How France Is Persuading Its Citizens to Get Vaccinated

Alex Whiting

 

**This is an excerpt from an article that first appeared in Mosaic. (Reprinted with permission under a Creative Commons Attribution 4.0 International License.) Read the rest of the article here.

 

In February this year, a holiday in paradise turned into a nightmare for one French family. Soon after their arrival in Costa Rica, their unvaccinated 5-year-old son developed measles, the country’s first case since 2014. The parents, also unvaccinated, tested positive for the virus too. They were believed to have brought it from France.

 

The family were swiftly quarantined, and the Costa Rican authorities contacted people at risk. A few weeks later, two American children – again, unvaccinated – also developed measles in the country. Again, the authorities had to act quickly to contain it.

 

Measles is more contagious than Ebola, tuberculosis or flu; it has no specific treatment; and it can be picked up from the air or from surfaces for as long as two hours after an infected person has come and gone. Because it’s so infectious, health experts see it as an early warning sign that there’s a problem with vaccination coverage.

 

 “Measles is like a canary in the mine,” says Heidi Larson, director of the Vaccine Confidence Project and a professor of anthropology at the London School of Hygiene & Tropical Medicine. To protect a population from measles, she says, at least 95 percent of people need to be vaccinated – a higher threshold than for most other infections. This means that if vaccination rates start falling, “it’s going to be the first to show its ugly head.

 

When last measured in 2017, Costa Rica had a vaccination rate of 96 percent for the disease – a clear sign that its people shouldn’t have been at risk from each other. That same year, France’s measles coverage stood at only 90 percent.

 

This isn’t surprising in light of the widespread concern about childhood vaccines in France. One in three French people think vaccines are unsafe – the world’s highest rate – and nearly one in five believe they aren’t effective – second only to Liberia. This is according to new data from the Wellcome Global Monitor, a worldwide poll of more than 140,000 people in 144 countries.

 

France may be on the extreme end, but it’s part of a global trend that has many health experts worried.

 

Trust in vaccination programs is crucial to maintaining high immunity rates. But across the EU, people are delaying or even refusing vaccines, contributing to a rise in disease outbreaks.

 

Between 2010 and 2017, over half a million French infants didn’t receive a first dose of the measles vaccine. And last year, France was among the ten countries with the highest year-on-year increases in measles, with confirmed cases jumping from just over 500 in 2017 to nearly 3,000 in 2018.

 

According to the World Health Organization (WHO), reluctance or refusal to vaccinate is now one of the top-10 major threats to global health. One manifestation of this is that even people in high-income countries, with good healthcare systems, are dying from easily preventable diseases. More than 70 people died of measles across Europe in 2018 – three of them in France.

 

 

“It’s a tragedy for Europe that a child or an adult has died because of a preventable disease,” says Patrick O’Connor, a team lead in WHO Europe’s Vaccine-Preventable Diseases and Immunization program. “We owe it to them to protect them.”

 

A critical mass of unvaccinated people produces a wildfire effect, O’Connor adds. “Next year it could be diphtheria, or a variety of things.”

 

“The good news is that a lot of people who are skeptical, who don’t think vaccines are safe, still vaccinate their children,” says Hania Farhan, senior director of methodology at Gallup, which carried out the Wellcome Global Monitor poll.

 

This is true for France, where vaccine coverage rates exceed levels of trust. But the spike in measles shows that, for some diseases, coverage still desperately needs to improve.

 

 “It’s all about money for the pharmaceutical companies,” says Priscille, a young mother who lives in Paris. Like many French parents, she is unsure about vaccinating her child. The 25-year-old doubts the effectiveness of injections, and is worried about damaging her baby’s immune system, even though there’s no evidence to support these fears.

 

“I think the immune system builds itself, and if it’s broken somewhere, it becomes complicated,” she says, holding her daughter, Madeleine, in the family’s apartment.

 

“Maybe the basic idea of a vaccine is very good,” she adds, “but the vaccines we have today are not good enough.”

 

This lack of trust in vaccines, despite overwhelming evidence that they are safe and effective, can be traced at least in part to the French government’s mishandling of a series of medical scares.

 

A blood transfusion scandal rocked the country in the 1990s. In the previous decade, thousands of people had been given blood contaminated with HIV – most of them before the link between blood, HIV and AIDS was fully understood. Many of those who received contaminated blood died.

 

Global headlines screamed “Transfusion of Death” and “Blood Scandal Ministers Walk Free” as the world’s media tracked it for nearly a decade.

 

Former Health Minister Edmond Hervé was convicted for his role in two people being given HIV-tainted blood, though he was spared a sentence. He was alleged to have delayed introducing a blood-screening test developed by an American firm until a rival French product was ready for market.

 

On the heels of this scandal came reports from medical professionals who claimed to have developed multiple sclerosis after receiving the hepatitis B vaccine. Although the WHO investigated and concluded there was no evidence of a link, the government suspended its school vaccination program and promised to investigate in a bid to calm public outcry.

 

“But suspending it also raised suspicions,” says Heidi Larson.

 

Then in 2009, controversy around vaccinations to protect against the H1N1 flu pandemic led to an “absolute, total breakdown of trust,” Larson says.

 

 

France had ordered 94 million doses of H1N1 vaccine at a cost of almost 1 billion euros. It was enough to inoculate about 80 percent of the population with two doses. But by the time the bulk of the vaccines had been delivered, it was realized that only one dose was necessary, and in any case the pandemic was less dangerous than initially thought. By the end of the vaccination campaign in January 2010, less than 10 percent of the population had come forward for vaccination, and the government was trying to cancel or sell off its surplus supplies.

 

“The public was angry at the WHO for what they thought was overinflation of the risk, angry at the government for having bought so much vaccine,” Larson says.

 

The percentage of people who were favorable towards vaccinations fell from 91 percent in 2000 to 61 percent in 2010, according to national health agency Santé publique France. By 2016 it had recovered somewhat, but only to 75 percent.

 

Until the late 1980s, the French media rarely covered health-related scandals. Journalists focused on the great achievements of medicine and relied almost exclusively on bigshot professors at big universities, says Jeremy Ward, a researcher on vaccine hesitancy at the VITROME laboratory in Marseille.

 

**This is an excerpt from an article that first appeared in Mosaic. (Reprinted with permission under a Creative Commons Attribution 4.0 International License.) Read the rest of the article here.

 

 

Images:

James Gillray illustration, The Cow Pock (1802) (Wikipedia); Pixabay (Creative Commons); Wikimedia.org (Creative Commons).

 

 

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James Gillray illustration, The Cow Pock (1802) (Wikipedia); Pixabay (Creative Commons); Wikimedia.org (Creative Commons).
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