Vaccination: French hesitation

Home of Louis Pasteur, whose research constituted a decisive advance in the development of vaccination, France is today one of the countries of Western Europe where vaccine hesitation is greatest. Jocelyn Raude is a teacher-researcher in social psychology at the School of Advanced Studies in Public Health. This specialist in prevention and infectious diseases retraces for The Conversation the story of a recent drift.


The Conversation : First of all, could you explain to us what is covered by the expression “vaccine hesitation”?

Jocelyn Raude: Vaccination hesitation is a concept designating a very broad spectrum of behaviors, which range from unconditional acceptance of vaccination to its complete rejection. Between these two extremes, resistance to vaccination can be more or less strong.

TC: Historically, what was the attitude of the French population towards vaccination?

JR: For historical reasons, linked to the work of Louis Pasteur in particular, France has long been a very “pro-vaccine” country. Vaccination was an instrument of influence and national pride, exploited as such by institutions, especially at the end of the XNUMXth century.e century. Until under the Ve Republic, this provaccinal tradition has remained deeply rooted. There was a very strong social and cultural consensus around the value of vaccination. It is all the more important to emphasize that this was not necessarily the case with our neighbors. In many countries, notably the UK, very powerful anti-vaccine leagues and anti-vaccine movements emerged very soon after the development of vaccination.

TC: What made the situation change?

JR: A major controversy emerged in 1998, following the publication of Andrew Wakefield's work. This former surgeon claimed to have demonstrated a link between vaccination against measles / mumps / rubella (MMR) and autism. The scientific publication presenting these results ended up being retracted, because the link turned out to be false (Editor's note: the British General Medical Council (GMC), equivalent to the Council of the Order, has also struck off Andrew Wakefield in 2010, calling it "dishonest and irresponsible"). However, this affair led to a major childhood vaccination crisis among our neighbors across the Channel: a considerable drop in vaccination coverage for children against measles was observed in England from the end of the 1990s. had a resounding impact in developed countries, vaccine criticism increased from this period. However France was rather spared.

In our country, the first warning shot nevertheless occurs the same year as the publication of the work of A. Wakefield: it is about the public controversy around the vaccine against hepatitis B. The Minister of Health of the At the time, Bernard Kouchner then suspended the vaccination of schoolchildren, because of a supposed link with the occurrence of multiple sclerosis. All the scientific data will tend to conclude that there is no correlation between the two. However, from this moment, we see the emergence of mistrust vis-à-vis vaccination in our country (we can also notice that France is the only country where this controversy has taken place).

This new trend then led researchers in the social sciences to carefully study adherence to vaccination. From 2000, the INPES (National Institute for Prevention and Education for Health, which was integrated into Public Health France when it was created) raised the question of the attitude of the French towards vaccination. This survey will be repeated in 2005, then in 2009-2010.

TC: What do these various surveys reveal?

JR: At the time of the first survey, in 2000, 90% of French people are in favor of vaccination, and only 10% are reluctant. This rate does not change between 2000 and 2005. From 2009-2010, we ask this question again in the context of vaccination against H1N1 influenza, we see that the rate of people who say they are unfavorable to vaccination has exploded. : it now reaches 40%. This is a dramatic change, rarely seen in recent history. It is a real change.

TC: What explains it?

JR: This shift took place following the conjunction of 3 phenomena. First of all, for the first time, the issue of links of interest and conflicts of interest is entering the public debate. This issue had until then been confined to medical literature, and rarely relayed or commented on in the general press. The influenza A (H1N1) epidemic, which runs from 2009 to 2010, is a game-changer. To face it, the Minister of Health at the time, Roselyne Bachelot, orders 94 million doses of vaccine from various pharmaceutical companies, at a cost of several hundred million euros. However, a large majority of these doses will remain unused, which will lead some parliamentarians to criticize this decision (part of the order will be terminated against compensation from the laboratories). The minister will sometimes be accused of "precaution", in other words of having carried out a policy of extreme, disproportionate precaution.

This situation will raise the issue of conflicts of interest, because many of the experts who advised Roselyne Bachelot had links of interest with the pharmaceutical industry. The debate will gain momentum, following in particular the publication at the end of 2010 of Martin Hirsch's book entitled “To end conflicts of interest”.

