France raises prospect of mandatory Covid-19 jabs for healthcare staff

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The French government is making a last push to convince healthcare workers to be vaccinated against Covid-19, before deciding whether to make the jab mandatory to improve uptake.

Olivier Veran, health minister, has written an open letter to healthcare workers urging them to get vaccinated “quickly” to protect “our collective security and the capacity of our health system”.

Alain Fischer, an immunologist who advises the French government on the vaccine rollout, told the Senate last week that if the pace did not roughly double “in the next 15 days”, the state would have to discuss making the jab mandatory for workers in the sector.

While international comparisons are difficult because of variable disclosure, France appears to be lagging behind other countries. Roughly a third of its 2.5m doctors, nurses and care home workers had received one dose of a Covid vaccine as of last Tuesday, with a fifth receiving two, according to the health ministry. 

This compares with England, where 95 per cent of frontline NHS workers had been inoculated with one dose and 8 per cent with two by the end of February, according to official data. Denmark’s figures show 62 per cent of healthcare workers have had one dose and 23 per cent two. In Italy, almost half the 5.7m shots administered have gone to healthcare workers, suggesting that enough has gone out for 92 per cent of them to have received two doses, according to an analysis of official data by think-tank Gimbe.

Chart showing that France is struggling to vaccinate its healthcare workers. 37% of its healthcare staff have received at least one dose of a Covid-19 vaccine, compared with 62% in Denmark, 95% in England and at least 92% in Italy.

France is the most vaccine-hesitant country in the world, according to a 2018 Gallup-Wellcome Trust study. There has also been concern among health workers that the Oxford/AstraZeneca jab — a key part of Europe’s immunisation strategy — is less effective and has more side effects than others.

President Emmanuel Macron himself wrongly said in January that the AstraZeneca shot was “almost ineffective” for the over-65s, when there was simply insufficient data at the time to judge, although he later corrected his remarks. Further confusion was sown when France, Germany and other countries initially chose not to use the vaccine in the over-65s, although the European Medicines Agency approved its use in all age groups.

The uncertainty has led to unused stockpiles of the AstraZeneca vaccine building up across Europe. In France, 61 per cent of available doses of that jab remained unused last Thursday.

Efforts by officials to boost confidence in the vaccine were dealt a further blow last week when Denmark, Iceland, and Norway suspended its use after a Danish woman died with blood clots following inoculation.

Public health officials see vaccination of healthcare staff as crucial because clusters of infection can easily develop in hospitals, clinics and care homes. Researchers believe vaccines reduce Covid-19 transmission, but more data is needed to prove by how much.

In France, Fischer said he hoped the government would not have to make the vaccine compulsory. “My vision is that there is still room, even if it must be done quickly, for education, consultation and explanation to win over healthcare workers,” he said. 

“I believe that the professional conscience of healthcare workers will win out. But this process should not drag on too long.” 

A medical worker with an elderly resident at care home in France. Research in the country suggests staff were the source of a third of the coronavirus clusters found in such settings
A medical worker with an elderly resident at a care home in France. Research in the country suggests staff were the source of a third of the coronavirus clusters found in such settings © Benoit Tessier/Reuters

France already requires healthcare workers to be immunised against diphtheria, tetanus, pertussis and hepatitis B. The National Academy of Medicine on Tuesday called for Covid-19 to be added to the list.

A French public health agency study published last month showed staff were the source of a third of the coronavirus clusters found in such settings since the epidemic began. Some 44,401 workers and patients have been infected in care facilities and 186 have died.

Frederic Filloux, a Paris entrepreneur, said both his parents contracted Covid-19 in care settings. His father was hospitalised with “an early-stage and treatable cancer” in February last year and died of coronavirus a month later, he said, while his mother caught it while being treated for a broken leg, but recovered. 

“I have a lot of gratitude for the doctors and caregivers who treated my parents. But I simply do not understand how anyone who works in such a setting can refuse to be vaccinated,” said Filloux. “It’s a scandal. If they don’t want to be vaccinated, let them change jobs.”

A manager at a large Marseille hospital said some of her nursing staff were reluctant to be vaccinated both for valid and unfounded reasons. But she believed forcing them would backfire at a time when hospitals were nearly full. “It would be like telling them that even though they have risked their lives to care for people, they are now unethical and bad,” she said.

Hospitals across France have been holding webinars and listening sessions to try to win over staff. But there were “no quick easy solutions”, said Nathan Peiffer-Smadja, an infectious-diseases doctor at Hospital Bichat in Paris, adding: “We have the same dynamic in the hospital as outside it — some people are worried, others are mistrustful.”

Time may help change minds. A poll by Divi and Dgiin, two German doctors’ organisations, published last Thursday showed the number of doctors and nursing staff in Germany willing to be vaccinated increased from 64 per cent to 76 per cent between December and February.

But only 27 per cent said they would accept the AstraZeneca shot, 34 per cent were unsure and 38 per cent said they would not. 

“There are doubts about the safety of the vaccine,” said Professor Christian Karagiannidis, head of Dgiin. “There is also criticism of how quickly it was developed and of the lack of long-term studies.”

Back in France, Malika Belarbi, an assistant in a home for the elderly, said she wanted more information on side effects before agreeing to be immunised, although she did not rule out being vaccinated once she knew more. “We are afraid,” she said. “They are making us feel guilty, but there has been no education campaign for us.”

Additional reporting by Domitille Alain and Richard Milne

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