Shaping pneumococcal vaccine policy in France: evidence from literature review and dynamic modelling

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.