemophilus influenzae b, is given in a “2+1” schedule: two primary doses and a booster. The primary doses are administered at roughly two and four months of age, with the booster following at eleven to twelve months.³

The pneumococcal conjugate vaccine follows a similar 2+1 pattern during the first year. The MMR (measles, mumps, rubella) vaccine is typically given as a first dose at twelve months and a second dose a few months later, usually between sixteen and eighteen months. This means that by the time a French child turns two, all eleven mandatory vaccinations should be complete.

Meningococcal Vaccination and Ongoing Changes

Meningococcal C vaccination was initially introduced in France in 2010 as a single dose at twelve months, with a catch-up campaign targeting people under twenty-five. The idea was to build enough herd immunity to protect younger children indirectly. That strategy did not pan out as hoped: vaccine uptake among adolescents and young adults stayed too low, and an increase in meningococcal disease among infants was observed between 2011 and 2016. France responded by adding a dose at five months and then, in 2018, folded both meningococcal C doses into the mandatory schedule.⁴

The meningococcal landscape in France has continued to shift. Roughly 500 cases of invasive meningococcal disease occur each year. Since mandatory vaccination against serogroup C brought those particular cases down, the majority of remaining disease now involves serogroups B, W, and Y.⁵ This has prompted the French National Authority for Health to reconsider its recommendations. There is growing support for switching from the meningococcal C vaccine to a quadrivalent ACWY vaccine for both infants and adolescents, and for adding a meningococcal B vaccine to the infant schedule.⁶ This is an area where the schedule is actively evolving, so parents and providers should watch for updated guidance.

HPV Vaccination for Adolescents

Human papillomavirus (HPV) vaccination is recommended in France but not mandatory. Coverage historically lagged behind targets, so in 2023 the government launched a nationwide free HPV vaccination campaign in schools, targeting students aged twelve to thirteen.⁷ The campaign aims to close the gap between France and countries with higher HPV vaccination rates.

Research on the school-based approach has shown promising results. A cluster randomized trial found that offering vaccination at school increased coverage by about five and a half percentage points overall. The benefit was even larger in areas with poor access to family doctors, where school-based vaccination raised coverage by more than eight percentage points compared to control areas. Interestingly, educational campaigns aimed at motivating adolescents or training for general practitioners did not move the needle much on their own; the physical convenience of in-school vaccination was what made the difference.⁸

Adult Boosters

The French schedule does not end with childhood. Adults are recommended to receive boosters for diphtheria, tetanus, pertussis, and polio at fixed ages, with the first adult booster at age twenty-five and subsequent ones at forty-five and sixty-five, then every ten years after that. Coverage at age twenty-five has been historically low. A study of an awareness campaign run by the French national health insurance found that only about seventeen percent of targeted twenty-five-year-olds who received campaign materials actually got their booster. However, among those who visited a general practitioner during the study period, the vaccination rate was roughly double in the group that received campaign reminders compared to the control group.⁹ The takeaway is that reminders help, but only if people are already seeing their doctor. Reaching young adults who do not visit a GP regularly remains a challenge.

Vaccination During Pregnancy

France added a pertussis vaccination recommendation for pregnant women in 2022, aligning with practices already established in several other countries.¹⁰ The goal is to transfer protective antibodies to the baby before birth, bridging the gap between delivery and the infant’s first pertussis-containing vaccination at two months. Seasonal influenza vaccination is also recommended for pregnant women during the flu season, and COVID-19 vaccination has been recommended for those at higher risk.

RSV Prevention for Newborns

One of the most notable recent additions to the French immunization landscape is not a traditional vaccine at all. In September 2023, France became one of the first countries to launch a national immunization campaign with nirsevimab, a monoclonal antibody that protects infants against respiratory syncytial virus (RSV).¹¹ RSV is a leading cause of bronchiolitis in infants, and until recently there was no widely available preventive option beyond an older, costly antibody reserved for high-risk premature babies.

Nirsevimab is given as a single injection, and France chose to administer it before maternity unit discharge, free of charge. A study at one French perinatal center found that nearly 88 percent of eligible newborns received the injection, with the median age at administration being less than three days old. The free cost and the convenience of in-hospital delivery were credited for the high uptake.¹²

Real-world effectiveness data from the first French campaign season has been encouraging. One analysis estimated that nirsevimab was about 76 to 81 percent effective at preventing RSV bronchiolitis cases serious enough to require pediatric intensive care.¹³ A larger nationwide study found about 65 percent effectiveness against all RSV-related hospitalizations, with higher protection (around 74 percent) against admissions to pediatric intensive care specifically.¹⁴ These numbers confirmed what clinical trials had predicted and established France’s campaign as a model that other countries are watching closely.

