Monday, January 30, 2023

France’s vaunted health system fails its biggest test in generations: COVID-19 vaccine rollout

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For decades, France has bragged about how its world-class public health system – on which the French pay a lot in taxes – has taken ample care of its 67 million people, from birth to end of life. . And Louis Pasteur, the Frenchman who invented the world’s first vaccine in the 1880s, is revered nationally, with streets and a renowned research institute named after him.

Yet in recent days, France’s failure to organize a credible COVID-19 vaccine program has exposed deep flaws in its health and political systems – those that could prolong the pandemic, cause thousands of needless deaths and threaten the chances of re-election of President Emmanuel Macron. in a little over a year.

Consider the evidence: Less than two weeks after the start of coronavirus vaccination campaigns around the world, about 4.2 million Americans and about 4.5 million Chinese have been vaccinated so far. A quarter of the Israeli population has already been vaccinated. Great Britain, with the same population as France, has vaccinated over 944,000 people. And Germany has stolen from around 239,000 people out of a population of 83 million.

Now take France: Monday morning, 515 people in the country had received their first injection of the two-dose Pfizer-BioNTech vaccine; this figure is not missing any figure. Under increasing pressure to explain his performance, the French Minister of Health, Olivier Véran says Monday at the end of the afternoon that “several thousand people” were vaccinated during the day.

Yet this vague figure lags considerably behind other rich countries – and for several reasons.

In a decision for which the government is now paying a high price, officials decided months ago to only administer COVID-19 vaccines by the country’s roughly 60,000 general practitioners. This is different from the annual flu shot, for example, which is given in thousands of neighborhood pharmacies or by regular nurses. Vaccines against the coronavirus are not mandatory, much different from 11 diseases like mumps and measles, which are mandatory for children to attend school.

“There is a very, very cautious approach to not forcing people to be vaccinated,” explains Emmanuel Rivière, director general in France of the Kantar Public polling agency. Behind the government’s reasoning lies the deep reluctance of millions of French people to accept the COVID-19 vaccine, partly reflecting a general distrust of the government, as well as a distrust of for-profit Big Pharma .

Vaccine suspicions

About four in 10 French people are very reluctant to be vaccinated against the coronavirus – a far higher proportion than almost any Western country, according to an IPSOS poll of attitudes in several countries. Kantar discovered in November that widespread skepticism stems in part from a deep distrust of the government, as well as the lightning speed at which the coronavirus vaccine has been developed. “People will accept that their children get vaccinated against diseases,” says Rivière. “But they say it takes at least 10 years to develop a vaccine.”

The deployment of the COVID-19 vaccine has slashed the process for years thanks in part to unprecedented global collaboration between drugmakers and researchers, as well as the adoption of innovative new drug development techniques. It of course helps that regulators are under tremendous pressure to review and approve clinical trial data as soon as possible.

Nevertheless, doubts persist in France. And in the face of this reality, French officials have chosen to exercise caution – so cautiously, in fact, that the vaccination campaign practically came to a halt at launch.

One issue, for example, is a government rule requiring everyone to see a doctor before being vaccinated against COVID-19, to discuss potential health risks, and then sign a written consent form. These measures have helped slow efforts to roll out mass vaccinations in nursing homes for the elderly, which have seen a large number of deaths from COVID-19. Many residents found unable to make independent choices require the consent of their loved ones.

To many, the rules appear to be absurd regulatory scope. France has had a higher COVID-19 death rate than the United States: more than 65,000 French people have died from the virus, among a population that represents one fifth of the United States. Some believe that the slow deployment of the vaccine could lead to unnecessary deaths. “There are significant costs in this delay in terms of lives lost”, estimates the French economist Antoine Lévy, who believes that the government, by not investing massively in mass vaccinations, could pay an economic price much more high if it fails to stop its spread virus. “We were forced to endure a lot of strain with the lockdowns, and the government had to be authoritarian,” he says. “But it must also be effective.”

Previous stumbles

The lack of efficiency has highlighted much broader problems with touted healthcare in France, which operates on a centralized, top-down structure. These problems appeared at the start of the pandemic and considerably complicated the deployment of the vaccine. As the COVID-19 crisis surfaced last February, French officials – including Macron – told the country that face masks would make little difference in containing the virus. It later emerged that France had virtually no national stock of masks. Likewise, officials insisted that only patients with active symptoms of COVID-19 should be tested. In fact, the country experienced a dramatic shortage of tests, until April.

“People had the impression that the government simply invented reality,” explains Marie-Estelle Dupont, a Parisian psychologist and author on issues related to French attitudes. “There was a lot of confusion about the masks and then the testing. Now people no longer trust the government.

Reclaiming this trust will require considerable effort, but it will be crucial in containing the pandemic.

In one major article in Last Friday, the newspaper “Le Figaro”, Lévy, the economist, suggested to the government to remove the rules of consent prior to vaccination and to allow all health professionals, including army doctors, to mass immunization of people. The article, which he says only brings together other people’s ideas, drew intense comment on television networks and among government officials. This surprised Lévy.

“It is very worrying that these ideas seem new among the French public,” he says, “we should have discussed this in April. We are in Kafka territory here.

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