ANALYSIS: Why are French health workers so reluctant to get the Covid vaccine?
For many people in France, getting an appointment for the Covid vaccine would be a dream come true, but while health professionals all have access to a vaccine, only one third of them have so far got the jab. So why are France's health workers so reluctant?
France's healthworkers have been able to get a vaccine since February 8th, but by the start of March only 30 percent of them had done so.
On Monday, emergency workers in the Bouches-du-Rhône département announced they would pause vaccination of firefighters and rescue workers with the AstraZeneca vaccine after one employee had an adverse reaction - this despite the health ministry deciding against suspending the AstraZeneca programme, saying the benefits of vaccination outweighed the risks.
“If you have not yet been vaccinated, do it quickly,” French Health Minister Olivier Véran wrote in a public letter addressed to the country’s health workers on March 5th.
Only 30 percent of them had by then received the Covid injection, according to the letter, despite it being available to health workers since February 8th. The number rose to 40 percent when looking solely at those involved in care of the elderly.
“It’s not enough,” Véran said.
"Your vaccination is an act of protection. To protect yourselves . . . (and) also your patients and the community."
Se protéger et protéger ceux que l’on soigne.
Ma lettre aux soignants sur la vaccination. pic.twitter.com/GBlAuv1qRu
— Olivier Véran (@olivierveran) March 5, 2021
President Emmanuel Macron, dreading the economic, social and political consequences of a third nationwide lockdown, has gambled that the Covid vaccine would be the game changer required to avoid it.
But if hospitals cannot cope with the number of Covid cases - and already hospitals in the capital are cancelling surgical procedures - a third nationwide lockdown will be unavoidable.
On Tuesday, the National Academy of Medicine recommended making the Covid vaccine compulsory for health workers, who they said represented 34 percent of all Covid cases that originated inside the hospital or in other medical establishments.
🔴L’hésitation vaccinale est éthiquement inacceptable chez les soignants.
La #vaccination des #soignants contre la #COVID19 doit devenir obligatoire pour les pros de santé du secteur public ou libéral.
COMMUNIQUÉ➡️https://t.co/peI2Z0oGnc pic.twitter.com/l01bBdd1tT
— Académie Nationale de Médecine (@acadmed) March 9, 2021
So why won't they get vaccinated?
"Conspiracy theories have massively affected the health care community," Célestin-Alexis Agbessi, an emergency doctor at the Bichat Claude-Bernard Hospital in the north of Paris, told The Local.
A Covid reference hospital, Bichat is again on the brink of becoming overwhelmed with patients. Still, many nurses and other medical staff remained reluctant to get vaccinated, according to Agbessi.
"They don't want to get vaccinated," he said. "It's not just here, it's like that across France."
France as a whole has been one of the most vaccine-sceptic countries in the world for the last 10 years.
A series of pharmaceutical scandals and public health policy errors sent the country's confidence in vaccines plunging from around around 2009. Distrust in immunisation was one of the main reasons the government quickly discarded the idea of making the Covid-19 vaccination compulsory, fearing it could bolster anti-vaccine sentiments.
Sixty percent of the population said they doubted whether to get vaccinated against Covid in January. That number has since dropped, but remains relatively high compared to peer countries - even in the world of medicine and science.
"We have a tendency to think that everyone in the health world agrees with the health authorities' advice. That's not the case," Jeremy Ward, a sociologist who specialises in vaccine controversies, told Le Journal du Dimanche (JDD).
Nurses and care workers are the most reluctant to get the Covid injection, according to a Santé Publique France report published in February. While 89 percent of doctors said they intended to get vaccinated against Covid-19, only 44 percent of care workers (aides-soignants) and 68 percent of nurses said the same.
Graphic: Santé Publique France
“I’m waiting to get more information," Marie France Boudret, a nurse at an elderly care home north of Paris, told the TV channel France 24 earlier this month.
Boudret wanted to "see how it goes" before getting injected herself, saying she worried about unknown long-term side effects.
This a commonly expressed opinion among vaccine-reluctant health workers. Of those doubting whether to get the vaccine, 66.2 percent said it was due to lack of information, according to a study by the GERES, a French research group focusing on health personnel. Nearly as many, 62.2 percent, said they worried about unidentified side effects.