Vaccinations for Older Adults

For people aged sixty-five and over, the French schedule recommends annual influenza vaccination and, more recently, COVID-19 vaccination. Since the 2022–2023 season, France has supported co-administration of influenza and COVID-19 vaccines during autumn campaigns, particularly targeting healthcare workers and people at risk of severe disease.¹⁵ A systematic review found no safety concerns and no interference between the immune responses to the two vaccines, regardless of age group.¹⁶ The co-administration strategy is now standard across France and most other EU countries, the UK, the US, and Canada.¹⁷

Older adults are also recommended to receive a shingles vaccine and pneumococcal vaccine, with the pneumococcal vaccine particularly aimed at those with chronic conditions that increase their risk of invasive pneumococcal disease.

Who Decides What Goes on the Schedule

The French National Authority for Health, known by its French acronym HAS (Haute Autorité de santé), plays the central role in shaping vaccine policy. HAS performs clinical assessments of vaccines and, when it recommends one, its Transparency Commission and the economic committee on drugs decide whether and how the vaccine is reimbursed by the public healthcare system.¹⁸ Every health technology reimbursed in France, including vaccines, goes through this assessment process.¹⁹

This centralized process means that when HAS updates a recommendation, it cascades through the entire public health system. The shift from meningococcal C to a broader meningococcal ACWY approach is a current example of HAS reassessing recommendations in light of changing disease patterns.

Pharmacists Can Now Vaccinate

Historically, most vaccinations in France happened at a doctor’s office. That began to change in 2022, when HAS extended vaccination competencies, including both prescribing and administering vaccines, to community pharmacists. The move was designed to simplify access and boost coverage rates. Modeling suggests that with pharmacists playing an increasing role, France could reach an 80 percent vaccination coverage target by 2030, two years sooner than under the previous doctor-only model, while saving the national health insurance system an estimated €212 million. The expanded role would also free up roughly 603,000 GP consultations per year nationwide.²⁰

For families, this means that getting certain vaccines no longer requires a separate doctor’s appointment. Pharmacies already handle flu shots widely, and the scope of what pharmacists can administer continues to grow. This has been especially welcome in rural areas or regions with fewer GPs.

Catch-Up Schedules for Children Arriving in France

Children who arrive in France through adoption, as refugees, or as migrants often have incomplete or undocumented vaccination histories. The catch-up process is not one-size-fits-all: it depends on the child’s age, their country of origin, and sometimes serology (blood tests to check for existing immunity) when there is doubt about what vaccines were previously received. The goal is to bring the child’s vaccinations in line with the French schedule while avoiding unnecessary repeat doses of vaccines they may have already received.²¹

This is an area where providers need to exercise clinical judgment. Vaccination records from some countries may be unreliable or use different vaccine products, and the catch-up schedule has to account for minimum intervals between doses. French guidelines provide detailed protocols for each scenario, but the process can take several months and requires careful tracking.

Vaccine Hesitancy in France

France has long had one of the highest rates of vaccine hesitancy in Europe, which is part of why the government chose to mandate rather than merely recommend childhood vaccinations. Research into the roots of French vaccine hesitancy points to two major drivers: low trust in institutions and a preference for getting health information from social media. A nationally representative study found that both factors independently predicted hesitancy, but social media’s influence operated largely through eroding institutional trust rather than spreading specific misinformation directly.²²

The 2018 mandate was partly a response to this dynamic. Rather than trying to persuade hesitant parents through information campaigns alone, the law created a practical requirement tied to school enrollment. The approach has drawn both praise for raising uptake and criticism from those who see it as an overreach. France’s mandate sits within a broader European trend: Italy, Germany, and several other countries introduced or tightened their own vaccine requirements around the same time.²³

The tension between public health imperatives and individual choice remains a live issue in French society. But the early data from the post-2018 era suggest that the mandate succeeded in raising childhood vaccination rates substantially, even among families who expressed skepticism. Whether France eventually extends mandatory status to additional vaccines, as the meningococcal B discussion suggests might happen, will depend on how the ongoing balance between coverage goals and public acceptance plays out.