# Vaccination Against Covid 19 in France

Anne-Marie Duguet

► To cite this version:

Anne-Marie Duguet. Vaccination Against Covid 19 in France. WAML Newsletter, 2021, 49, pp.5.
hal-04338081

HAL Id: hal-04338081

https://ut3-toulouseinp.hal.science/hal-04338081v1

Submitted on 19 Dec 2023

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<figure><img src="image_1.png" /></figure>

Distributed under a Creative Commons CC BY 4.0 - Attribution - International License
doses of the Moderna vaccine and will establish
manufacture of an mRNA vaccine in Australia.

Australia rapidly closed its international borders,
excepting there was a debacle, when infected
passengers from a cruise ship, the Ruby Princess,
disembarked without quarantine. All overseas
passengers must hotel quarantine, rather than home
isolate as originally accepted, for a period of at least 2
weeks, initially at taxpayers' expense, but now at the
passengers' personal cost. Australia banned flights
from India, with heavy penalties prescribed, including
5 years' incarceration and heavy fines, for those not
adhering to the rules. Those flights resumed, after 2
weeks, with those returning being quarantined and
Covid negative before boarding flights to Australia.
Some flights were only half full, because not all Covid
testing was reliable with many who were positive being
subsequently shown to be negative, when tested in an
alternative laboratory.

NSW, using a QR digital system, a smart phones
Application, plus pen and paper recording, for those
choosing same, allowed tracking of positive Covid
tested cases. This facilitated contact with all who visited
the same venues or were in close proximity to the
infected individual. Recently, special restrictions were
imposed due to genomic testing showing that Covid
was transferred to an infected male, from a returning
passenger from the USA, but the link, from that
traveller to the infected person was never established.
Restrictions included: wearing masks on all public
transport; wearing masks in retail and public places;
limitations on numbers of visitors to homes and private
gatherings; singing in public; drinking while standing
in public venues; and dancing in public venues, to
protect against community transmission. After 1 week
of no new community transmission, the restrictions
were reduced and after 2 weeks they were lifted,
although safe distancing and limitations on numbers
at venues was maintained and enforced with potential
penalties. Wearing masks is longer mandated, but still
strongly encouraged.

The question of overseas travel and when to open the
international borders, is gaining momentum. A poll of
Australian citizens reported >70% wanted the borders
kept shut, at least until the middle of 2022, when
the rollout of the vaccine, worldwide, should add a
further layer of protection. Only ~20% of respondents
favoured opening the borders to international travel.
The Australian Prime Minister, Scott Morrison, stated
it was too early, acknowledging limited repatriation of
those still stranded on the subcontinent. Australia's

unemployment is reaching pre-Covid status, even with
the removal of the 'job keeper' subsidy, in March, 2021,
which paid a limited salary to those still employed in
enterprises which lost ≥30% of their usual income and
validated same. Australia fared better than most of the
world, but it is still not out of the woods. The Federal
Government issued its second Covid budget, a very
big spending budget with a trillion-dollar deficit. There
has been a rapid economic turnaround, following
a technical recession, defined by two quarters of
negative growth, replaced with continued positive
growth being predicted. Australia is being touted as
an example to be followed and it is to be hoped that this
remains the order of the day.

Vaccination Against Covid 19 in France

<figure><img src="image_2.png" /><figcaption>**Anne-Marie Duguet MD PhD**
Emeritus Senior Lecturer Inserm CERPOP UMR 1295 INSERM
Paul Sabatier University, Toulouse France
WAML Governor</figcaption></figure>

Vaccination against covid-19 started in France on
December 27, 2020 at the same time as in all EU
countries. But in the implementation of the vaccination,
France is behind in comparison with the United
Kingdom, which started a mass vaccination before
the European countries, and Germany, which had
anticipated the arrival of the vaccine by organizing
large vaccination centers. On January 15, 2021,
it ranked 12th in the world with 388,730 doses
administered.

In fact, there is a lack of confidence in the vaccination.
In 1990, the vaccination coverage of the population had
fallen following unfounded allegations about the risks
of vaccinations (links between the rubella vaccination
and autism, and between the hepatitis B vaccination and
multiple sclerosis). Anti-vaccine leagues have flourished.
This "vaccine hesitancy" was further accentuated
following the failure of the mass vaccination organized
against H1N1 flu in 2010. 40% of French people were
opposed to this vaccination and finally only 10% of the
population was vaccinated. This organization has been criticized with conspiracy theories, starting point of sanitary conspiracy networks.

Vaccination against Covid 19 is not mandatory. The vaccine is free. The state manages the vaccination centers and the distribution of the vaccines. In January, there was still uncertainty about the safety and efficacy of RNA vaccines. This is why vaccination has been highly regulated in terms of safety, with national pharmacovigilance monitoring of adverse effects.

## 1) Which vaccination strategy?

Vaccination in France is a medical act, after information on the risks and the collection of a consent.

The vaccines currently authorized in France are the 2 RNA vaccines (Pfizer-BioNTech and Moderna), the AstraZeneca/Oxford and Johnson and Johnson vaccine. Supplies are based on orders from the European Union, with delivery difficulties due to laboratory failures that continued until May.

In this context of dose restriction and cautious implementation, a prioritization strategy was proposed in January 2021. Priority has been given to the most vulnerable likely to develop the most severe forms who are the elderly in institutions (8.8% of the over 75 years) and the staff who work there; then to people over 75 years living at home and health staff over 50 years. Then people aged 50 to 64, and professionals in sectors essential to the functioning of the country, and finally vulnerable and precarious people. Children are not included in the vaccination strategy.

## 2) Who vaccinates and in what structure?

To ensure the conservation of messenger RNA vaccines, a secure distribution is organised from hospital pharmacies which have adapted freezers. Priority was given to establishments caring for the elderly. Personalized support to obtain consent was organized according to the recommendations of the National Ethics Committee in order to respect their dignity and autonomy. Approximately 80% of residents had received their first dose of vaccine by early February.

Specialized centers were opened in hospitals to vaccinate people over 75 years old living at home. The health insurance invited them individually to be vaccinated. Appointments were made electronically,

creating inequalities in access. Mayors and associations organized free transportation to the vaccination centers.

As soon as the AstraZeneca vaccine was available, with more flexible storage conditions, general practitioners and pharmacists were able to vaccinate on a priority basis.

To accelerate vaccination, large vaccination centers were created, despite the bad memory of the failed H1N1 campaign.

A national campaign to promote vaccination has been organized by health authorities to reach the goal of 20 million people vaccinated with the first dose by May 15 and 30 million by June 15, 2021.

## 3) What public acceptance?

The French people are rather resistant to Covid 19 vaccination « vaccine hesitation ». On December 23, 2020, 40% of French people said they will refuse the injection, but on January 15, 56% want to be protected against Covid-19. Doubts faded when vaccination was actually implemented in France and when it was proven safe on millions of people in the world.

Public resistance is also felt among caregivers and physicians. While 75% of non-hospital doctors want to be vaccinated and 79% advise their patients to do so, for other health care professionals, it is not the case.

The strategy has been adapted in line with public opinion. First of all, health professionals over 50 years old wanted to be vaccinated quickly. But the side effects of the AstraZeneca vaccine and its temporary suspension caused further reluctance. The vaccine is now limited to those over 55. It is increasingly refused. To avoid wasting doses, on May 14, the government authorized the vaccination of volunteers over 18 years of age with the doses refused each day.

On May 15, 20 million received the first injection (eg 36.7% of adults). By age group, 70% of 65-74 years old and 45% of 50-64 years old received the first dose. The forecast of 30 millions around June 15 will certainly be reached.