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France’s vaunted health system fails its greatest test in generations: the COVID-19 vaccine rollout

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France's vaunted health system fails its greatest test in generations: the COVID-19 vaccine rollout


For decades, France has boasted how its first-rate public health system—for which the French pay heavily in taxes—amply cares for its 67 million people, from birth to the end of life. And Louis Pasteur, the Frenchman who invented the world’s first vaccine in the 1880s, is nationally revered, with streets and a renowned research institute named after him.

Yet in recent days, France’s failure to organize any credible COVID-19 vaccine program has exposed deep flaws in both its health and political systems—ones that could prolong the pandemic, cause thousands of unnecessary deaths, and threaten the reelection chances of President Emmanuel Macron in just over a year.

Consider the evidence: Less than two weeks after coronavirus vaccine campaigns began rolling out across the world, about 4.2 million Americans and about 4.5 million Chinese have so far been vaccinated. A full quarter of Israel’s population has already been vaccinated. Britain, with the same population as France, has vaccinated more than 944,000 people. And Germany has jabbed the arms of about 239,000 people, out of a population of 83 million.

Now take France: As of Monday morning, 515 people in the country had received their first shot of the two-dose Pfizer-BioNTech vaccine; that figure is not missing any digits. Under mounting pressure to explain his performance, French Health Minister Olivier Véran said late afternoon Monday that “several thousand people” were immunized during the day.

Still, that vague figure lags drastically far behind other rich countries—and for several reasons.

In a decision for which the government is now paying a high price, officials decided months ago that it would administer the COVID-19 vaccinations only by the country’s 60,000 or so general practitioners. That is unlike the yearly flu shot, for example, which is given at thousands of neighborhood pharmacies, or by regular nurses. Coronavirus vaccines are not mandatory, far different from 11 diseases like mumps and measles, which are obligatory for children to attend school.

“There is a very, very cautious approach not to oblige people to get vaccinated,” says Emmanuel Rivière, director general in France of the polling agency Kantar Public. Behind the government’s reasoning is the deep reluctance among millions of French to accept the COVID-19 vaccine, partly reflecting a general distrust of government, as well as a distrust of profit-making Big Pharma.

Vaccine suspicions

About four in 10 French are highly reluctant to be vaccinated against the coronavirus—a far higher proportion than almost any Western country, according to an IPSOS poll of attitudes across several countries. Kantar found in November that the widespread skepticism stems partly from a deep distrust of government, as well as the lightning speed at which the coronavirus vaccine was developed. “People will accept their kids getting shots for diseases,” Rivière says. “But they say it takes at least 10 years to develop a vaccine.”

The COVID-19 vaccine rollout has shaved years off the process thanks in part to an unprecedented global collaboration between drugmakers and researchers, plus the adoption of new innovative drug development techniques. It helps of course that regulators are under tremendous pressure to review and approve the clinical trial data as soon as possible.

Nonetheless, doubts linger in France. And faced with that reality, French officials have opted to tread carefully—so carefully, in fact, that the vaccine campaign virtually stalled at launch.

One problem, for example, is a government rule requiring each person to consult a doctor before being vaccinated against COVID-19, to discuss possible health risks, and then to sign a written consent form. Those measures have helped slow down the effort to roll out mass vaccinations in senior-citizen nursing homes, which has seen large numbers of COVID-19 deaths. Many residents deemed to be unable to make independent choices require consent from relatives.

To many, the rules seem to be absurd regulatory overreach. France has had a higher COVID-19 death rate than the U.S.: More than 65,000 French have died of the virus, among a population that is one-fifth the U.S. Some believe the slow vaccine rollout might cause needless deaths. “There are large costs in this delay in terms of lives lost,” says French economist Antoine Lévy, who estimates that the government, by not investing heavily in mass vaccinations, might pay a far higher economic price, if it fails to end its virus spread. “We have been forced to endure a lot of constraints with the lockdowns, and the government has had to be authoritarian,” he says. “But it also has to be efficient.”

Previous stumbles

The lack of efficiency has highlighted far broader problems with France’s vaunted health care, which operates on a centralized, top-down structure. Those problems arose early in the pandemic, and have greatly complicated the vaccine rollout. As the COVID-19 crisis emerged last February, French officials—including Macron—told the country that facial masks would made little difference in containing the virus. It later emerged that France had virtually no national stockpile of masks. Similarly, officials insisted that only those with active COVID-19 symptoms needed to be tested. In reality, the country had a dramatic shortage of tests, until well into April.

“People got the impression that the government simply invented reality,” says Marie-Estelle Dupont, a Paris psychologist and author on issues related to French attitudes. “There was a lot of confusion about masks, and then tests. Now people do not trust the government anymore.”

Winning back that trust will take major effort—but would be crucial in stemming the pandemic.

In a major article in “Le Figaro” newspaper last Friday, Lévy, the economist, suggested the government scrap the pre-vaccination consent rules and allow all health professionals, including Army medics, to immunize people en masse. The article, which he says simply collated other people’s ideas, has attracted intense commentary on TV networks and among government officials. That has amazed Lévy.

“It’s very worrying that these ideas seem to be novel among the French public,” he says, “We should have been debating this back in April. We are in Kafka territory here.”

