In 2022, Santé publique France continued and continuously adapted its surveillance of the COVID-19 pandemic and expanded scientific knowledge:

• Production of weekly national and regional bulletins and provision of open-data indicators to track the pandemic and provide real-time information to decision-makers and the general public (virus circulation, COVID-19-related morbidity/mortality, impact on the healthcare system, vaccination, etc.).

• Launching or participating in numerous studies and research projects on the prevalence and impacts of COVID-19, including flash surveys, CoviPrev, APCOVID-19, and Coset-Covid, for example.

• Publication of an analysis of the medical causes of death among residents who died in France in 2020, in partnership with DREES and Inserm (CépiDc-Inserm), showing that the COVID-19 epidemic was the third leading cause of death, behind tumors and cardio-neuro-vascular diseases.

Winter outbreaks of bronchiolitis and influenza have been subject to increased surveillance and prevention measures due to an atypical epidemiological situation. While previous years were generally characterized by a succession of different respiratory viruses, the end of 2022 was marked by significant co-circulation of COVID-19, influenza, and bronchiolitis viruses.

• Publication of national and regional epidemiological surveillance bulletins for bronchiolitis, influenza, and acute gastroenteritis.

• Strengthening of prevention measures with the release of:

  • a brochure designed to provide parents with key information on bronchiolitis;

  • information resources on bronchiolitis and winter viruses that are accessible to everyone and translated into several languages;

  • prevention tools for healthcare professionals, including the brochure “Rotavirus Vaccination—Guidelines for Your Practice”

Several public health alerts marked the year 2022, leading to increased surveillance, the publication of situation reports, and a reminder of prevention recommendations:

• cases of pediatric hemolytic uremic syndrome (HUS) caused by E. coli infections linked to the consumption of Buitoni® brand Fraîch’Up pizzas;

• cases of salmonellosis linked to the consumption of Kinder brand products;

• cases of acute pediatric hepatitis of unknown origin;

• pediatric cases of invasive Group A streptococcal infections;

• cases of monkeypox reported in France and around the world.

To address the monkeypox outbreak in particular, Santé publique France has strengthened ongoing surveillance of the virus through mandatory reporting. Information and alert messages have also been sent to healthcare professionals. Prevention measures and an information and support system have been established, notably through the website sexosafe.fr and the “Monkeypox Info Service” hotline (toll-free number 0 801 90 80 69).

Each year, Santé publique France publishes annual surveillance data to support stakeholders in their prevention efforts.

In 2022, the agency reiterated the importance of testing for early HIV diagnosis and access to antiretroviral treatments, whose preventive effect has a direct impact on the dynamics of the epidemic. The agency is also implementing a targeted STI prevention strategy throughout the year, relying in particular on the sexosafe, onsexprime, and QuestionSexualité websites. In 2022, the agency is launching the PréVIST study, which will estimate the proportion of people carrying a sexually transmitted infection and examine the associated risk factors.

Since 2010, outbreaks of locally transmitted vector-borne diseases such as dengue, chikungunya, and Zika have gradually become commonplace. These outbreaks are expected to recur, increase in scale, and occur in new departments, particularly due to the impact of climate change.

From May 1 to November 30 each year, Santé publique France coordinates and publishes data from the enhanced seasonal surveillance of chikungunya, dengue, and Zika in metropolitan departments. The year 2022 was marked by an increase in locally transmitted dengue cases and an expansion of the risk across metropolitan France, with outbreaks occurring in departments that had previously been spared.

The Health Reserve, a community of volunteer healthcare professionals who can be mobilized by the government (doctors, nurses, laboratory technicians, radiology technicians, etc.), is tasked with responding to exceptional health crises. In 2022, the Health Reserve was extensively mobilized. It had 65,019 registered members on the platform representing 230 professions. 3,217 missions were carried out by 1,297 mobilized health reservists, representing 44,414 person-days, 69% of which were overseas.

The Health Reserve was notably involved during the testing phase to ensure the best possible preparation for the catch-up vaccination campaign in Mayotte, beginning in November 2022. Indeed, following the alarming results of the 2019 vaccination coverage survey in Mayotte, the Regional Health Agency and the Mayotte Education Office, in collaboration with the Association of Mayotte Mayors, are organizing a school-based catch-up vaccination campaign primarily targeting diphtheria, tetanus, polio, and pertussis. Nine reservists participated in this pilot program. The campaign will run throughout the first half of 2023.

