La sécurité sanitaire en France : de l’affaire du sang contaminé à la réforme des vigilances

Abstract

To understand the policy for the implementation of the overhaul of the vigilance, it was useful to recall the context by revisiting the literature and regulation related to health security and the tragedy of contaminated blood, which was the founding element of the new health institutions. The concept of health security was born with the creation of several national agencies. They have proved their usefulness but remain, however, compartmentalized with a division of competences, in terms of vigilance, distributed between several agencies, in a complex territorial mesh constituting a hindrance to the declaration of undesirable events. Review of legal texts and literature, from the crisis of contaminated blood followed by the creation of health safety laws, the creation of health safety agencies to the texts relating to the reform of vigilance. Haemovigilance and the creation of the French Blood Establishment, the sole operator of blood transfusions, have been decisive in reducing transfusion chain accidents and the risks associated with infectious diseases. The merging of several agencies has led to a more comprehensive approach to risk assessment related to exposure to contaminants and more effective protection of the health of populations. At the regional level the management of sanitary vigilance at the ARS is well established and contributes locally to the management of alerts and health crises. The sanitary structures put in place have proved their usefulness but that is not enough. The culture of health events reporting that is insufficiently developed is changing with the implementation of the unique national portal for reporting and the development of health democracy. In addition, we must constantly prepare ourselves for new or re-emerging threats. The health risk linked to the foreseeable increase in exposure to pollutants and toxic products will be the major challenge for the years to come.