It's what some have called a "French paradox": a country with historically high medicine consumption has notably low confidence in vaccines, a trend that has sparked concern in the early days of the COVID-19 vaccination rollout.
Trailing its European neighbours in the first weeks of its vaccination campaign, the French government was accused by some of capitulating to a vaccine-hesitant population. Experts say the delay, however, was likely also logistical.
Yet France remains one of the most vaccine-hesitant countries in the world, despite some recent signs that as more people are vaccinated for COVID, confidence rises.
Nevertheless, just 40% of people in France said that if a COVID-19 vaccine was available they would get it, according to a December 2020 Ipsos survey.
The same survey showed that 77% of respondents in the UK, 65% in Germany and 62% in Italy and Spain would be willing to get a coronavirus vaccine.
**Recent surveys, however, have shown that may be rising slightly, with an IFOP poll released on Monday showing 54% of French people would be willing to be vaccinated, 15 points higher than in December.
Ipsos' survey from October had shown French willingness to get the vaccine at around the same level before the drop in December.**
A December survey carried out by Public Health France showed a significant difference in confidence between genders and ages, something that remains the same in polls released earlier this week.
Under a third of people aged 18-49 said they intended to receive a coronavirus jab, compared with 61% of people over the age of 65.
The study for Public Health France also showed in December that just 29% of women in France said they intended to get a COVID-19 vaccination, compared with 53% of men.
Experts say this statistic could be explained because women typically have lower confidence in vaccines. It could also be explained by women being less at risk of developing severe COVID-19.
A concerning internal study from the Federation of Hospital and Care Establishments said that just 19% of care workers would be willing to receive a COVID-19 vaccine, Les Echos magazine had reported in December.
Jean-Luc Melenchon, leader of the far-left party La France Insoumise, appeared to voice the concerns of many French people in terms of the coronavirus vaccines, stating earlier this month: “I want to choose my type of vaccine. I don’t want to be a guinea pig.”
Similar fears are very present on social media where many users have said that older adults in care homes are “guinea pigs” for new vaccine technology and said they were concerned about the speed at which vaccines were developed.
'Underlying distrust' of authorities
France's slow start to coronavirus vaccinations likely fed "into an underlying distrust, which is one of the driving reasons for the historic [low confidence] in France," said Heidi Larson, director of the Vaccine Confidence Project at the London School of Hygiene and Tropical Medicine.
She pointed out that the government's "management" of different health scandals "has either confused or disappointed the public at different points."
Indeed, vaccine hesitancy in France is nothing new.
"It relates on the one hand to our social and political history. It is true that in France we expect a lot from the state and at the same time we are very critical of the state," said Lucie Guimier, a geopolitical expert specialising in public health at the University of Paris' Institute of Geopolitics.
Resistance to vaccines in the country "is the defence of individual freedoms, it is the refusal of the intrusion of the state into our private lives," Guimier said, calling it a "French paradox" as the country has been one of the top consumers of medicine globally and is the home of Louis Pasteur, famous for developing a vaccine against rabies.
Multiple health scandals contributed to vaccine hesitancy in France
"After large health scandals, there is a decline in confidence in vaccines," Guimier explained, even if it is unfounded.
These cases include an infected blood scandal in the early 1990s when the public learned that more than 1,000 haemophiliacs in France had received HIV-infected blood. Four French ministers went to trial over the scandal and three were convicted.
"The public felt authorities should [have come forward] sooner... it’s very much an issue with trust in government, trust in authorities, and distrust in big business," Larson said.
For Guimier, another three main health events, some scandals and others mere rumours, also influenced opinion on vaccines.
Like in other countries, a controversy over possible links between the Hepatitis B vaccine and multiple sclerosis created a media storm, resulting in the halting of France's vaccination campaign in 1998.
"Politically, the crisis was managed very badly," explains Guimier, stating that the abrupt end to the vaccination campaign made the jab seem "dangerous" to the public even though there was not a causal link found between it and multiple sclerosis.
Indeed, stopping the Hepatitis B vaccination campaign "confused the public, because on the one hand, they were hearing it wasn’t a problem and on the other hand [the health minister] was cancelling it," Larson said.
A drug scandal that erupted in 2010 heavily influenced French confidence in authorities as well, experts say.
The Mediator drug scandal involved millions of people who received a diabetes medication/appetite suppressant that had harmful side effects.
Estimates suggest it caused the deaths of hundreds of people between the 1970s and 2009.
But perhaps the key health scandal that influenced vaccine confidence was the purchasing of an oversupply of H1N1 vaccines in 2009. The country ordered 94 million doses of the vaccine for H1N1 but under six million people were eventually vaccinated.
It's an event that led to "the public feeling that the government was in bed with big business," Larson said who previously told Euronews that reliance on big business was a weak point in the vaccine "trust chain".
This scandal, however, was recently revisited in light of the COVID-19 crisis with former health minister Roselyne Bachelot being commended for her preparations for a potential crisis amid criticism over a lack of masks early on in the COVID-19 pandemic.
This coupled with the rise of social media and disinformation in the last decade has contributed to low confidence levels, Guimier says.
Does vaccine hesitancy translate to low levels of vaccinations?
French President Emmanuel Macron has repeatedly said that the country will not make the vaccines mandatory. But it's uncertain whether the low intention to be vaccinated will translate into refusals once the jab becomes more widely available.
Already, a website launch in France to schedule COVID-19 vaccinations was delayed by the government due to what multiple French media reported was saturation. Screenshots on Twitter showed that too many people were trying to access the website when it was first launched on Thursday.
And last year, increased demand for the flu vaccine led to restocking issues in France.
A recent Vaccine Confidence Project survey also showed that overall confidence in vaccines had gone up in France over the past five years though it remains low compared to other countries.
The French government also made seven additional vaccines mandatory in 2018 for children, bringing the total of mandatory childhood jabs to eleven, for instance, which increased vaccinations.
After its initial slow start, France has now vaccinated more than 300,000 people and plans to speed up inoculations with the opening of vaccination centres.
With January polls showing a rise in confidence, many hope that as more people receive the vaccine, this will continue.
"[They are] trying to do a fast response and at the same time trying to give enough information and get enough engagement," said Larson.
It's an example of the main challenge to these vaccination campaigns of how "countries navigate publics [critical] about the speed of the vaccine with those who eagerly want it and say it’s not quick enough."
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