More health care and Big Pharma coverage from Fortune:

  • The biggest conspiracy theories of 2020 (and why they won’t die)
  • Timeline: From the first coronavirus cases to the first vaccinations
  • Trump hyped Verily’s coronavirus testing tool. It led to less than 1% of all tests in 2020
  • Commentary: Cracking the code of biological aging could solve America’s health care crisis
  • Data delays aren’t slowing the global rollout of a Chinese COVID-19 vaccine

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Business

Biden’s inauguration was good news for our world

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Biden's inauguration was good news for our world


Good morning. David Meyer here in Berlin, filling in for Alan.

I’m a South-African-British dual citizen living in Germany. So, while I’ve been saddened by the rancor that’s infected American politics over recent years, and while I naturally have personal opinions on the issues that divide the country, I’m not an American voter, and my family and I have no direct stake in the choices that American voters make.

Except when it comes to one particular issue: the climate emergency.

The world is heating up due to human actions, and there is strong scientific consensus that this will have terrible outcomes if not mitigated. We’re seeing them already, in the U.S., in Germany, in the U.K., in South Africa—everywhere. We all share this world, we are all suffering from its degradation, and we must all act to save it.

That responsibility lies with every country, but there’s no getting around the fact that the greatest onus to cut carbon emissions rests on the biggest emitters, namely China, the U.S., the EU, India and Russia. The fifth entry on that list is dragging its heels—and shame on the Putin regime for that. But China, the EU and India are all taking this challenge seriously, and it is of the utmost importance that the U.S., the second-biggest emitter, does the same.

Based on this, I can only applaud yesterday’s inauguration of President Joe Biden. I’d do the same for a Republican president who took the climate emergency seriously—on this side of the pond, it’s much less of a partisan issue, and I hope that will soon become true in the U.S. as well.

As soon as he took office, Biden was a whirlwind of climate-defending activity. Most importantly, he recommitted the U.S. to the Paris Agreement, which aims to keep global warming well below 2 degrees Celsius. The significance of this is enormous.

Before yesterday, countries producing half of all global carbon emissions had committed to carbon neutrality or net-zero emissions. “Today’s commitment by President Biden brings that figure to two-thirds,” said United Nations Secretary-General António Guterres as he welcomed the move.

But, Guterres warned, “there is a very long way to go. The climate crisis continues to worsen, and time is running out to limit temperature rise to 1.5 degrees Celsius and build more climate-resilient societies that help to protect the most vulnerable.”

I have no doubt that the U.S. will be rewarded for bringing its considerable heft to this fight, not only in terms of national security—climate change is a far more fundamental threat than terrorism—but also when it comes to international standing. The country will find it easier to achieve its foreign-policy aims when others see it as a partner rather than a holdout.

It should also go without saying that clean-energy investors will find the new administration’s policies rewarding. Solar stocks are on a tear, thanks to the prospect of more stimulus and subsidies, and the likely continuation of low interest rates that aid financing for new projects. Unsurprisingly, with a green-hued infrastructural push on the way, a BofA note this morning points out that fund managers are throwing money into energy and materials.

All in all, yesterday’s transition provides grounds for climate optimism around the world. But now there’s work to do. More news below.

David Meyer
@superglaze

[email protected]



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Do government deficits matter?

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Do government deficits matter?


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In support of political contributions

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A deluge of feedback in a turbulent week


Good morning.

Most Americans don’t want CEOs involved in politics. A poll conducted last week by Golin and Ipsos found only 41% favored CEOs weighing in on disputed elections, and only 43% wanted them speaking out on impeachment. On the other hand, 74% say CEOs should call for unity and a peaceful transfer of power, and 57% believe it was appropriate for CEOs to speak out after the January 6 insurgency at the Capitol. That pretty well tracks with the way most CEOs and business groups have behaved since election day. They kept their powder dry until all legitimate avenues for disputing the election were exhausted, then came out strongly endorsing the election results and attacking efforts to undermine them. Relatively few have backed impeachment. (You can see the poll results here.)

But how about political contributions? That’s the question raised last week, as a host of companies—Marriott, AT&T, American Express, Best Buy, Cisco, Comcast, Dow and Amazon among them—suspended campaign contributions to members of Congress who challenged the election results. Another large group—Microsoft, Boeing, Blackrock, Coca-Cola, JP Morgan, Ford, GM, UPS, Goldman Sachs and Citigroup—temporarily halted all political contributions to members of both parties. (Quartz has a more comprehensive list of what companies did here.)

Some business leaders are even contemplating permanently shutting their political action committees and exiting the money game altogether. But absent a broader overhaul of campaign finance—which is unlikely anytime soon—I think that’s a mistake. Most big companies remain balanced players in the money game, dividing their dollars roughly equally between members of each party. Walmart, for instance, has kept its contributions at exactly 50-50. Their strategies have less to do with trying to influence outcomes, and more to do with assuring they have access to whoever wins.

The more important question for 2021 is how big business uses that access. There are a host of issues where business has the potential to help broker positive outcomes for the U.S. economy and society: economic stimulus, infrastructure, worker training, climate change. On each of these, business leaders occupy the center, and can help bring the parties together to solve urgent problems.

But on tax and regulatory issues, in particular, corporations will be playing defense. And they’ll be tempted to use what influence they can muster to seek tax breaks and regulatory exemptions that aren’t in the broader public interest. That’s where the commitment to stakeholder capitalism will be tested. The nation desperately needs business involved in government. But business, now more than ever, needs to use its influence to focus on solving long-term challenges.

News below.

Alan Murray
@alansmurray

[email protected]



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