Family practice physicians discuss the uproar over H1N1 vaccinations in France

H1N1 virus. Wikipedia

Michael Cosgrove interviews three family physicians in Lyon, France, about the country’s radical shift in public opinion toward H1N1 vaccinations and health officials’ handling of the vaccination campaign in this exclusive interview for Flesh & Stone.

Less than one month ago, French public opinion was overwhelmingly hostile to the idea of vaccination, with over 80 percent saying they would not, or most likely would not, get vaccinated and that the authorities were fear-mongering.

Today, however, vaccination centers are massively overburdened; there have been instances of public disorder among people waiting to be vaccinated, and some are complaining that the government has not done enough to facilitate vaccination.

Rudolph Chastel, Vincent Deslous-Paoli and Olivier Giraudon are general practitioners in Lyon, France. They, like general practitioners in many countries, are part of the national network of physicians known as “family doctors” or “local doctors.” They are also generally the first to see patients who come down with the flu.  

We discussed various aspects of the H1N1 issue. Below are extracts from that conversation.

MC: We haven’t seen many articles about the role of GPs during the pandemic. The press has been full of H1N1 news, including coverage of government activity and the vaccination centers. Why have family doctors been so noticeably absent from the debate?

Because no one asked us our opinion until very recently, it’s as simple as that. France is a highly centralized country which is run by the elite. We are very angry that we have been ignored until now. We have not even been authorized to diagnose people as having H1N1. Only hospitals have been authorized to do that. The result is that hospital staff can’t cope efficiently with test demands.

It’s as if we are a sort of last resort in the eyes of the government. Now that they have messed up their campaign and that people are clamouring to get vaccinated they are frantically asking us to help cobble together some kind of adequate response to the situation.

We weren’t even authorized to get vaccinated along with the rest of health care personnel until very recently.

MC: Are you vaccinated now?

Dr. Chastel: Yes, but I was lucky and just happened to go to get vaccinated on a day when there weren’t many people around, or maybe because the person controlling candidates was not too fussy about authorizations.

Dr. Giraudon: I got vaccinated, too, but I had a hard time with the administrative side of it. People didn’t seem sure of whether or not we were allowed to get vaccinated.

Dr. Deslous-Paoli: I still haven’t been vaccinated. They refused to let me in, saying that I was not a priority. Phone calls I have made to try and sort things out have led to an impasse and it is evident that there is a lot of confusion at the administrative level. Many other doctors have still not managed to get vaccinated.

MC: What has the government asked you to do now that they have mobilized you? Are you happy with those arrangements? People are saying that you are only going to vaccinate people because you will be paid more to do so.

Yes, we are aware of those rumours but in fact the opposite is true. As things stand, everyone is in a lose-lose situation.

We have been asked to vaccinate people in the centers, but doing so would mean that we would have to close down our practices. The effect of that would be that not only would we lose the revenue from our regular patients but, more importantly, they would not be able to obtain consultations during that time.

In fact, we would vaccinate people for free on our premises during consultations, but the government will not allow us to carry stocks of vaccine.

It’s a lamentable mix-up, we have the feeling that we are being used as a stop-gap, and some doctors are even saying that they will not go and vaccinate in the centers under those circumstances, even if requisitioned to do so.

MC: OK, let’s backtrack three weeks, to the time when the vast majority of the public was anti-vaccine. How and why did that situation arise?

First of all, you have to understand that the French are automatically “anti” anything that any government proposes and they are very often suspicious of government motives. For example, there was a lot of talk about profit-based wheeling and dealing between the authorities and the pharmaceutical companies. In fact, the French are anti-state in a way, which is paradoxical given that at the same time the people always expect the state to deal with their problems, thus dispensing them from having to find their own solutions.

The press was also to blame. Every day brought its lot of scare-mongering articles, most of which were not based on any scientific elements. But as long as it “sells paper” as you say, it’s OK in their view.

And, as has been the case for doctors, there was a lack of clarity in government efforts to inform the population of the risks of a pandemic. That gave rise to many unfounded rumours concerning the safety aspects of the vaccine. Mind you, the press didn’t do much to dispel the lack of clarity by using an objective approach, as it should have done.

MC: And now, just three weeks later, here we are with people and the press complaining bitterly of government inefficiency concerning the organization of vaccination facilities, which have been flooded out with long lines of worried people. In other words, the public has changed its views in the blink of an eye. How would you explain that?

First of all, it is incontestable that the sudden increase –- a two-fold hike in both deaths and infections –- has had an effect. But, again, the press has latched onto it and now it’s all about how bad and serious things are getting. The sudden surge in Paris and the highly publicized fact that more young people are dying than was initially predicted has undoubtedly brought many sceptical younger people, including those of school age, back down to earth.

And although it could be argued that the public’s previous perception was that the government was doing too much and scaring people -- the government has not, in effect, done enough. We doctors are a good example of that. We are only now being asked to contribute to the vaccination effort in what have become chaotic circumstances.

All of that may seem difficult to understand to Anglo-Saxons, but the French are “Gauls” – that is to say fiercely independent in thought and action.

MC: How do you think the pandemic will develop? Is the worst behind us?

No, it most certainly is not. We doctors have varying opinions on how things will develop, but a consensual opinion says that things are going to get worse, or maybe much worse, and that a quick build-up to the climax of this pandemic will begin somewhere between Christmas and the middle of January, due to the increased geographical mobility of people during that time.

MC: Finally, do you consider that the H1N1 pandemic and the highly varying reactions to it will teach us any lessons for the future?

Absolutely not. As stated earlier, the French are suspicious of government and, concerning health care in particular, many people have not forgotten past scandals such as those involving the tragic thalidomide vaccination campaign and the scandal of HIV-tainted blood transfusions.

Thank you all very much for taking the time to talk to us.