It is then that the conspiratorial networks, emerging in our country, come into play. They seize on this criticism, which can be considered legitimate, to build dystopian discourse around vaccination, which is fueled by personalities like Henri Joyeux or, later, Luc Montagnier. Plot stories will thus be built by feeding on the debate on conflicts of interest: the pharmaceutical industry would instrumentalize epidemics - when they do not construct them from scratch - to sell its products, make a profit, etc.

During this period, vaccination becomes a mainstay of conspiratorial discourse, which was not necessarily the case before. Until then, their favorite themes were rather the attacks of September 11, 2001, supposed political conspiracies (such as those around the Kennedy assassination), government cover-ups (Roswell and the extraterrestrial question for example), etc.

Then begins to emerge a very well constructed story, centered on the figure of Bill Gates, because this billionaire has invested a lot in the vaccination against polio. A whole discourse emerges on the fact that vaccines could be biological weapons of mass destruction, used to carry out a true genocide on a part of the world population. We have seen these theses reemerge recently, with the video Hold-up.

Finally, this deadly sequence for vaccination will be further aggravated by a third element: the case of the Pick. This health scandal has nothing to do with vaccination, since it concerns a drug. Nevertheless, in a way, it will reinforce the idea that there is a major safety problem with respect to pharmaceutical products.

Strangely, it is not really the drugs that will suffer from the scandal, but the vaccination. Our investigations will reveal that, very quickly after this affair, a change in perceptions of the vaccine occurs: the idea that vaccines are dangerous takes hold in collective representations, including among people who are in favor of vaccination. People think, for example, that serious side effects are common, even though all epidemiological surveillance data indicates that they are in fact extremely rare.

This change, which occurs from 2010, does not only concern representations and perceptions, but also practices: some vaccines will lose their attractiveness, in particular the vaccine against seasonal influenza. In 2011, a third of people vaccinated in previous years will not be vaccinated (especially the elderly). There is therefore a decrease in vaccination coverage.

TC: Who are these conspiratorial networks?

JR: We have identified 3 types of actors. The first are actors of the "political" type, mostly from the extreme right and the extreme left libertarian. For them, vaccination represents above all a hold of the State on private life, and must therefore be fought as such. These actors produce a form of criticism that is rather political, even if it feeds conspiratorial positions.

The second category of actors is purely economic. These are start-ups working in the field of “attention economy”, which have positioned themselves on this subject because they have detected a potential market there. These "entrepreneurs of mistrust", who are located in Eastern Europe or in certain Western countries, will create sites specializing in conspiracy to monetize them, but are not necessarily themselves convinced by the stories they convey. They exploit the vein of this “cognitive market”, to use the expression of sociologist Gerald Bronner.

The third type of actor is formed by the nebula which revolves around the market of alternative medical practices, which have always held a critical and vaccinosceptic discourse. Vaccine criticism is a way for these actors to acquire a certain visibility. These networks are polymorphic and complex, often anonymous. In addition, some heralds of vaccine criticism may have a double positioning, for example being both close to extreme right-wing circles and to structures with commercial aims promoting alternative medicines.

TC: Did the new digital tools play an important role in the dissemination of these ideas?

JR: Indeed, these networks quickly adopted new digital tools to disseminate their stories. Moreover, specialists who have examined the discourse on vaccination on digital social networks have shown that vaccinosceptic and vaccinocritic networks are much more responsive and produce much more (especially new) content than institutional sites or people who defend the vaccine. vaccination, which are often scientists, doctors or experts who have little time to devote to this production of content.

An asymmetry is therefore created between on the one hand a very dynamic negative discourse, very relayed by very committed people, who invest a lot of time and energy, and on the other hand the production of the discourse in defense of vaccination. less "dynamic".

So much so that a few years ago the sites that came first when you just typed the word vaccine or vaccination in search engines were vaccinosceptic or vaccinocritical sites, which were ranked better than institutional sites. Since then things have changed, because the public authorities have taken the necessary steps to improve their referencing on search engines.

TC: Who is sensitive to these speeches?

JR: The socio-professional categories which are the most permeable to vaccinosceptic theses are rather the intermediate categories: social workers, paramedical professions, secondary and primary teachers, etc.