Women are generally more hesitant to get vaccinated than men, according to several studies.
"We don't have enough of a perspective yet," Elodie Daulcle, a nurse in Paris, told JDD. "I ask myself: how is it possible that we discovered (the Covid vaccine) this quickly? Where is the scam?"
READ ALSO: Lockdowns and vaccine scepticism – how France and Italy are struggling to get Covid under control
AstraZeneca
Healthworkers in France currently receive the AstraZeneca vaccine, while over 75s get Pfizer.
AstraZeneca was initially only licenced in France for under 65s, after the medical regulator said there was not enough data on its effectiveness for over 65s.
President Macron himself fuelled these doubts when he called AstraZeneca "quasi-ineffective" for over 65s, although the regulator has since licenced it for all under 75s after new test data.
READ ALSO: Why have three quarters of France’s AstraZeneca vaccines not been used?
But AstraZeneca remains unpopular among many health workers, who maintain that their high exposure to the virus merits access to what they perceive to be the "best" vaccine.
"(AstraZeneca) is suitable for the general population, but not for overexposed care workers," Thierry Amouroux, a nurse and SNPI union spokesperson, told JDD.
"It's a bit like the surgical mask: it protects everyone very well, but we need an FFP2," he said, referring to the highest-grade protective face masks hospital staff in France wear.
Perceived vaccine safety from Dec vs now shows that, while Pfizer + Moderna vaccines have made strong gains, AstraZeneca has not
e.g. in 🇫🇷
AZ safe 33% (+15) unsafe 43% (-5)
Pfizer safe 49% (+25) unsafe 29% (-19)
Moderna safe 39% (+21) unsafe 33% (-14)https://t.co/rppoUptxIO pic.twitter.com/2JAC19kmhP
— YouGov (@YouGov) March 7, 2021
'From hero to zero'
Agbessi, the hospital doctor at Bichat, called this a "paradox": vaccine-reluctant nurses and health care staff who rejected the AstraZeneca vaccine "are doing everything to get the Moderna and Pfizer," he said.
One of the reasons had nothing to do with conspiracy theories, but was simply due to the fact that AstraZeneca has produced serious - albeit temporary and not dangerous - side effects in some people, particularly those who have already had the virus.
At least 149 health workers had by February 11th reported suffering from high fever following the injection, according to the National Agency of Medical Security (ANSM). Having to stay from home for several days due to high fever is something many want to avoid during a health crisis.
This was the reason Agbessi himself had not yet been injected - he tested positive for Covid in mid January and would have to await June to get his first and only AstraZeneca jab.
But short term side effects can only explain some of the reluctance, and the main reason seems to be a widespread, simmering distrust in health authorities that predates the pandemic, but grew in the months since.
"I think many of them had a hard time understanding why they weren't put first in the line for the vaccine," Agbessi said, referring to the government's strict priority list of vulnerable groups, which prioritised the oldest and most vulnerable first, although health workers were quickly added to the list.
"I'm caricaturing a bit, they went from hero to zero," Agbessi said.
For months, people in France took to their balconies to applaud the healthcare heroes who were sacrificing themselves for the greater good. But back then France lacked protective gear and its stocks of face masks had run dry. Health workers later called out the way they had been treated, reiterating longstanding demands of increased salaries and better working conditions.
READ ALSO: How do nurses’ salaries in France compare to the rest of Europe?
An increasing number of people have over the past few days spoken out in favour of making the vaccine compulsory to all health professionals. Several vaccines are already mandatory for this group: diphtheria, hepatitis B, tuberculosis, tetanus and poliomyelitis. The flu vaccine was compulsory until 2006.
For now, the government has chosen "dialogue and conviction," said Véran, who is himself a doctor and received the AstraZeneca vaccine live on TV in an attempt to boost confidence.
After a visit to a vaccination centre in Pas-de-Calais, Véran said he was "convinced that the adherence rate among health professionals towards the vaccine will catch up with the general rate".
He could be right: the trend seems to be a rise in the number of health professionals willing to get vaccinated. Back in December 2020, only 20 percent of care workers said they intended to get the Covid injection, less than half of the 44 percent registered a month later.
