In a recommendation on the evaluation of the relevance of compulsory vaccination against influenza, the High Authority for Health considers that anti-flu vaccination for people aged 65 and over living in a community must remain recommended without becoming compulsory. On the other hand, it recommends the establishment of a vaccination obligation. for all healthcare professionals, as well as other professionals working in healthcare establishments or in social medical establishments housing elderly people, in contact with people at risk of severe influenza, with priority deployment in nursing homes and USLDs. Communiqué.
Each year, seasonal flu causes a significant number of hospitalizations and deaths among older adults. It was thus the cause of around 53,000 hospitalizations including 26,500 among those aged 65 and over in 2023-2024, and 92,000 hospitalizations and excess mortality of around 17,000 deaths in 2024-2025. Nine out of ten deaths concern people aged 65 and over, and mainly those aged 75 and over. However, the burden of influenza has long been underestimated due to the absence and/or low use of diagnostic tests before the Covid-19 pandemic, but also due to the recent recognition of the role of influenza in the aggravation of chronic diseases, particularly cardiac ones.
As the flu season is concentrated over a period of 10 to 12 weeks, it also causes strong tensions on the healthcare system to the point of causing exceptional measures (deprogramming, white plans, etc.). Added to this are the risks – also underestimated for a long time before the pandemic – of transmission of the virus within hospital or medico-social establishments. welcoming vulnerable people likely to develop severe forms. This risk is all the more significant as there are more and more vulnerable people in health establishments, across all hospital services. In 2022, people aged 65 and over and immunocompromised people represented 58% and 11% of people hospitalized, respectively(1).
It is in this context that the HAS, contacted by the ministers responsible for Health to assess the relevance of establishing compulsory vaccination against seasonal flu among people aged 65 and over residing in accommodation establishments for dependent elderly people (Ehpad), among self-employed health professionals and staff of health and medico-social establishments, is today issuing its opinion.
Flu vaccination remains recommended for those aged 65 and over in the community
At the end of its analysis, the HAS does not recommend the implementation of an annual influenza vaccination obligation for people aged 65 and over residing in a community. It proposes maintaining the existing influenza vaccination recommendation, for this population, according to the terms provided for by the current vaccination schedule.
HAS took into consideration the already high vaccination coverage rate of people aged 65 and over residing in communities (82.7%), higher than the threshold of 75% recommended by the World Health Organization (WHO) as well as the reservations mainly expressed by stakeholders and experts regarding compulsory vaccination for these people. The ethical requirements governing the use of compulsory vaccination when it concerns residents of nursing homes, establishments constituting real living spaces, were also taken into consideration.
HAS calls for maintain incentive measures for vaccination of people aged 65 and over and strengthen use additional means of prevention. The necessary efforts concern both the operation of establishments (good ventilation of spaces, isolation of sick people, etc.), and all the people who access them (wearing a mask, hand hygiene, use of disposable tissues, etc.).
A progressive annual vaccination obligation for professionals to protect the most vulnerable people
Concerning professionals, the HAS recommends the establishment of an annual flu vaccination obligation, on the one hand, for all health professionals (employees and/or self-employed), on the other hand, for other professionals in health establishments and medico-social establishments housing elderly people, in contact with people at risk of severe form of influenza. For consistency, the HAS recommends the implementation of the same vaccination obligation for pupils and students in medical and paramedical sectors.
To develop its opinion, the HAS relied in particular on the extent of the health burden of seasonal influenza described previously, but also on the increased risk of influenza among professionals, and of transmission in healthcare and medico-social environments from these professionals to people being treated or accommodated. It also took into account the effectiveness and safety of influenza vaccines and the expected benefit of an increase in vaccination coverage among professionals on the health of those in care. Furthermore, she recalls that no study has identified an alternative to vaccination to reduce the incidence of influenza in healthcare establishments or nursing homes; barrier measures do not replace vaccination although they are complementary to it.
The HAS has also noted that despite the recommendations that have existed for many years and the incentive measures put in place, anti-flu vaccination coverage for professionals is not increasing and remains largely insufficient (20% in health establishments and 21% in nursing homes during the 2024-2025 season). It took into account the position of the WHO as well as foreign experiences (Finland and the United States) which demonstrated the rapid and lasting effectiveness of compulsory influenza vaccination for professionals to increase vaccination rates to levels above 90%; and also French surveys published between 2024 and 2025 showing that a majority of professionals and the general population were in favor of such an obligation in order to strengthen the safety of care. The duty of exemplarity, ethics and professional responsibility, as well as the need to ensure the protection of people in care and the consistency of public health messages conveyed by health professionals was also highlighted by several professional organizations interviewed by the HAS, and taken into account in the opinion.
The HAS recommends the priority deployment of this obligation in nursing homes and in long-term care units (USLD) given the particular vulnerability of the people accommodated due to their age (75% of residents are 75 and over) and their exposure to particularly close, repeated and prolonged contact with caregivers. In addition, vaccination protects them less well from influenza than caregivers, because the capacity for immune response decreases with age (immunsenescence), with differences in effectiveness ranging from 20 to 40 points depending on the year. This explains why the high vaccination coverage of residents (82.7%) is not enough to prevent the frequent occurrence of influenza episodes (cluster) in nursing homes associated with a high risk of serious forms and mortality among residents (6% vs. 0.1% for caregivers). This risk is reinforced by the difficulties in implementing certain prevention measures, in particular wearing a mask during meals and other activities of daily life. Several studies, specific to nursing homes, show that vaccination of professionals helps protect residents by reducing respiratory infections and mortality. These data encourage a rapid increase in vaccination coverage for professionals working in nursing homes, which has been insufficient for many years (21% in 2024-25).
In other places affected by the flu vaccination obligation (health establishments, other medico-social establishments housing elderly people, professional practice structures, etc.),HAS recommends a gradual deployment over a period of two years, renewable for one year, within a concerted framework, in order to guarantee the feasibility and acceptability of the measure. This period will make it possible to define in these establishments and in consultation with local stakeholders, the professionals concerned by the vaccination obligation and possibly priorities based on the profile of the patients received (high risk of severe forms). Similar actions could be carried out within private practice structures, involving local and regional stakeholders. HAS will be able to provide scientific support for the smooth running of this phase.
To optimize the proper deployment of these recommendations, the HAS underlines the need to ensure the availability of vaccines, a surveillance system allowing in particular the traceability of vaccinations and the definition of an appropriate regulatory framework. HAS reminds that the definition of people at risk of severe form of influenza is available in the vaccination schedule set by the Ministry of Health.
These recommendations may be updated in light of available data.
Seasonal flu: Assessment of the relevance of a vaccination obligation, HAS, July 20, 2026
