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why compulsory vaccination of caregivers remains a dilemma in France

Caregivers’ adherence to vaccination will increase. I believe that the time for reluctance is behind us “, hammered Olivier Véran, Thursday March 4, in a press conference. “We have effective vaccines, starting with AstraZeneca. It is our responsibility to protect ourselves and those we take care of.”, added the Minister of Health. And to announce that he was going to send the next day “a letter to all caregivers in our country, whether they are in town, at the hospital, in a medico-social establishment, to strongly encourage them to be vaccinated”.

>> Covid-19: follow all the information related to the pandemic live

Because only 25% of the doses of the viral vector vaccine from the AstraZeneca group had been used, according to the Ministry of Health. The situation is all the more striking as Covid-19 could be the leading nosocomial disease in France today. On February 14, nearly 27,000 patients caught the coronavirus in hospital, according to Public Health France, which identifies “186 related deaths”.

A judged situation “unacceptable” by François Chast, head of the clinical pharmacy service at Necker hospital. Asked Tuesday on France Inter, the latter believed that the vaccination was “part of good practices”, as well as “wearing the charlotte, mask or gown during treatment”. Not being vaccinated could even constitute, according to him, “professional misconduct”. Gilles Pialoux, head of the infectious and tropical diseases department at the Tenon Hospital, claimed on franceinfo “that we rediscuss” the introduction of an obligation for caregivers.

Sea snake from the winter flu campaigns, this debate on vaccine obligations is back. This measurement is “double-edged because we create blockages”, estimates Bruno Pozzetto, head of the virology service of the CHU of Saint-Etienne (Loire) and member of the High Council of Public Health (HSCP). “I am in favor of the generalization of the vaccine but what is the smartest way to convince people?

“It’s not as simple as forcing you to wear a mask or use hydro-alcoholic gel.”

Bruno Pozzetto, head of the virology department of the Saint-Etienne CHU

to franceinfo

Several criteria seem to justify this recourse, such as the seriousness of the disease concerned, its frequency and the effectiveness of the vaccine. But epidemiologist Judith Mueller, professor at the School of Advanced Studies in Public Health (EHESP), reminds Franceinfo that vaccines seem to break only part of transmissions – “maybe between 30 and 60%” – and this, in spite of the encouraging data of the large studies carried out in Israel. Under these conditions, it is not intuitive “to force caregivers to be vaccinated and to tell them to continue wearing the mask”, especially since some have complained of side effects. The authorities had also recommended a staggering of the vaccination to avoid disrupting the services.

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But above all, what about caregivers who refuse to be vaccinated? “We are in the middle of an epidemic where one of the main problems is precisely the maintenance of the healthcare system”, adds the researcher, who works with the study group on the risk of exposure of caregivers (Geres) on the vaccination of health professionals.

If there isn’t much of a benefit from increasing immunization coverage, and there is a risk of losing caregivers, then that’s not worth it. “

Judith Mueller, epidemiologist

to franceinfo

The researcher therefore believes that the vaccine obligation is not entirely based on scientific arguments, but that it is also “of a political choice”, Which one is “necessarily complex”. The public authorities, in fact, seem to be in the middle of a dilemma.

In retirement homes (Ehpad) and long-term care units (USLD), less than 200,000 professionals have thus received at least one dose of vaccine, ie 42% of the workforce. “Clearly, that’s not enough”, reacted the Minister of Health, Olivier Véran, at a press conference on Thursday, March 4, adding that 30% of caregivers, in town and in hospital, had been vaccinated. The measure of an obligation applied to all caregivers has indeed been mentioned in the Council of Ministers, according to information from franceinfo, but no decision has been taken and the option raises questions of law anyway.

Some vaccines are already compulsory for health professionals, as provided for in the Public Health Code. Students, exposed professionals and staff in medical analysis laboratories are already required to be vaccinated against hepatitis B, diphtheria, tetanus and polio. In 2006, it was also compulsory to be vaccinated against the flu, but the measure was abandoned the following summer.

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What do professional organizations say? Contacted by franceinfo, the National Order of Nurses recalls that vaccination “falls under the ethical duty” and that the nurse must “always act in the interest of the patient”, without, however, specifying its position on the ongoing debate. Asked by AFP, the president of the National Federation of Nurses (FNI), Daniel Guillerm, believes that it would not be “not abnormal to include the Covid in the list of compulsory vaccines” for caregivers. “I don’t like bonds”, adds Jean-Paul Ortiz, President of the Confederation of French Medical Unions (CSMF), considering that vaccination “is more in the order of ethics and professional commitment”.

“Any initiative aimed at increasing immunization coverage is welcome”, declares for his part Jean-François Gehanno, professor of occupational medicine at the Rouen University Hospital, member of the High Council of Public Health. But he is not convinced by the need to go through an obligation. He underlines the importance of setting an example in small units, with team leaders who are vaccinated, “which tends to lead teams”. He also strongly believes in local discussions, in order to “discuss feelings” and dispel “fears” of each other.

In fact, vaccine hesitation seems to be more widespread in certain categories of caregivers. In January, in a survey (PDF) conducted by the study group on the risk of exposure of caregivers (Geres) with which Judit Mueller is associated, some 60% of caregivers declared an intention to be vaccinated, with strong nuances among caregivers (30% ), nurses (47%) and doctors (82%).

“There is a dichotomy in the nursing staff. The nurses have taught the medical staff a lot about hygiene measures, but when it comes to vaccination, there is a really historic blockage.”

Bruno Pozzetto, head of the virology department of the CHU de Saint-Etienne

to franceinfo

Bruno Pozetto also remembers an experiment carried out a few years ago in the two Saint-Etienne hospitals, consisting in submitting the choice to the staff to be vaccinated or to wear the mask throughout the winter, period of circulation of the influenza virus. “I remember a debate with the team of midwives in gyneco-obstetrics, who had all opted to wear a mask, although it was an unusual practice”, he testifies.

There is currently little data on vaccinations by occupational category. But The Parisian however, managed to obtain figures from the AP-HP: 36% of medical staff had received at least one dose, against 17 to 18% of others, mainly nurses and nursing aides. Several hypotheses are put forward to explain the relative mistrust, especially in this last category: level of education and training, keen interest in approaches related to naturopathy or limited confidence in vaccines and authorities …

“It goes beyond a fear of side effects”, decrypts Judith Mueller. “The vaccine intention is strongly linked to the level of confidence expressed towards the authorities. And pointing the finger at a professional category will precisely strengthen this position”, further analyzes the epidemiologist. And to remind that caregivers are attentive to “patient’s needs” and that they “are careful not to put them at risk”. According to her, we must therefore put the debate in its place: “Vaccination is not society, it is my health.”

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