Professor Yves Buisson is an epidemiologist and member of the National Academy of Medicine.
FIGAROVOX. - Italy introduces compulsory vaccination for those over 50 who do not work and a reinforced vaccination pass for those who work. Do you think this is an effective measure? Should France be inspired by it?
Yves Buisson. -
Mandatory vaccination is a necessary decision to achieve collective immunity when all persuasive and incentive measures have reached their limits, which has unfortunately been the case for several months. Such a measure can only be truly effective if it is universal, that is to say extended to the entire “vaccineable” fraction of the population. Reserving this obligation for people over 50 will reduce the frequency of severe forms requiring hospitalization, without however eliminating them. In fact, there will remain subjects under the age of 50 who are also at high risk due to comorbidities such as obesity, diabetes and arterial hypertension. Such discrimination would be inapplicable because it would penalize unvaccinated people,not only because of their age over 50, but also in view of their body mass index, their blood sugar level or their blood pressure figures, which would constitute a violation of medical confidentiality.
France can draw inspiration from Italian determination to equip itself with effective means to fight the epidemic.
But it should aim for an even more daring objective than the sole protection of people at risk by raising the vaccination coverage of the entire population from the age of 5 years in order to reach the level of collective immunity essential to finally get out. of this health crisis.
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Do you support executive decisions against the unvaccinated?
The universal vaccination of the population must be presented as a civic duty and not as a threat of punishment.
The procrastination of the executive power feeds the anti-vaccine movements and a loss of confidence in the general public.
The vaccine obligation, presented as a general mobilization against a common enemy, Covid-19, could lead to the support of a very large majority of French people.
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Medicine is not an infallible science. Do you understand the mistrust of some of the French towards a vaccine developed in less than 2 years, among others by a laboratory condemned several times in the past?
All epidemiological studies
and
pharmacovigilance data confirm the efficacy and safety of messenger RNA vaccines.
Yves buisson
The distrust of a new vaccine using a revolutionary process, messenger RNA, is understandable. It was initially shared by the medical profession, even among specialists in infectious diseases and vaccines, before data was available, which today is large enough and solidly supported to restore confidence: the technology of messenger RNA vaccines. has been developed for over 30 years; its relative simplicity has made it possible to respond to the challenge of developing a vaccine against Covid-19 more quickly than conventional platforms; the development of these vaccines and their clinical trials were carried out according to good pharmaceutical practices, the validation procedures having been carried out urgently in the face of the pandemic, but in total independence,by European (EMA) and American (FDA) Agencies before they are put on the market. That one of the vaccine-producing laboratories has multiple criminal records can naturally increase mistrust by recalling the deplorable history of health scandals, however, the number of people vaccinated against covid-19 approaching 4 billion, or 50% of the population. world population, we have a wealth of information never before obtained for other vaccines.With the number of people vaccinated against covid-19 approaching 4 billion, or 50% of the world's population, we have a wealth of information never before obtained for other vaccines.With the number of people vaccinated against covid-19 approaching 4 billion, or 50% of the world's population, we have a wealth of information never before obtained for other vaccines.
All real-life epidemiological studies and pharmacovigilance data confirm the efficacy and safety of messenger RNA vaccines.
The health pass was not a success, we can estimate. Why think that the vaccine pass will be?
The implementation of the health pass, which entered into force on June 9, 2021, was a major step in the fight against the pandemic, since it encouraged several million French people to be vaccinated to access establishments open to the public and, from August 9, 2021, to cafes, restaurants, hospitals, retirement homes, planes and trains.
This measure was however too late to counter the 4th wave of the epidemic which appeared in July and too partial to avoid the 5th wave which appeared in November: 10% of people eligible for vaccination (i.e. say aged 12 and over) are still not vaccinated.
The transformation of the health pass into a vaccination pass extended to all gathering places (work, leisure, travel) would be a strong and beneficial incentive for unvaccinated people so that they benefit from protection as soon as possible. vaccine, at least against severe forms of the disease. This is obviously an obligation to vaccinate and this must be clearly stated. This measure, recommended for more than six months by the National Academy of Medicine, is based on the concept of liability, already in force for the 11 infant vaccines which condition entry into nursery and nursery school.
Should the vaccinated be treated as a priority, as some argue? Do you think it would be fair to charge the unvaccinated for their medical bills, as others claim?
The current saturation of hospitals, linked in large part to the influx of severe forms of Covid-19, requires doctors to make very difficult prioritization choices.
The vaccination status of patients does not enter into this choice, but only the benefit / risk assessment of intensive care treatment.
This debate was not initiated with the intention of making unvaccinated patients pay for care and even less to make them understand that they will no longer be a priority for access to intensive care.
But it should provoke an examination of conscience in each refractory to vaccination.
Yves buisson
This exemplary attitude of the doctors, in accordance with the Hippocratic oath they took, does not exclude a deep discomfort each time an unvaccinated patient passes before a patient awaiting an intervention requiring post-operative resuscitation and thus makes him lose chances.
This debate was not initiated with the intention of making unvaccinated patients pay for care and even less to make them understand that they will no longer be a priority for access to intensive care.
But it does have the merit of making everyone aware of the dilemma that caregivers face every day.
It should provoke an examination of conscience in each refractory to vaccination: "if I develop a severe form of Covid-19, would I find it normal to take the place of a patient hospitalized for a medical or surgical emergency?"
The WHO boss warned in mid-December against the illusion that it would be enough to administer booster doses to get out of the Covid-19 pandemic. How to navigate?
The third dose of vaccine is an essential booster to stimulate the immunity acquired after the first two injections. Its protective efficacy is now well demonstrated to prevent severe forms of Covid-19 due to the Delta and Omicron variants. Maintaining this protection may require further boosters, but it is not yet clear how long the neutralizing antibodies persist after the first boost.
Only collective immunity will get us out of the pandemic.
It can be reached in two ways: either naturally, by letting the virus spread and mutate, or artificially thanks to a very wide vaccination coverage.
The first choice would prolong the health crisis by multiplying the number of victims;
the second would make it possible to quickly classify the Covid-19 among the banal seasonal epidemics.
