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Unvaccinated pockets of France expose inequalities and could fuel a winter wave

Slim Hadiji administered coronavirus vaccinations to people in their homes in Marseille, France, where vaccination rates are lower than the national average. (Video: Alexa Juliana Ard, Rick Noack/The Washington Post, Photo: France Keyser for The Washington Post/The Washington Post)

MARSEILLE, France — For eight months, 85-year-old Traki Ismail hesitated to get vaccinated.

She knew that her age, along with high blood pressure and diabetes, put her at high risk of getting sick with the coronavirus. And that risk increased as building after building around her became a covid hot spot. Yet twice she canceled vaccination appointments over fears about serious side effects.

It was only when helicopters began airlifting patients out of this city’s saturated hospitals that she changed her mind.

“People say I will die if I get the vaccine. But people also say I will die if I don’t get the vaccine,” she said, lying in bed moments after doctor Slim Hadiji, making a home visit, injected a Moderna shot into her arm. “I’ve taken destiny in my own hands, and I’ve done it.”

With 67 percent of residents fully vaccinated, France is now one of Europe’s most immunized nations. The number of new coronavirus cases is in decline, even though restaurants are once again fully booked and maskless partygoers returned to bars and clubs months ago.

But health authorities remain concerned about unvaccinated pockets of the country — pockets that expose stark inequalities and could fuel a winter wave.

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Northern Marseille, where Ismail lives, has some of Western Europe’s highest poverty levels — and some of its lowest coronavirus vaccination rates. In some neighborhoods, fewer than 35 percent of people were fully vaccinated as of last month, roughly half the rate of Marseille’s richer areas only 15 minutes away.

In its most serious form, covid-19 “has become a social illness, an illness of the poor,” said Jean-Luc Jouve, the head of Marseille’s hospital commission.

“The people who are in intensive care now,” said Michèle Rubirola, the deputy mayor in charge of public health, “largely come from that set of districts that are part of France’s and even Europe’s most impoverished neighborhoods.” Nearly 90 percent of patients in intensive care in Marseille were not fully vaccinated, according to mid-September data released by the public hospital network.

Vaccination rates of other European cities and their surrounding regions — including Brussels and Stockholm — have shown similar gaps between rich and poor communities.

In Marseille, France’s second-most-populous city, officials say a number of factors are to blame. Limited public transportation in the city’s northern neighborhoods can make it difficult for people to get to vaccination centers and hospitals. The metro and tram don’t reach most parts, and many buses stop running early.

Misinformation has also fallen on fertile ground here.

“Unfortunately, a lot of people think that, for instance, taking the vaccine will sterilize young women or that they will have a microchip implanted into their shoulder,” Hadiji said.

Anti-vaccine messaging may have resonated, in part, because the region views itself as a counterweight to Paris and is frequently skeptical about decisions made by the national government, said Jouve, the hospital official.

Jouve said this historic antagonism may have elevated one of his colleagues, Marseille-based microbiologist Didier Raoult, who gained international attention last year for promoting hydroxychloroquine and other dubious covid cures. Raoult’s more-recent videos on YouTube emphasize potential risks and unknowns about coronavirus vaccines.

The founding members of his institute agreed last month to replace him, but not until next year. And his critics fear that will allow him to continue to spread doubt, when vaccinations are already stalling in Marseille.

A further reason for the persistent hesitancy here: Some people have never even heard of the digital health passes that triggered a national surge in vaccinations — along with protests, now in their 13th week.

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The passes — proving immunity, vaccination or a recent coronavirus test — are required to enter restaurants, museums and long-distance trains, among other crowded spaces in France.

But those spaces are not part of the daily routine of many people in the poorer neighborhoods of Marseille.

“People here struggle to survive,” Hadiji said. “They don’t even think about going to the restaurant.”

On a recent Friday, as Marseille’s wealthier residents began heading to the beach, Hadiji left Ismail’s apartment building and drove past a broken motorbike and toppled shopping carts that mark a notorious local drug-dealing spot.

Few doctors are willing to drive beyond this point, he said. It has become a “medical desert.”

After losing two patients to covid-19 early in the pandemic, Hadiji worked to increase coronavirus screenings in northern Marseille, and then to get shots in people’s arms. He partners with a local nonprofit, SEPT, that offers medical services and at-home vaccinations, with the help of private donations and government money.

“If you tried to come here with the navy firefighters and said, ‘We’ll vaccinate,’ there would be war,” he said, referring to Marseille’s military fire brigade that has been a backbone of the city’s broader vaccination effort. “Every neighborhood has a key. Here, you smile, you talk a bit — you go in.”

Next to him in the passenger seat, SEPT’s president, Yazid Attalah, was on the phone trying to prevent one of their next appointments from being canceled. “Don’t worry, we won’t be checking your health passes,” he assured a family.

In addition to making house calls, Hadiji treats patients with all kinds of illnesses at a clinic supported by SEPT. It’s one of the only treatment centers accessible to residents of this part of northern Marseille at night, and demand is high. On a recent evening, patients waited in a crowded room and outside the entrance, and cars kept arriving in the parking lot.

Some people had been waiting in line since 4 p.m., Attalah said. He reached for a canister of hand sanitizer only to realize it was empty.

Hadiji uses his clinic consultations as another opportunity to urge people to get vaccinated. There’s no need for health campaign slogans here. The danger of the virus is clear. As Hadiji tried to encourage patients to get a shot, a woman who had just tested positive for the virus was on the other side of a curtain.

The doctor administered 23 shots that night.

Local health officials say personal contact is the only effective way to counter vaccine misinformation that’s being spread online. They have urged local sports associations to encourage vaccinations among their members. SEPT deploys “vaccine mediators” who talk to residents on the street or at events to dispel fears.

Olivier Gauché, coordinator at a local health center in Marseille’s north, said that when mediators were recently out on the streets, he saw the number of vaccinations increase more than fivefold, from a low of 12 a day to 70.

“You have to talk to people with empathy, with nuance and with patience,” Gauché said.

But as cooler weather arrives, again forcing people into crowded apartments and increasing transmission risks, some fear time is running out.

Coronavirus: What you need to know

Vaccines: The CDC recommends that everyone age 5 and older get an updated covid booster shot designed to target both the original virus and the omicron variant. Here’s some guidance on when you should get the omicron booster and how vaccine efficacy could be affected by your prior infections.

Variants: Instead of a single new Greek letter variant, a group of immune-evading omicron spinoffs are popping up all over the world. Any dominant variant will probably challenge a key line of treatment for people with compromised immune systems — the drugs known as monoclonal antibodies.

Tripledemic: Hospitals are overwhelmed by a combination of respiratory illnesses, staffing shortages and nursing home closures. And experts believe the problem will deteriorate further in coming months. Here’s how to tell the difference between RSV, the flu and covid-19.

Guidance: CDC guidelines have been confusing — if you get covid, here’s how to tell when you’re no longer contagious. We’ve also created a guide to help you decide when to keep wearing face coverings.

Where do things stand? See the latest coronavirus numbers in the U.S. and across the world. In the U.S., pandemic trends have shifted and now White people are more likely to die from covid than Black people.

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