The French response to COVID-19: intrinsic difficulties at the interface of science, public health, and policy
Authors: Jean-Paul Moatti
Journal: The Lancet Public Health (2020)

Faced with criticisms, French authorities claim that their policy towards the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has been evidence-based—they appointed an advisory board of 11 scientists to help manage the crisis. However, in situations where decision makers face radical uncertainty, sticking to conventional approaches might jeopardise the science-policy interface. First, just looking at the evolution of confirmed cases does not allow drawing of real-time lessons for policy.1Luchini S Teschl M Pintus P Degoulet M Baunez C Moatti JP Urgently needed for policy guidance: an operational tool for monitoring the COVID-19 pandemic.SSRN. 2020; (published online March 30.) (preprint).DOI: 10.2139/ssrn.3563688Crossref Google Scholar Although the outbreak started concomitantly in South Korea, Italy, and France—on Feb 1, 2020, the number of confirmed cases of coronavirus disease 2019 (COVID-19) were 12 in South Korea, six in France and three in Italy—South Korea was able to control the epidemic 6 weeks later,2Balilla J Assessment of COVID-19 mass testing: the case of South Korea.SSRN. 2020; (published online March 18.) (preprint).DOI: 10.2139/ssrn.3556346Crossref Google Scholar while a rapid increase of cases was clear in Italy and starting in France. In spite of WHO recommendations,3COVID-19: what science advisers must do now. Nature 579: 319–20.Google Scholar a South Korean strategy of mass testing, contact tracing, and physical distancing was not adopted in France and Italy, and the biggest step was a lockdown of the country as late as March 9 in Italy and March 17 in France. France did not have the logistic capacity to promote mass testing, due to the limited number of accredited laboratories (only 45 in public facilities) and the limited availability of SARS-COV-2 reagents for RT-PCR. But, rather than explicitly setting the goal of scaling up testing with priorities (health-care professionals, vulnerable groups) until capacities became sufficient, authorities argued that systematic testing was not needed as soon as the epidemic had generalised (phase 3 of national guidelines).4Preparation a la phase épidémique de COVID-19. Ministère des Solidarités et de la Santé, March 16, 2020https://solidarites-sante.gouv.fr/IMG/pdf/guide-covid-19-phase-epidemique-v15-16032020.pdfDate accessed: March 27, 2020Google Scholar This policy was only reversed on March 28, with the aim of managing a way out from the lockdown.5Godeluck S Coronavirus: la France s'engage dans une stratégie de dépistage massif. Les Echos, March 20, 2020https://www.lesechos.fr/economie-france/social/coronavirus-la-france-sengage-dans-une-strategie-de-depistage-massif-1190362Date accessed: March 27, 2020Google Scholar Second, maintaining the first round of national elections on March 15 but enforcing a closure of schools at the same time was in contrast with social science literature establishing that disaster communication should avoid confronting the population with a double-bind situation through dissonant incentives.6Lagadec P A new cosmology of risks and crises: time for a radical shift in paradigm and practice.Rev Policy Res. 2009; 26: 473-486Crossref Scopus (77) Google Scholar Third, preliminary—although inconclusive—results about the use of hydroxychloroquine and azithromycin for treatment of COVID-197Gautret P Lagier JC Parola P et al.Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial.Int J Antimicrob Agents. 2020; (published online March 20.)DOI:10.1016/j.ijantimicag.2020.105949Crossref PubMed Scopus (3613) Google Scholar have fuelled ethical controversies in the biomedical community with extensive media coverage. Only referring to randomised clinical trials to prove efficacy of treatment without considering alternative evaluation methods for providing quicker evidence in a context of urgency8Frieden TR Evidence for health decision making — beyond randomized, controlled trials.N Engl J Med. 2017; 377: 465-475Crossref PubMed Scopus (476) Google Scholar has reduced the ability of authorities to mitigate the effect of irrational online rumours9Cowper A COVID-19: are we getting the communications right?.BMJ. 2020; 368: m919Crossref PubMed Scopus (48) Google Scholar and regulate prescription practices of health professionals. On March 24, a second experts' committee was nominated, complementary to the first one.10COVID-19: la Pr Françoise Barré-Sinoussi nommée à la tête du Comité de chercheurs chargé de conseiller le gouvernement.vih.orgDate: March 24, 2020https://vih.org/20200324/covid-19-la-pr-francoise-barre-sinoussi-nommee-a-la-tete-du-comite-de-chercheurs-charge-de-conseiller-le-gouvernement/Date accessed: March 27, 2020Google Scholar This committee for analysis of research and expertise includes 12 experts, ten of them being different from the members seated in the Scientific Advisory Board, and is chaired by Françoise Barré-Sinoussi, virologist and recipient of the Nobel Prize of Medicine in 2008. The second committee seems an implicit recognition of the intrinsic difficulties of directly using science in political management of a health crisis. I declare no competing interests.