To promote accurate information for everyone and encourage vaccination against infectious diseases such as COVID-19, the flu, and certain types of gastroenteritis, Santé publique France has made new resources available to as many people as possible: healthcare professionals, the general public, and vulnerable or disadvantaged groups. All information can be found at https://vaccination-info-service.fr

Bacterial resistance to antibiotics (or antibiotic resistance) is a natural phenomenon that is significantly accelerated by the use of antibiotics. With more than 5,500 deaths attributed to infections caused by multidrug-resistant bacteria in France in 2015, antibiotic resistance is a major public health issue. Santé publique France leads the epidemiological surveillance and prevention of antibiotic resistance in France and participates in European surveillance through various initiatives aimed at preserving the effectiveness of antibiotics.

In 2022, continuing the work of previous years, Santé publique France:

• Published annual data on antibiotic consumption and resistance during World Antimicrobial Awareness Week and European Antibiotic Awareness Day. In 2021, antibiotic consumption began to rise again, though it remained below 2019 levels.

• Launched the campaign “Antibiotics: Treating Yourself Right Means Using Them Right,” aimed at reminding the public that antibiotics are effective only against bacterial infections and should be taken only under medical supervision. This campaign is accompanied by new tools for healthcare professionals and the general public.

In 2022, the agency continued to generate knowledge to support initiatives addressing the health impacts of global warming by developing benchmark indicators and analyzing best practices in cities to improve on-the-ground action:

• Publication of the results of the study “Changes in the Temperature-Mortality Relationship in France Since 1970.” These results suggest a decrease in relative risks (RR) associated with extreme heat since the 1970s, and an increase in RR associated with extreme cold.

• Publication of an overview of municipal practices regarding heat adaptation measures in cities and heat prevention for schoolchildren, the homeless, and vulnerable individuals.

• Publication of the summer report on heatwave episodes as part of the annual monitoring and coordination of the Heatwave and Health Alert System in close collaboration with Météo France. The summer of 2022 ranks as the second-hottest summer recorded in France since the beginning of the 20th century. Three intense heatwave episodes marked the monitoring period. Excess mortality this year is the highest since the implementation of the National Heatwave Plan in 2004.

• April 8, 2022: a day of discussions dedicated to climate change and public health, organized in collaboration with the International Association of National Public Health Institutes as part of the French Presidency of the Council of the European Union. The goal was to promote greater consideration of the links between climate, biodiversity, and health in public policy, and to encourage concrete actions at the local, national, and European levels.

Pesticides, air pollution, endocrine disruptors… the general public is exposed to numerous substances in their daily lives. One of the Agency’s key areas of focus is analyzing these exposures in order to contribute to preventive measures.

Santé publique France and ANSES launched the second phase of the PestiRiv study, running from March to August 2022, involving people living near vineyards and those living far from any agricultural land. The goal: to better understand pesticide exposure among people living near vineyards or far from any agricultural land. Last
year, Santé publique France’s Air and Health Monitoring Program (PSAS) celebrated its 25th anniversary. To mark this occasion and in observance of National Air Quality Day on October 14, Santé publique France reviewed the key developments of the past five years and published the results of the latest quantitative assessment of the long-term impact on mortality at the regional and departmental levels as open data.

PARC Project: First Meeting of the French Stakeholder Exchange Hub

Santé publique France, in collaboration with ANSES, has been actively involved in the development and implementation of a research and innovation program related to the assessment of risks associated with chemicals at the European level by participating in the European PARC partnership project. Following a call for expressions of interest to establish the French Hub in the spring of 2022, the first meeting of the project’s French Hub was held on September 21, attended by the 17 selected participants alongside partner ministries and scientific institutions.

Workers may be exposed to various occupational hazards (exposure to chemicals, biological agents, physical agents, or biomechanical factors) that also interact with the ways in which work is organized within the settings where workers perform their duties. Health effects can vary in nature over the short, medium, and long term. Through its work, Santé publique France contributes to improving knowledge about occupational risks (surveillance, identification of occupational determinants of health) with the aim of informing and supporting decisions by public authorities and occupational health and safety stakeholders to prevent occupational risks.

In 2022, the agency published new regional summaries of occupational disease surveillance as well as an educational report on Santé publique France’s activities in the field of occupational health and safety to better understand and prevent the impacts of work on health.

Vulnerable populations, who are more at risk from COVID-19 and its consequences, have less access to vaccination than the general population. To address barriers to COVID-19 vaccination, Santé publique France launched a knowledge-sharing and mobilization initiative (MobCo) in 2020, involving more than 120 researchers, field workers, and policymakers. The goal of this initiative is to collectively define appropriate approaches and courses of action. In 2022, Santé publique France published the key findings of this initiative regarding vaccination. Directly linked to this work, two initiatives were launched: support for the Prevac study, which estimates COVID-19 vaccination coverage among this population and supplements national estimates of the VAC SI program in the general population; and the creation of a set of tailored educational resources, updated monthly, intended for frontline workers serving vulnerable individuals.

