Country report: ECDC Public Health Emergency Preparedness Assessment for France, 2025
This report presents the findings and recommendations of the first assessment conducted in France. This involved a desk review of relevant documents, followed by a five-day country visit that took place between 23 June and 27 June 2025. As per the assessment methodology, all of the 16 capacities included in Article 7 of the Implementing Regulation (EU) 2023/1808 self-assessment template were assessed, with five of them considered in-depth: Laboratory (Capacity 3); Surveillance (Capacity 4); Health emergency management (Capacity 6); Health service provision (Capacity 7); and Antimicrobial resistance (AMR) and healthcare-associated infections (HAI) (Capacity 12).
The report also provides specific recommendations for the country to improve prevention, preparedness and response planning. France is requested to provide an action plan addressing these recommendations within nine months of receipt of this report.
Introduction
The aim of the Public Health Emergency Preparedness Assessment, as mandated in Article 8 of the Regulation (EU) 2022/2371 on serious cross border threat to health, is to improve prevention, preparedness and response planning in EU/EEA countries through the implementation of recommendations following individual country assessments. As specified in the Regulation, each EU/EEA country will undergo an assessment every three years, with the first cycle of these occurring between 2024 and 2026.
Key findings
France has a multifaceted public health system involving multiple stakeholders at different geographical and administrative levels, which is effective and operational with a high level of implementation for most of the capacities assessed. The public health system is centralised, with legislative, decision-making and coordination authority at the national level and strong dependence on the 18 Regional Health Agencies (Agence Régionale de Santé – ARS) for implementation and adaptation to the local context. The national public health strategy is defined by the Ministry of Solidarity and Health, with the contribution of the National Public Health Agency (Santé publique France). The strategy is implemented by the National Public Health Agency in collaboration with its regional representations (16) and other regional and local level actors.
As a result of lessons learned from the COVID-19 pandemic and in preparation for the Olympic and Paralympic games (2024), a coordination hub for management of health crises – the Center for Health Security (Centre de crises sanitaires (CCS)- was established (1 March 2024) within the Directorate-General for Health, in the Ministry of Solidarity and Health. There is a strong collaboration between different entities at national and regional levels which ensures a continuous information flow between the key stakeholders, rapid mobilisation of expertise and resources, and dynamic adaptation of plans in response to evolving threats. The roles of the National Public Health Agency, the Centre for Health Security and the Regional Health Agencies are pivotal for responses to health threats, including alerts, epidemiological situation awareness, scientific advice, risk assessment and communication.
The financing framework at the national and regional levels allows for the rapid mobilisation of the necessary funds with a solid mechanism in place to respond to public health emergencies at different administrative levels. In the event of a public health emergency crisis, there are strong connections in place within and between sections of the healthcare system and across sectors (public health, animal health, civil protection, etc.). The national preparedness and response strategy is based on intersectoral coordination mechanisms, with a robust and representative crisis governance. Comprehensive and adaptive legal instruments and procedures are in place to implement the IHR and provide a multi-sectoral response to serious cross-border health threats. There is a culture for performing regular assessments and conducting simulation exercises to test preparedness and response plans in the health sector. Extensive use of professionals in crisis situations, as part of a reserve of healthcare personnel, provides an opportunity for upgrading the required professional and organisational skills when responding to health threats.
The emergency plan ORSAN ‘Organisation de la réponse du système de santé en situations sanitaires exceptionnelles’ (organisation of the healthcare response system in exceptional public health situations) provides the national framework for the organisation of the healthcare system's response and support to regions and areas affected by an exceptional health situation, making it possible to mobilise resources and reinforce service provision. The regional ORSAN system is developed by the Regional Health Authority in each region. The national authorities do not validate regional plans, but provide necessary guidance (planning framework and objectives). More efforts could be envisaged for collecting structural feedback from regional and local levels to further improve planning activities and identify resource needs. The hierarchical system for health resource mobilisation is set to involve different geographical levels - national – ‘zonal’ (area-wide) - regional ORSAN - healthcare operators. There are well established mechanisms to ensure an increase in human resources in the event of a public health emergency – reserve of healthcare personnel or national solidarity mechanism, which are coordinated jointly at national and regional level. A dedicated national risk communication plan is in place which includes media, online and social media.
In an emergency, the national and regional authorities are able to quickly write or update procedures for health care professionals, activate response plans (national and regional), coordinate messages to health facilities and provide necessary advice for enhanced collaboration between primary care and hospital service providers to ensure continuity of care and surge capacities. There is a mechanism for cross-regional collaboration to support crisis response, however analysis of such efforts could be performed in a more structured and regular basis. Prevention, preparedness and response plans in France include the actual or foreseeable effects of climate change. A list of priority zoonotic diseases for surveillance, preparedness and response has been established based on human and animal health legislation, expert opinions and response procedures that are already available.
The surveillance system, composed of several extensive networks, combines data from laboratories, hospitals, general practitioners, and health insurance data, including statistical data on mortality. Upgrades and innovations have been implemented during and post-COVID-19 to capture sequencing, wastewater monitoring and real-time hospital data. Overall, the respiratory surveillance system is highly automated, comprehensive and robust, providing timely information to decision-makers regarding the epidemiological situation to inform public health measures. Challenges remain in regulatory arrangements to facilitate data linkage, vaccine coverage and effectiveness monitoring and contact tracing in pandemic situations.
The Centre for Health Security provides methodological support for development of recovery plans, guidance on simulation exercises (SIMEX), After-Action Reviews (AARs) and training programmes. Standards and indicators, based on ISO certification, are used for routine improvements and quality assurance.
