Covid tests: "Whatever it costs more politics than health?"

Frédéric Bizard is Professor of Economics, ESCP and President of the Health Institute.

He is the author of “Solidarity autonomy in health”, Michalon editions, October 2022.

The Prime Minister affirmed on January 6 that “

”. Even if these statements are debatable in fact (we were 7th with 17 tests per 1,000 inhabitants at the end of 2021), the question is whether this political will to be world champion on the number of screening tests is very relevant.

At this rate, France risks winning another global trophy, that of the highest level of public spending on Covid screening tests.

After 2.6 billion euros in 2020, 6.2 in 2021 and 1.5 in January 2022 alone, we are at more than 10 billion euros in public spending on Covid tests since the start of the pandemic.

The testing budget planned for 2022 was fully spent in January.

A return to a rationale that is more health and economic than politician will impose itself fairly quickly.

From one extreme to another since 2020

“

” declared the Director General of the WHO on March 16, 2020, calling for the detection of Covid-19 cases as widely as possible. At this time, France is choosing another strategy, targeted screening of people with severe symptoms and of those who have been in close contact with confirmed Covid cases.

In reality, France's position is dictated by the test shortage in March 2020 and by bureaucratic brakes.

The health system is not prepared for such a pandemic.

The health technostructure decides to carry out the tests only in public hospitals.

City laboratories lack PCR test kits and reagents.

Regional health agencies are blocking authorizations for vending machines in several regions.

The week of August 9, when the health pass became compulsory to go to many public places, we go to more than 5 million tests per week, including 70% of antigenic tests carried out in pharmacies.

Frederic Bizard

The comparison with Germany was instructive at the start of the pandemic.

The Germans track massively, 10 times more than France, using private actors and their strong industrial network from the start.

At the end of March, the Germans deplore 0.4 deaths per million inhabitants against 3.6 in France.

The French strategy is ineffective, leading to strict and long collective confinement and a high death rate.

Before the release of this first confinement on May 11, the government drastically changed its position and decided to carry out massive screening from May 2020. However, the massive deployment of tests is struggling to settle, the chain "

" is fragile.

The government will then do everything to regain control and go from one extreme to the other with the tests.

100% reimbursement by health insurance, hasty negotiation with biologists of a sufficiently attractive price to encourage them to multiply technical and human resources.

The same Prime Minister proudly announced on December 15, 2020: “

”.

We must erase from the collective memory the first months of the health management of the Covid, whatever the cost.

Free

tests extended to tourists

After carrying out 38 million tests in 2020, there will be 168 million (PCR and antigens) in 2021. As the Prime Minister says, we must be the champions of the number of tests. Free tests are applied to foreign tourists passing through France, unlike most of our European neighbors. Many foreigners living near the French border come to France to be tested for free. It doesn't matter, we have to make numbers. France even tries to convince its neighbors to generalize this free, in vain without great surprise. We are ending free testing for tourists only on July 7, 2021.

In parallel with the massive tests, the vaccination campaign is struggling to take off and the President of the Republic, in his speech of July 12, 2021, decides to activate the lever of the health pass. The latter will have a double effect, a sharp acceleration in the rate of vaccination of the French and an explosion in the number of tests. The week of August 9, when the pass became compulsory to go to many public places, we go to more than 5 million tests per week, including 70% of antigen tests carried out in pharmacies. This shift from biology labs (PCR tests) to 22,000 pharmacies (antigen tests) is a powerful accelerator in the number of tests.

Massive screening in 2021 is probably a very profitable investment.

First, it makes it possible to maintain almost normal economic activity with the exception of the third confinement in April.

Then, it makes the health pass acceptable to the greatest number and is a success in encouraging the French to get vaccinated.

This is true...until Omicron arrives.

Omicron changes the game but not the political line

The arrival in early December 2021 of Omicron in France changes the situation due to its higher potential for contamination, its lower pathogenicity and its relative resistance to vaccines.

Anxious not to slow down economic and social life while avoiding a saturation of hospital services, the government will once again rely on massive screening, in particular with self-tests in pharmacies and even in supermarkets in early January 2022.

The cost of tests exploded in December to 1 billion euros, with more than 8.3 million tests in the last week, two thirds of which were antigenic.

With a majority Omicron at more than 80% of contaminations in January, this inflationary spiral raced to 1.5 billion euros in January.

Massive screening makes France one of the world records for density cases with, for example, 450,000 cases on January 19, 2021... knowing that the Germans have just exceeded 100,000 daily cases and the English have almost never exceeded the 150,000.

The very high level of screenings over several weeks put very strong pressure on pharmacies, laboratories, school staff and parents.

This social cost is to be added to the financial costs.

Frederic Bizard

While it is still too early to robustly assess the cost-benefit ratio of these two months of overspending on tests, a revision of the protocols will quickly become necessary.

The very high level of screenings over several weeks put very strong pressure on pharmacies, laboratories, school staff and parents.

This social cost is to be added to the financial costs.

The large difference in the number of contaminations between France and our neighbors cannot only be explained by the greater number of tests.

With Omicron, mass screening proves to be ineffective in breaking the chains of contamination.

Thus, Castex's complacency in December 2020 was much more justified than in December 2021.

Since the start of the pandemic, after a difficult start, France has screened 3.3 times more than the Germans (3.3 million against 1 million per million inhabitants). The latter had twice as many declared cases but a death rate a quarter lower and public accounts less degraded than France. As for the English, they carried out twice as many tests as France and six times as many as the Germans (6.4 million per million inhabitants) for a death rate 20% and 62% higher than France and Europe. Germany respectively.

Making the number of tests an indicator for evaluating the performance of the health strategy currently therefore seems rather erroneous.

It seems all the more urgent to redefine our testing strategy as the 60 billion cumulative deficit in 2020 and 2021 by health insurance, which will still be in deficit of 14 billion in 2025, requires us to return to a certain economic rationality, science and health.

Probably wishful thinking during an election period!