The lag was blamed largely on bureaucratic obstacles. But those obstacles were no accident. They reflect the French government’s struggle with how to calibrate a mass vaccination campaign in one of the world’s most vaccine-skeptical countries.
“The government has been afraid of anti-vaxxers and the public mistrust of collective vaccination campaigns,” said Françoise Salvadori, an immunology researcher and author of a book on anti-vaccination movements.
About 60 percent of the country is disinclined to get vaccinated against the coronavirus, according to an Ipsos survey for the World Economic Forum, compared with about 30 percent in the United States.
To acknowledge public concerns, the French government set up multiple layers of precautions — mandating that recipients engage in an often time-consuming consultation process before getting a shot, which could be administered only by a doctor or a health worker under direct supervision of a doctor.
Health Minister Olivier Véran defended the pre-vaccination consultations — recommended to occur at the latest five days before a shot — as a “token of confidence” for the country, ensuring “informed consent.”
As a result, in the first week of the European Union’s vaccination rollout, the bloc’s second-most-populous country vaccinated far fewer people than Luxembourg, a nation with less than 1 percent of France’s population of 67 million. Only a few European countries moved slower, including the Netherlands, which began vaccinating Wednesday, a week and a half after the E.U. launch.
The French approach exasperated vaccine proponents, with some viewing it as an attempt to peddle to skeptics and people who are anti-vaccine. The leader of France’s Grand Est region, hit particularly hard by the virus in recent weeks, called the slow progress a “state scandal.”
This week, the French government shifted tactics, announcing that the process would be simplified and that the vaccine would be offered in more places and to a broader group of people in the initial round. At a news conference Thursday, Véran said the country aims to vaccinate 1 million people by the end of the month.
Still, the government is also moving ahead with plans to form a vaccine council of 35 ordinary French citizens — a move many scientists view as inappropriate and too late, given that a vaccine is already being administered.
Government officials have framed the council as an attempt to reflect public concerns. But critics warn that it could provide a stage for conspiracy theories.
The debate could portend one of the West’s most difficult vaccination campaigns this year, as health officials appear anxious to avoid repeating the mistakes that helped to give rise to France’s widespread anti-vaccination sentiments in the first place.
“It would be reductive to equate the people who are currently reluctant to get the vaccine to conspiratorialists,” said Antoine Bristielle, a public opinion researcher with the center-left Jean-Jaurès Foundation.
A rapid shift in public opinion
The first cracks in vaccine support in France, one of the birthplaces of modern vaccination, emerged in the 1990s, amid questions about whether a hepatitis B vaccine was causing multiple sclerosis. The vast majority of subsequent studies found no such link. But French health officials withdrew the vaccine from schools, and hepatitis B vaccinations declined sharply in the following years.
The concerns appeared to remain limited to hepatitis B, however, with 90 percent of the population still approving of vaccines in general by 2005, said Jocelyn Raude, a researcher focusing on the intersection of psychology and infectious diseases.
Some might say France was prepared too well, one decade too early.
Unlike the coronavirus, the H1N1 virus did not turn out to be the killer it was feared to be, and millions of vaccine doses had to be disposed of. Many French felt misled. The influenza debacle created a perfect storm, playing into the hands of anti-vaxxers, and prompted “a complete shift in attitudes,” Raude said.
Around the same time, a French pharmaceutical company was accused of having killed hundreds with a weight loss drug, which last year prompted a trial on manslaughter and deceit charges, with a verdict expected this year. The scandal tarnished the reputation of France’s drug regulator.
Though not directly connected to vaccines, the drug scandal quickly became linked to the H1N1 debate. It lent weight to reasonable criticism of the French pharmaceutical industry — including questions over ties between the industry and politics — but also to conspiracy theories and debunked rumors, researchers said.
The debate had a long-lasting impact, both on public attitudes and on politics. France’s authorities were “traumatized by the vaccination campaign in 2009,” Raude said. “As a consequence, they were extremely cautious these last months.”
Whereas Germany began planning and constructing purpose-built mass vaccination centers months ago, France this week was still debating what they might look like.
Few efforts to debunk misinformation
When coronavirus vaccinations began in Europe on Dec. 27, President Emmanuel Macron appealed to French citizens: “Let’s have trust in our researchers and doctors. We are the nation of the Enlightenment and of [Louis] Pasteur. Reason and science should guide us.”
But rather than emphasizing the positive case for vaccines, Macron has repeated the refrain that they won’t be mandatory.
The government’s boldest proposal to date — a bill that could have required people using public transportation, for instance, to be vaccinated against the coronavirus or to have proof that they are not infected — was almost immediately postponed after it sparked opposition. Among the most vocal critics was far-right leader Marine Le Pen, who called it a “totalitarian” proposal. Her comments served as a reminder that the French far right is both fueling the fears of vaccine skeptics and hoping to benefit from government missteps ahead of the presidential election next year.
Some worry the government’s restraint may do more harm than good. “If this caution continues for too long, it will be counterproductive and reinforce mistrust,” Salvadori said.
On French social media, anti-vaccine videos have been viewed millions of times during the pandemic, whereas reliable governmental information has been harder to come across, according to the pro-vaccine group Les Vaxxeuses.
The group began to use Twitter and Facebook to debunk misinformation about vaccines after realizing in 2017 that people who are anti-vaccine were gaining momentum online without being challenged or corrected.
The absence of effective governmental information campaigns meant that “the space was empty, there was no scientific discussion,” said a member of the group who, like the rest of the team, spoke on the condition of anonymity because of threats they’ve received.
In contrast, other countries with fewer vaccine skeptics have planned more-energetic campaigns. Britain is seeking social media influencers to tout the jab, while Germany launched a website to counter myths and specific rumors weeks ago.
In France, the groups that are most skeptical of vaccines are also among the ones that are most active on social media: young people, women and people on the extreme ends of the political spectrum.
But the misinformation spreading online has penetrated other parts of society, too. Didier Seyler, who leads a preventive health-care center for older citizens in the southern French city of Marseille, said young people tend to pass false information found on social media on to their parents or grandparents — the people who are most at risk of dying of covid-19.
More than half of all people being advised by his health center — who on average are 72 years old — have recently asked him and his employees about the safety and efficacy of coronavirus vaccines, Seyler said.
“I’ve scheduled basic training for my team,” said Seyler, who previously headed Marseille’s public vaccination center, “so that our employees are equipped to answer these questions.”
Many French health workers lack detailed knowledge of vaccination issues, Seyler said.
But their one-on-one interactions with skeptics could ultimately determine the success of the coronavirus vaccination campaign, as general practitioners are expected to play a key role. “If your doctor is stubborn [and hesitant regarding vaccines], it means you’re less likely to have confidence,” said Lucie Guimier, who has analyzed geographical differences in France’s vaccination coverage in recent years.
She found that doctors in the south of France have in the past been particularly hesitant to give certain kinds of vaccines.
In Marseille, the south’s biggest city, health worker Seyler worried that the French government’s hesitant approach — including the creation of the citizens’ council — won’t counter vaccine reluctance.
It would be more helpful if the government focused on health professionals getting adequate training, Seyler said, rather than on efforts that “perhaps simply serve to hide the lack of political courage to take decisions and to shoulder responsibility.”