The agency has released new findings from the “UNONO WA MAORE” survey on nutrition, cardiovascular disease, diabetes, and viral hepatitis in Mayotte. Launched in November 2018 among the population of Mayotte, the survey aimed to gain a better understanding of their health status and to estimate vaccination coverage among children under the age of 2. Among the key findings:

• overweight, obesity, and malnutrition coexist in the Mahoran population;

• a high prevalence of obesity, particularly among women, and other major associated chronic diseases (including diabetes in over 12% of those aged 18 to 69 and hypertension in 38.4% of those aged 18 to 69);

• a prevalence of HBsAg ten times higher than in mainland France and a high proportion of unvaccinated 15- to 29-year-olds.

• Publication of several documents translated into Ukrainian and Russian regarding access to healthcare and prevention, as well as preventive measures, testing, and vaccination offered in France to adults and children in response to the COVID-19 pandemic.

• Bilingual health booklets translated into several languages (French/Ukrainian; French/English; French/Russian; French/Georgian) to facilitate communication with healthcare professionals have also been made available.

In 2022, the agency:

• Launched a campaign to encourage smokers to quit, targeting smokers and particularly those from the most socio-economically vulnerable groups, in partnership with the Ministry of Health and the National Health Insurance. Objective: to address fears associated with quitting smoking and encourage smokers to seek help.

• Launched the 7th edition of Tobacco-Free Month. Santé publique France has gone all out to support smokers in their efforts to quit: numerous artists were brought together for a brand-new entertainment show, “Respire, the Smoke-Free Month Evening.” This new initiative aims to provide a new form of collective support to all smokers participating in the Smoke-Free Month challenge, already well-known to the French public. After two years marked by the COVID-19 pandemic, this new edition of the Smoke-Free Month challenge puts the collective back at the center of the initiative while offering information and advice so that everyone can choose their own strategy and take the first step toward quitting smoking. The campaign encourages smokers to turn to the remote support service Tabac info service. Nationwide, this edition attracted a total of 162,012 registrants on the website.

From September 5 to October 9, 2022, Santé publique France relaunched the “Histoires de joint” campaign, an initiative designed to raise awareness about the health risks associated with cannabis use. Without demonizing or trivializing cannabis use, the campaign gives a voice to cannabis users through illustrated audio testimonials or “voice notes” of about two minutes each, based on real-life stories. Complementing these stories, short one-minute videos provide educational content on the various topics covered. Laurent Karila and Jean-Michel Delile thus break down the questions and misconceptions raised in the testimonials.

Sports betting can be highly addictive and have significant consequences for the health and social well-being of those who engage in it and their loved ones. That is why the Agency launched the “Betting Is No Small Matter” campaign just a few weeks before the start of the World Cup. Through an audio “debate show” that debunks common misconceptions about sports betting, the “Betting Is No Small Matter” campaign raises awareness among bettors and their loved ones about the risks associated with problematic betting and directs them to the Joueurs Info Service, a remote support and assistance program.

Physical activity acts as a protective factor against many chronic diseases, such as cardiovascular disease, cancer, and overweight or obesity. In young people, physical activity improves cardiorespiratory and muscular fitness, metabolic health, and bone health, and helps them maintain a healthy weight.

However, according to the results of the Esteban¹ study among children aged 6–17, only 50.7% of boys and 33.3% of girls met the WHO recommendation: to engage in at least 60 minutes of moderate-to-vigorous physical activity per day.
In 2022, to encourage physical activity among young people and reduce their sedentary lifestyles, Santé publique France launched a two-part campaign:

• First phase of the campaign: “Getting teens moving isn’t easy. But encouraging them is important.” launched for the start of the 2022–2023 school year to encourage parents to motivate their teens to be more active every day.

• The second phase of the campaign targets teenagers directly via social media, leveraging the momentum of a challenge launched by @EnModeDeter or by a personality popular with teens on Snapchat and TikTok.

^{1- Health Study on the Environment, Biomonitoring, Physical Activity, and Nutrition (Esteban 2014-2016). Nutrition Section. Chapter on Physical Activity and Sedentary Behavior. Saint Maurice: Santé publique France, February 2022. 2nd edition. 58 p.}

Launched in 2018, Nutri-Score is a nutritional labeling system designed to encourage consumers to choose products that are healthier from a nutritional standpoint. The agency coordinates the scientific research underlying the Nutri-Score algorithm and evaluates its impact over time. It also manages the registration of companies that commit to using the logo in accordance with the brand usage regulations and provides them with support. We regularly conduct information campaigns as well as studies to track changes in awareness, perception, and use of the Nutri-Score logo.

