Launch of citizens’ consultation on French COVID-19 vaccine campaign

As France boosts pace of its nation-wide vaccine campaign, French government has decided to refer the matter to the Economic, Social and Environmental Council (CESE) to monitor the Covid-19 vaccination strategy, at a time when 58% of French people do not wish to be vaccinated. But this skepticism goes way back. Already in 2016, Health Minister Marisol Touraine, worried about insufficient vaccination coverage and the resurgence of certain diseases in France, launched a public consultation through “Santé Publique France” to analyse the mechanisms and causes of this mistrust. Missions Publiques moderated the two citizen juries (one composed of the public, the other composed of non-immunization health professionals).

Why are the French so skeptical about vaccines?

If the current question is how to accompany the Covid-19 vaccine campaign, it is useful to understand what were (and still are in part) the mechanisms that explain the skepticism of the French towards vaccines in general.

This citizen consultation was based on the conviction that “the expression of public expectations, representations or fears must be sought because it can confer relevance and legitimacy on public decisions, in the same way as technical, political or institutional considerations”. The special feature of the approach was the setting up of two citizen juries: from the general population, the other selected among health professionals who are not specialists in vaccination. This system was supplemented by a participatory space on the Internet.

About 40% of French people had already expressed doubts about the safety of vaccines – this proportion varies from vaccine to vaccine. But why is France among the world’s most vaccine-skeptic countries?

Several factors explained the rise in doubts among French folks. Firstly, sociological factors. Now that the major infectious diseases have been eradicated, citizens argue they may not need to get vaccinated against risks that have become non-existent; the adjuvants present in vaccines are a cause for concern (at the time, there was a supposed link between vaccination against hepatitis B and multiple sclerosis); the juxtaposition in the vaccination calendar of compulsory and recommended vaccines also causes some confusion. Added to this is the role of general practitioners, who often find it difficult to respond to their patients’ concerns, and the fact that, since the 2002 Kouchner Law, French society has recognised the right of citizens to take responsibility for their own medical decisions.

Last but not least, the unfavourable context: the health scandals (contaminated blood, the French Mediator affair, poor management of the hepatitis B-multiple sclerosis vaccine controversy) and the positions of hostile associations widely disseminated on social media. Faced with these challenges, the inadequacy of responses or even the lack of awareness and the weak commitment of public authorities has in recent years left the field open to anti-vaccine mis-or disinformation.

Whether they were citizens, medical professionals, all agreed that vaccine confidence requires radical transparency discussed at expert level and at the level of access to data, i.e. the dissemination of scientific information on vaccines (benefits, risks, etc.), with progress to be made on the reporting of adverse events and reactions.

Since then, it has been possible on the Santé Publique France website to obtain information to better understand vaccines in the same way as tobacco or nutrition. Education (health education programs for all, for example) and ambitious communication were two ways of re-inscribing vaccines as an effective solution for preserving public health.

Six years have passed since this last health consultation*, and still, such concerns are still widely shared among French citizens. As COVID-19 continues to spread across the country, President Macron’s government choses to consult the public.  

Faced with these challenges, the inadequacy of responses or even the lack of awareness and the weak commitment of public authorities has in recent years left the field open to anti-vaccine mis-or disinformation.

A randomly-selected citizens’ jury to monitor the COVID-19 vaccines

President Macron has officially announced a Citizens’ Jury made of 35 randomly-selected French citizens who will support and advise the government’s roll-out strategy up until next fall. “Vaccinations must be carried out in a clear and transparent manner by sharing all information at every stage. Our strategy is based on several vaccines. (…)”

Missions Publiques together with Eurogroup Consulting, will support the CESE in the overall structuring of the consultation and the organisation of the sessions and inter-sessions with the citizens’ jury.

The approach is based on three pillars:

  • A temporary committee within the CESE to steer the scheme and organise consultation of all stakeholders. The committee will also be responsible for organising a recurrent mechanism for sharing concerns and information with associations (patients, users, etc.) not represented on the board. The recommendations of this temporary committee must be based on the work of the citizen’s collective.
  • A group of 35 citizens will accompany the launch of the vaccination campaign, monitor its progress and then evaluate it. The work of the group will feed the temporary committee but also the Vaccine Strategy Orientation Council. It will also express its views on the questions, fears, resistance and ethical issues that vaccination campaign against COVID-19 may give rise to.
  • A platform for consulting the general public, administered by Cap Collectif to gather, on a large scale, the expression of citizens’ concerns, expectations or information needs relating to the vaccination campaign.

The results of the work of the temporary committee, the citizen’s collective and the contributions on a platform will be submitted in 2021 to the policy council on vaccination policy, chaired by Doctor and Researcher Professor Alain Fischer, who is in charge of coordinating the development and logistics of the nation’s vaccine strategy and who will produce recommendations to the French government.

The current context is very different in that the need to organise mass vaccination quickly is unprecedented. There is also this precarious balance with, on the one hand, the rapid development of the vaccine, which does not allow us to have any perspective on its possible side effects nor on its level of effectiveness, and on the other hand, a proven epidemic whose impact is well known to everyone and the absence of an alternative at this stage for a return to normal life. Expectations from the citizens are delicate. They will have to prove their usefulness in order to make decisions in short term and also to complement other forms of consultation required by health professionals and local decision-makers.

 *To find out more about the 2016 consultation and citizens’ recommendations, go to http://concertation-vaccination.fr/wp-content/uploads/2016/11/Rapport-de-la-concertation-citoyenne-sur-la-vaccination.pdf (in French)

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