France begins controversial nationwide H1N1 vaccinations today

H1N1 mask advisory sign at the entrance to a French hospital. Randalfino (CC)

After months of often ugly debate over the best way to go about vaccinating the population of France against H1N1, the program begins today in a climate of administrative confusion and widespread health sector and public skepticism.

Tempers have flared over the last few months over the program, with many authoritative personalities expressing serious doubts that there should even be a program, never mind its implementation modalities.

The national daily, Liberation, went so far as to conduct a “no” campaign on the issue, assimilating mass vaccination to a potentially totalitarian denial of basic human rights and freedom of choice.

But the vaccination lobby has won out and the campaign has begun.

French health authorities have decided to begin with key categories of hospital personnel before extending the program to the general population, and according to the official "Priority List" issued by the government at the end of September, those key categories are intensive care, neonatology and pediatrics. Next in line will be all other medical, paramedical and auxiliary nursing staff along with doctors and ambulance personnel.

General population vaccinations will begin immediately after All Saints Day on November 5. Priority will be given to women who have been pregnant for over three months. They will be given a special vaccine without an adjuvant because the government contends that studies on vaccines with adjuvants and their effects on pregnant women are not yet complete.

After that the effort will be concentrated on babies, young children, and anyone else with pathologies which make them more vulnerable than they would normally be. Adults considered to present no risk factors will be vaccinated last of all.

The public will be informed when their turn comes by an official convocation letter, and vaccination is not obligatory. Vaccinations will be done in one of the 1,080 vaccination centers dispersed all over the country, and parallel access to seasonal inflenza vaccinations will be unrestricted.

French Health Minister Roselyne Bachelot announced this morning at a press conference that the vaccine chosen for the beginning of the campaign will be a version developed by GlaxoSmithKline (GSK) which she said has been delivered to health authorities. She said 1.5 million doses have been delivered, and initial vaccination using the GSK vaccine will consist of a double injection method.

Bachelot also expressed the hope that European-wide recommendations would soon permit single-dose vaccination of the GSK vaccine as that would speed up the vaccination process.

So much for the official picture. On-the-ground realities show a more confused situation, with many hospital staff expressing doubts as to whether or not they would opt for vaccination even though French health authorities are presenting vaccination as a “public duty” for hospital staff, as reported by the French daily Le Figaro.

Administrative glitches are being reported, and some sites are said not to have the necessary number of doses, whereas others have all the doses they need.

Administrative procedures vary from hospital to hospital, with one Parisian hospital struggling to overcome major last minute IT problems which have blocked access to the internet site it created and which contains the six page inscription form that its personnel are required to fill out online.

On the other hand, other hospitals organized their inscription programs weeks ago and are ready to begin.

What is not known at this time is what proportion of medical personnel will choose to be vaccinated. It is well known that several pessimistic studies carried out on the vaccines' efficiency and safety during the summer have resulted in many hospital staff being unconvinced and even hostile towards the H1N1 program.

Some of this reticence is suspected to be of political origin, with some staff said to be using the vaccination issue as a way of protesting against government policies in general.

Bertrand Guidet, an intensive care specialist at the Saint-Antoine hospital in Paris, observed “I have seen unwillingness to vaccinate in my service, and particularly a sense of confusion with the seasonal influenza vaccine.”

One particularly candid point of view was that of a management level health worker in a hospital in the south of France who declared that he was ready to take the risk of the the virus responsible for the pandemic becoming virulent. “The problem is that the vaccines have been developed in urgent circumstances." he said. "There hasn’t been any long term thinking. We hear so much about it and don’t know what to think any more. Even some scientists are reserved about it.”

In the opinion of Emmanuel Hirsch, ethics professor at the Paris South-XI medical faculty, “The current controversy going on in the professional health sector is indicative of changes which are perplexing and even worrying.” He expressed surprise that in an era supposedly dominated by the logical processes of evidence-based medicine “Data validated by competent national and international bodies is the object of contestation which is often based on scientifically baseles a prioris.”

Hirsche thinks that the refusal of medical staff to be vaccinated may be a symptom of a more deeply rooted dissatisfaction. “It’s as if this is a way of demonstrating defiance towards public authorities who are diffusing the message that vaccination is necessary.”

The situation in hospitals is mirrored in the attitudes of the general French population.

Various polls here show that between 60 and 65 percent of French people are skeptical about the vaccines and that many of them will not present themselves for vaccination. Many French people think that the dangers of H1N1 have been greatly exaggerated, and almost no one wears an anti-H1N1 mask in public.

The H1N1 vaccination debate in France seems set to continue unabated and, if anything, may well become even more venomous as the program progresses.

This correspondant’s morning coffee radio news catch-up consisted almost entirely of claims and counter claims concerning H1N1 vaccines. In one debate  on a quality national radio station, an expert claimed that the vaccines contain “dangerously toxic substances.” He was immediately accused of “obscurantism” by those who support the vaccination program.