Vaccines: Prevent anti-vax populi and decentralise the doses

France must devolve its vaccine strategy and win over inoculation sceptics

Despite bringing stormy weather, the clouds of major crises sometimes have silver linings for political leaders. If emergencies are managed with clarity and efficiency, they can make premiers seem more “presidential” and encourage their subjects to “rally around the flag”.

This was the case for French president Emmanuel Macron and then prime minister Edouard Philippe at the start of the Covid-19 pandemic. After the government’s decision to lock the country down in March gained widespread approval, France’s two most senior public figures enjoyed popularity ratings of around 44 percent. Such high levels of public support had rarely been seen since the start of Mr Macron’s tenure.

Ten months on, the French president and his new prime minister, Jean Castex, have not been as successful. After implementing a lacklustre vaccination plan, support for Mr Macron and Mr Castex has fallen to 38 and 37 percent respectively, with sixty percent of the population declaring themselves “dissatisfied” with their leadership. 

As of 7 January, only 45,000 people had been vaccinated, compared to over 1.5 million in the UK. To quell mounting criticism, health minister Olivier Véran announced on Monday his new target of setting up 600 vaccination centres in towns and inoculating one million people by the end of this month. 

But why has France taken so long to start vaccinating its citizens? The country had one million doses of the Pfizer/BioNTech vaccine available as of 6 January, and will soon be receiving 500,000 each week.

One explanation for the country’s inaction is that its strategy has been overly centralised. Local politicians say that they have been left out by the central government despite having adequate resources to administer the vaccine. Germany has devolved much responsibility for giving out the vaccine to regional Länder.

Xavier Bertrand, centre-right president of the northern Hauts-de-France region, told Le Monde that “We need to decentralise significantly and work with local politicians. […] If doses are made available to us, we are capable of organising the logistics.”

Valérie Pécresse, president of the central Île-de-France region, has argued that local governments could use secondary schools and empty medical training centres as vaccination sites, as well as hospitals.

Administering the vaccine on a truly local basis may indeed be difficult, given that the Pifizer/BioNTech vaccine must be stored at -70°C, and the recently approved Moderna vaccine must be stored at -20°C. The fact that the majority of “superfreezers” are located at hospitals, and that the Pfizer/BioNTech vaccines can only be stored between 2°C and 8°C for five days, brings additional problems. Nevertheless, experts like François Valletoux, president of the Federation of French Hospitals, have emphasised that the task must be undertaken locally, saying that “hospitals alone won’t be able to vaccinate everyone in France”.

However, France’s vaccination programme is doomed to fail for reasons other than mega-centralisation. According to a study carried out by the government body Santé Publique France [Public Health France] in December, more than half of the country’s population said that it would prefer not to receive the Covid-19 vaccine. The study found that 82 percent of anti-vaxxers are concerned about the safety of new vaccines. Until the French government can convince its vaccino-sceptiques that current vaccines are in fact safe, it is unlikely to succeed in rallying the entire population “around the flag”.

Mr Macron’s administration has several years of anti-vaccination sentiment to uproot. When fighting Hepatitis B in 1998, then health minister Bernard Kouchner decided to let families choose whether their children should be vaccinated against the disease after concerns about multiple sclerosis. Mr Kouchner went ahead with his decision despite criticism from professionals and the World Health Organisation.

Then, a well-intentioned response to the H1N1 influenza outbreak of 2009 ended up making matters worse. French leaders spent €700 million on masks and vaccines which ended up being thrown out, the government having overestimated the threat. Yet, even if it was better to be safe than sorry, many believed that the government pandered to large pharmaceutical companies. According to late senator François Autin, who published a report into the executive’s response in 2010, the government was handed an ultimatum by GlaxoSmithKline, who threatened not to deliver vaccines if leaders failed to place orders before a certain date. This episode reinforced the belief held by many anti-vaxxers that their fate was in the hands of “big pharma”.

Politicians have done little to uproot vaccine-related reticence this year. But forty-two percent of vaccine sceptics do say that “information which proved the efficiency and security of the vaccine” would change their mind. France’s government should now throw its energy into advertising campaigns aimed at convincing anti-vaxxers of the safety of Covid-19 vaccines.

What’s more, complicated vaccination rules have caused unnecessary concerns. A document mandating that medical consultations take place five days before care home residents are vaccinated had left some confused as to whether this applied to all citizens. Mr Véran has since outlined that pre-vaccine consultations will be more “direct”. He also outlined that both doctors and nurses can now administer vaccines, whereas the presence of a doctor had previously been a requirement. Yet these uncertainties, as well as the received idea that vaccines be somehow dangerous enough to require a doctor’s approval, are unlikely to have reassured people.

The country of liberté might have made admirable efforts to uphold individual vaccine rights. But politicians really ought to be urging every citizen to receive the vaccine, enabling France to get back to normal.

Covid-19 has caused widespread harm to France’s people and economy. But it seems that centralisation and misinformation have begun to infect the country’s political system as well.

Photo: Cromaconceptovisual (Pixabay)

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