Ward, the sociologist, said making the Covid vaccine compulsory risked making matters worse.
"Making the vaccine compulsory is a solution that can only be used when you have tried everything else," he said.
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France's healthworkers have been able to get a vaccine since February 8th, but by the start of March only 30 percent of them had done so.
On Monday, emergency workers in the Bouches-du-Rhône département announced they would pause vaccination of firefighters and rescue workers with the AstraZeneca vaccine after one employee had an adverse reaction - this despite the health ministry deciding against suspending the AstraZeneca programme, saying the benefits of vaccination outweighed the risks.
“If you have not yet been vaccinated, do it quickly,” French Health Minister Olivier Véran wrote in a public letter addressed to the country’s health workers on March 5th.
Only 30 percent of them had by then received the Covid injection, according to the letter, despite it being available to health workers since February 8th. The number rose to 40 percent when looking solely at those involved in care of the elderly.
“It’s not enough,” Véran said.
"Your vaccination is an act of protection. To protect yourselves . . . (and) also your patients and the community."
Se protéger et protéger ceux que l’on soigne.
— Olivier Véran (@olivierveran) March 5, 2021
Ma lettre aux soignants sur la vaccination. pic.twitter.com/GBlAuv1qRu
President Emmanuel Macron, dreading the economic, social and political consequences of a third nationwide lockdown, has gambled that the Covid vaccine would be the game changer required to avoid it.
But if hospitals cannot cope with the number of Covid cases - and already hospitals in the capital are cancelling surgical procedures - a third nationwide lockdown will be unavoidable.
On Tuesday, the National Academy of Medicine recommended making the Covid vaccine compulsory for health workers, who they said represented 34 percent of all Covid cases that originated inside the hospital or in other medical establishments.
🔴L’hésitation vaccinale est éthiquement inacceptable chez les soignants.
— Académie Nationale de Médecine (@acadmed) March 9, 2021
La #vaccination des #soignants contre la #COVID19 doit devenir obligatoire pour les pros de santé du secteur public ou libéral.
COMMUNIQUÉ➡️https://t.co/peI2Z0oGnc pic.twitter.com/l01bBdd1tT
So why won't they get vaccinated?
"Conspiracy theories have massively affected the health care community," Célestin-Alexis Agbessi, an emergency doctor at the Bichat Claude-Bernard Hospital in the north of Paris, told The Local.
A Covid reference hospital, Bichat is again on the brink of becoming overwhelmed with patients. Still, many nurses and other medical staff remained reluctant to get vaccinated, according to Agbessi.
"They don't want to get vaccinated," he said. "It's not just here, it's like that across France."
France as a whole has been one of the most vaccine-sceptic countries in the world for the last 10 years.
A series of pharmaceutical scandals and public health policy errors sent the country's confidence in vaccines plunging from around around 2009. Distrust in immunisation was one of the main reasons the government quickly discarded the idea of making the Covid-19 vaccination compulsory, fearing it could bolster anti-vaccine sentiments.
Sixty percent of the population said they doubted whether to get vaccinated against Covid in January. That number has since dropped, but remains relatively high compared to peer countries - even in the world of medicine and science.
"We have a tendency to think that everyone in the health world agrees with the health authorities' advice. That's not the case," Jeremy Ward, a sociologist who specialises in vaccine controversies, told Le Journal du Dimanche (JDD).
Nurses and care workers are the most reluctant to get the Covid injection, according to a Santé Publique France report published in February. While 89 percent of doctors said they intended to get vaccinated against Covid-19, only 44 percent of care workers (aides-soignants) and 68 percent of nurses said the same.
Graphic: Santé Publique France
“I’m waiting to get more information," Marie France Boudret, a nurse at an elderly care home north of Paris, told the TV channel France 24 earlier this month.
Boudret wanted to "see how it goes" before getting injected herself, saying she worried about unknown long-term side effects.
This a commonly expressed opinion among vaccine-reluctant health workers. Of those doubting whether to get the vaccine, 66.2 percent said it was due to lack of information, according to a study by the GERES, a French research group focusing on health personnel. Nearly as many, 62.2 percent, said they worried about unidentified side effects.
Women are generally more hesitant to get vaccinated than men, according to several studies.