It's particular. In fact, usually on other subjects related to public health (concerning physical activity, addictive products, food, etc.), there is a social gradient: the higher the level of education, the higher the level. of life, the higher the tendency to adhere to the recommendations. In the case of vaccination, this is not the case. The curve is “inverted U”. When you try to understand why, you realize that there is a very strong cultural influence, and in particular political.

This trend towards politicizing the vaccine issue has been observed for 10 years in the United States, and has been clearly exposed under the presidency of Donald Trump. Broadly speaking, people who feel close to far-right or far-left libertarian ideologies are more likely to be hesitant or critical of vaccination. This attitude is even more marked among people who do not vote. Conversely, people close to traditional "government" parties tend to join. In other words, vaccination becomes an ideological marker: to be against is to be anti-system.

This link between political opinions and vaccination is very new in France, it did not exist 10 years ago. This is probably explained by the fact that the closer one is ideologically to political extremes, the more permeable one is to conspiracy theories. However, since vaccination has become one of the pillars of conspiracy theories, in recent years there has been much greater exposure to anti-vaccine theses in these circles.

TC: How can we explain that vaccine hesitation affects the paramedical professions in particular?

JR: We have studied the link between adherence to alternative medicine and vaccine reluctance among nurses in Brittany. It is very strong, which can be explained by the way in which this sector is structured. One of the explanations is probably that in France, paramedical professions are generally less considered in their professional environment than doctors. As principals, the latter generally entrust them with execution tasks. The fact of appropriating theories competing with those of conventional medicine allows certain paramedics to justify a different form of expertise, which enhances them.

What is more, the alternative approaches, which had disappeared with the development of conventional medicine, tend to arouse enthusiasm again: holistic theories, questions of balance, alternative diets… All of this is accompanied by the emergence of figures of “healing gurus”. These speeches are increasingly meaningful in the collective imagination, and are relayed by certain media figures.

TC: Can the success of these “theses” be explained by the disappearance, in our countries, of major epidemics of infectious diseases?

JR: This is indeed the first historical argument: vaccine criticism is reemerging as people who have known the infectious diseases against which vaccination has been most successful, such as polio, disappear. Who remembers that, until the 1950s, each year thousands of children were severely disabled because of this virus? Following the vaccination campaigns, the incidence of poliomyelitis collapsed, like that of measles, smallpox ... The witnesses of these times have gradually disappeared, and we have lost the collective memory of the consequences of these great epidemics. The motivation to get vaccinated has disappeared.

This is not the case in countries where infectious diseases have wreaked havoc until recently. In India, in China, attitudes towards vaccination are very positive. There are certainly exceptions, as in Pakistan or Afghanistan, but they are linked to a particular context: at the time of the hunt for Bin Laden, vaccination campaigns made it possible to collect information. The consequences were a rejection of the vaccination which could have gone as far as the murders of vaccinators.

We must underline an important point concerning the success of anti-vaccination theses: experimental psychology teaches us that once people have developed a conviction on a subject, it is very stable. As long as people don't have a firm mind on a topic, discussion is possible, but then changing their mind takes a lot of time and energy. In the field of prevention, we advise not to try to discuss or converse energetically with convinced anti-vaccination, because this has a perverse effect: it strengthens their convictions.

TC: Has the Covid-19 epidemic changed the game?

JR: In recent years, there has been an ebb and flow of vaccine hesitation. Between 2010 and 2015-2016, its rate fell from 40% to 20%. Things were improving. However, in the current context of mistrust of institutions, we fear rather an explosion, despite the current epidemic. When we asked, last May, if people were ready to be vaccinated against Covid-19, 25% of them said they did not want it. Today that rate has climbed to 45%.

This is all the more surprising given that we have experienced a significant epidemic recovery in recent weeks, with devastating social and economic consequences. Given the pressure of the epidemic on our societies, we hypothesized that there would be a renewed interest in vaccination, but the reverse has happened. Yet we are unlikely to get out of this situation quickly without the availability of an effective vaccine.

Jocelyn Raude, Researcher at the Unit of Emerging Viruses Aix-Marseille University - IRD 190 - INSERM 1207 - IHU Méditerranée Infection, Teacher-researcher in social psychology, School of Advanced Studies in Public Health (EHESP)

This article is republished from The Conversation under Creative Commons license. Read theoriginal article.

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