The strange fiasco of the government’s flu strategy


Atlantic: While the government had widely communicated on the interest of a massive vaccination of all French people against the flu this year, evidence from all sides of the vaccine shortage and poor pharmacies. What exactly is it?

Charles Come back: This exceptional and dramatic year 2020 in the field of public health will in fact go down in history as the year of health shortages of all kinds: masks, intensive care beds, tests … Another shortage concerns seasonal flu vaccines. almost from the start. To be convinced of this, just read the regional daily press and even more concretely ask for the vaccine in nearby pharmacies: 100% of the pharmacies I interviewed are sold out with variable or approximate dates. when they are replenished, when they have not lost all hope of recovering new doses.

This situation may seem strange in light of a recurring health event. At this stage it is necessary to recall the terms of the public health policy in this area for thirty years. The National Health Insurance Fund (CNAM) has been offering the vaccine free of charge since 1985 to people over the age of 75, reduced to 65 in 2000 with support for vulnerable young people as part of an annual vaccination campaign. These people receive a voucher that allows them to pick up the vaccine for free at the pharmacy or even get injected on the spot.

Santé Publique France then provides a summary of the 2019-2020 campaign: 9 weeks of epidemic, 1.25 million consultations related to seasonal flu, 60,000 emergency room visits, 6,000 hospitalizations, 3,700 deaths. Vaccination coverage for people at risk (over 75 years of age or with an underlying disease) stood at 47.8% against a WHO target of 75%. During this campaign, 12 million doses of vaccines were distributed.

The strategy for the 2020/2021 season is not very different regardless of the context linked to the covid pandemic: opinion of the Alta Sanità on May 20, 2020, in September 15.8 million vouchers distributed to people at risk. Orders to pharmacists in the city and in health facilities rose to 13.5 million (+ 20%) while the Ministry of Health, undoubtedly burned by the mask affair, constitutes a government bond in hand 2 million additional doses. Production and distribution are heavy processes: seven months of processing from the communication by the WHO of the strains of the season, pre-orders made in the first quarter before the season.

The campaign starts on 13 October and runs until 31 January 2021. We immediately see a change in the behavior of the French as 5.3 million of them are vaccinated in the first week according to the Union of Community Pharmacists’ Unions (USPO), which represents nearly half of the total number of people vaccinated in the previous season. The USPO reports that 60% of pharmacies have sold out since October 21, pending further deliveries. The shortage continues and the Ministry of Health releases state shares from November 21, but especially to the priority public and EHPADs and in stages.

The shortage is therefore well established and appears more serious than elsewhere in Europe. People with a free withdrawal coupon and probably the same pharmacists will not all be vaccinated, let alone non-priority people.

What is the weight of this lack of government communication in perfectly predictable areas?

Regarding the communication of public authorities, we must distinguish between communication in the strict sense of the vaccination campaign against seasonal flu and the atmosphere created by the COVID situation on global public health communication.

The communication of 13 October on the occasion of the launch of the campaign is not very different from that of past years: it should be noted that 30% of additional doses have been ordered because an increase in the demand for vaccines is expected. There is no mention of supply difficulties and it can be seen that the WHO vaccination target of 75% of people at risk declared by the government would require 25 million doses while only 15 million are available.

But this communication dedicated to seasonal flu cannot be separated from the global communication, fundamentally anxious, in public health since the beginning of the covid-19 health crisis and in particular to justify the two borders of March 17 and October 30. In Emmanuel Macron’s speech of October 28, we mention the mention of a risk of 400,000 more deaths (compared to 54,858 on December 4) and the insurance of 9,000 patients in intensive care, a number never reached.

There has therefore been a huge “covid effect” which has encouraged countless numbers of people to be vaccinated, while France is quite a country of reluctance to vaccines. Should we blame the government for underestimating the request for additional vaccinations, knowing that it is particularly easy to criticize the predictions when the final situation is known? Indeed, France has experienced several seasons in the last decade where vaccines produced for the part of the coupon holders who had not been vaccinated had to be destroyed. In a sense, the dilemma was between the lack of vaccines attributable to the public authorities and the purchase of surplus vaccines to throw away and generate unnecessary expenses, an unfavorable situation to put into perspective in a time of extraordinary budget wealth.

If to govern is to foresee, has the state become incapable of it? Is it rather a question of political responsibility or a “Soviet” drift of the French administration?

The setback – objectively limited – in terms of public communication can be compared to the change in people’s behavior: we have gone from a vaccination rate of people at risk of about 45% to a rate of over 60% in only one year. This change in behavior, if sustainable, would bring France much closer to the WHO target of 75% of vaccinated vulnerable people: short-term failure could hide a lasting success in terms of public health policy.

Finally, this situation is emblematic of two consolidated weaknesses of French public action: on the one hand the weakness of impact studies and the evaluation of public policies, on the other hand the predominant part taken by communication for political leaders at the expense of the will to change. and improve reality.

There may be some lessons to be learned from this flu shot episode as the great epic of covid-19 vaccination begins …

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