"We don't have enough of a perspective yet," Elodie Daulcle, a nurse in Paris, told JDD. "I ask myself: how is it possible that we discovered (the Covid vaccine) this quickly? Where is the scam?"
READ ALSO: Lockdowns and vaccine scepticism – how France and Italy are struggling to get Covid under control
AstraZeneca
Healthworkers in France currently receive the AstraZeneca vaccine, while over 75s get Pfizer.
AstraZeneca was initially only licenced in France for under 65s, after the medical regulator said there was not enough data on its effectiveness for over 65s.
President Macron himself fuelled these doubts when he called AstraZeneca "quasi-ineffective" for over 65s, although the regulator has since licenced it for all under 75s after new test data.
READ ALSO: Why have three quarters of France’s AstraZeneca vaccines not been used?
But AstraZeneca remains unpopular among many health workers, who maintain that their high exposure to the virus merits access to what they perceive to be the "best" vaccine.
"(AstraZeneca) is suitable for the general population, but not for overexposed care workers," Thierry Amouroux, a nurse and SNPI union spokesperson, told JDD.
"It's a bit like the surgical mask: it protects everyone very well, but we need an FFP2," he said, referring to the highest-grade protective face masks hospital staff in France wear.
Perceived vaccine safety from Dec vs now shows that, while Pfizer + Moderna vaccines have made strong gains, AstraZeneca has not
— YouGov (@YouGov) March 7, 2021
e.g. in 🇫🇷
AZ safe 33% (+15) unsafe 43% (-5)
Pfizer safe 49% (+25) unsafe 29% (-19)
Moderna safe 39% (+21) unsafe 33% (-14)https://t.co/rppoUptxIO pic.twitter.com/2JAC19kmhP
'From hero to zero'
Agbessi, the hospital doctor at Bichat, called this a "paradox": vaccine-reluctant nurses and health care staff who rejected the AstraZeneca vaccine "are doing everything to get the Moderna and Pfizer," he said.
One of the reasons had nothing to do with conspiracy theories, but was simply due to the fact that AstraZeneca has produced serious - albeit temporary and not dangerous - side effects in some people, particularly those who have already had the virus.
At least 149 health workers had by February 11th reported suffering from high fever following the injection, according to the National Agency of Medical Security (ANSM). Having to stay from home for several days due to high fever is something many want to avoid during a health crisis.
This was the reason Agbessi himself had not yet been injected - he tested positive for Covid in mid January and would have to await June to get his first and only AstraZeneca jab.
But short term side effects can only explain some of the reluctance, and the main reason seems to be a widespread, simmering distrust in health authorities that predates the pandemic, but grew in the months since.
"I think many of them had a hard time understanding why they weren't put first in the line for the vaccine," Agbessi said, referring to the government's strict priority list of vulnerable groups, which prioritised the oldest and most vulnerable first, although health workers were quickly added to the list.
"I'm caricaturing a bit, they went from hero to zero," Agbessi said.
For months, people in France took to their balconies to applaud the healthcare heroes who were sacrificing themselves for the greater good. But back then France lacked protective gear and its stocks of face masks had run dry. Health workers later called out the way they had been treated, reiterating longstanding demands of increased salaries and better working conditions.
READ ALSO: How do nurses’ salaries in France compare to the rest of Europe?
An increasing number of people have over the past few days spoken out in favour of making the vaccine compulsory to all health professionals. Several vaccines are already mandatory for this group: diphtheria, hepatitis B, tuberculosis, tetanus and poliomyelitis. The flu vaccine was compulsory until 2006.
For now, the government has chosen "dialogue and conviction," said Véran, who is himself a doctor and received the AstraZeneca vaccine live on TV in an attempt to boost confidence.
After a visit to a vaccination centre in Pas-de-Calais, Véran said he was "convinced that the adherence rate among health professionals towards the vaccine will catch up with the general rate".
He could be right: the trend seems to be a rise in the number of health professionals willing to get vaccinated. Back in December 2020, only 20 percent of care workers said they intended to get the Covid injection, less than half of the 44 percent registered a month later.
Ward, the sociologist, said making the Covid vaccine compulsory risked making matters worse.
"Making the vaccine compulsory is a solution that can only be used when you have tried everything else," he said.
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