In 2022, the agency published the results of the first study evaluating adolescents’ perceptions and use of Nutri-Score. With 97% brand awareness in October 2021, nearly all adolescents have already seen or heard of Nutri-Score. The study confirms that adolescents act as both influencers and purchasers of food products, making them a key target for nutritional prevention initiatives:7 out of 10 had already purchased a product with the Nutri-Score, and 54% of adolescents who had already purchased a product with the Nutri-Score were motivated to buy that product because of the logo on the packaging. Their perception, knowledge, and use of the logo are also very positive, which is encouraging for the rollout of the logo in institutional and commercial food service settings, as outlined in the National Nutrition and Health Program 4 (2019–2023).

As a member of the scientific committee, we also contributed to the updates to the Nutri-Score algorithm for foods adopted by the competent authorities in Belgium, France, Germany, Luxembourg, the Netherlands, Spain, and Switzerland.

As part of its efforts to promote perinatal health, Santé publique France has highlighted the role of maternal and child health centers (PMI) and supported their work by organizing a national seminar for local early childhood stakeholders who have implemented the PANJO program, and by participating in the documentary “Maternity: The Big Leap,” which underscores the key role of PMI in promoting perinatal health.

2022 was a banner year for our campaigns. In total, we received 14 awards at the Effie Awards, Grands Prix Stratégies, and Prix Top/Com for:

• The adolescent mental health campaign for #JenParleA and the adult mental health campaign for “Talking about it is already part of healing,”

• The campaign against discrimination and violence faced by LGBT+ people for “Nous les amoureux” and “Et alors?”,

• The campaign “Getting teens active isn’t easy. But encouraging them is important.” for the film “Non,”

• The 2nd edition of the “En 2-2” campaign.

Santé publique France has stepped up the management and content development of its public-facing websites and remote support services, and is currently developing a digital app dedicated to prevention and health promotion. In total, in 2022, 14 remote support services are funded by the agency, and 5 are operated directly by the agency. In terms of activities, Tabac info service handled 41,274 calls; the Drugs, Cannabis, Alcohol, and Gamblers support services handled 152,682 inquiries (calls, chats, Q&As). In addition, the websites received 10,176,933 visits (3,500,904 for the Drug Info Service, 2,162,293 for the Alcohol Info Service, 4,153,736 for the Gambling Info Service, and 5,352,618 for the Tobacco Info Service).

The agency has released surveillance and screening data for three types of cancer: colorectal cancer, breast cancer, and cervical cancer.

In 2022, the agency:

• Published diabetes surveillance indicators for 2021, available as open data on Géodes.

• Published the initial results of the Entred 3 study. Conducted in mainland France in 2019, this study aims to improve understanding of the health status of people with diabetes in France.

In addition to the annual monitoring efforts, 2022 was marked by:

• The launch of the first national study on children’s well-being (Enabee), in partnership with the Ministry of National Education. This study will track changes in children’s well-being and mental health and assess the impact of public policies.

• The results of the 6th edition of the National Perinatal Survey (2021), which surveyed approximately 15,000 women immediately after giving birth in maternity wards and again two months postpartum to gather information on their health and that of their newborn(s).

To provide an overview of the epidemiological understanding of various conditions associated with a loss of independence during the aging process, the agency has published a report on health challenges related to aging and the increasing burden of chronic diseases. This report shows that, among people aged 40 to 64, many indicators related to the onset of chronic diseases and disabilities in later life are cause for concern, particularly among those with lower socioeconomic status. This report constitutes the first step in the “Health 40+” program developed by Santé publique France.

Publication of the results of the 9th edition of the NOYADES survey, conducted nationwide (mainland France and overseas territories) from June 1 to September 30, 2021. During the summer of 2021, accidental drownings decreased compared to 2018. The proportion of deaths, however, was comparable in 2021 and 2018.

In November 2022, InfoCovidFrance celebrated its first anniversary. This dashboard tracks pandemic indicators, which are available as open data. The goal is to provide everyone with a clear understanding of the progression of the COVID-19 pandemic and preventive measures, as well as Santé publique France’s response to the health crisis. In 2022, the InfoCovidFrance page recorded over 19,355,755 views, averaging 14,619 views per day. Since its launch, InfoCovidFrance has expanded to include an English version.

In 2022, Géodes was expanded to include new indicators covering topics such as COVID-19, monkeypox, night work, and air pollution. In total, the cartographic observatory of epidemiological indicators produced by Santé publique France now allows anyone to access more than 800 health indicators across France via open data. The platform attracted nearly 2,286,340 visitors over the course of the year.

Following the “Vivre-Covid19” study, France Assos Santé has signed a multi-stakeholder agreement with Santé publique France, the Health Data Hub, and Sanoïa to promote the sharing of health data for research in the public interest. This collaboration reflects the agency’s commitment to sharing its expertise with civil society—in this case, with people living with chronic conditions—to better inform decision-makers and guide health policies that serve patients.