Vaccination of caregivers, a crucial issue in the fight against Covid

The High Authority for Health unveiled on Monday the five phases of the future vaccination campaign against Covid-19, and caregivers will have priority

Illustration of a doctor.

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Caregivers and staff in medico-social establishments should be among the first to receive injections of an anti-Covid vaccine.
But at the moment, many of them are suspicious and undecided, which is not surprising since there are still many questions about these vaccines.
These caregivers will be the first to convince if the government wants to succeed in its vaccination campaign, which could be based on their example and the confidence they inspire in the population.

"Get vaccinated?

I do not know what will be in this vaccine, nor the consequences it can have on my health.

No, I'm going to wait and let the others serve as guinea pigs, ”warns Morgane, 27, a nursing home nurse, who responded to our call for testimonies.

This Monday, the High Authority of Health (HAS) defined the different phases of the vaccination campaign in France.

The residents, as well as the healthcare professionals of the oldest nursing homes and those suffering from co-morbidities, will be part of the first wave.

Other caregivers could be part of phases 2 and 3 of the plan.

Emmanuel Macron also made it clear that the vaccine against Covid-19 would not be mandatory.

Not enough hindsight

By the time the first doses of the vaccine (s) which have obtained the green light from the European Union arrive, there may be a lot of educational work if the government wants caregivers to agree to to get vaccinated.

Lucas, a 25-year-old physiotherapist, "does not want to be vaccinated due to the rapidity of the introduction of the vaccine, which does not yet make it possible to see the long-term side effects".

Similarly Mélodie, who works in nursing homes, questions the prioritization of audiences.

“I have no faith in the state and even less in pharmaceutical companies.

The fact of using our professional situation to invite us to take action, I'm not a fan at all.

Other branches are also at risk, restaurant owners, for example ”.

If some regret the pressures of their hierarchy, and sometimes even guilt, others qualify.

“I am for vaccines, my children and I are vaccinated,” explains Céline, 47 years old.

For the Covid-19, when there is sufficient hindsight, I will think about it, but not for this year ”.

Annie, 48 years old and nursing home care provider, holds a whole different story.

“I want to get the flu shot, I've been doing it against the flu for at least thirty years.

I find it normal to protect residents.

But I know, alas, that 90% of my colleagues will not do it… They will be more apt to be vaccinated if the airlines impose it, because vacations count more than residents… ”

Too many uncertainties to draw conclusions

As we have seen, acceptability does not seem to be won.

Not surprisingly given that very little is still known about these anti-Covid vaccines.

Alexis Spire, a sociologist at the National Center for Scientific Research (CNRS), is leading a research project on the trust of caregivers in state institutions in times of Covid-19.

For eighteen months and until September 2021, he investigates in two hospitals in Ile-de-France and Grand-Est.

“Most of the ones we've seen aren't anti-vaccine,” he explains.

In the interviews, we had very few firm and definitive answers on the vaccine against Covid-19, it is too early because there are a lot of uncertainties.

To say today what is the acceptability of this vaccine seems very fragile to me.

The flu vaccine, a revealing example

There would therefore remain a great deal of uncertainty.

But the example of the flu vaccine seems revealing.

“The issues are quite similar with the Covid-19, underlines Alexis Spire.

People who refuse to be vaccinated against the flu will also refuse to do so against the Covid ”.

What to worry about.

"The rates of influenza vaccination among nursing staff are very limited, including in services in contact with people at risk, in geriatrics for example," he analyzes.

And it is lower among nurses and orderlies than among doctors and health executives.

This is confirmed by the latest figures from Public Health France.

During the 2018-2019 season, 35% of caregivers in health facilities were vaccinated (67% of doctors, 48% of midwives, 36% of nurses and 21% of nursing assistants).

They were 32% in nursing homes (75% for doctors, 43% for nurses, 27% for nursing assistants and 34% for other paramedics).

The question of making the flu vaccine compulsory emerged in September 2020. "It is better to rely on the incentive than on the constraint", recommends Alexis Spire.

Why do some caregivers refuse to be vaccinated?

How can we explain that caregivers, who have a minimum of scientific background and spend their days in contact with patients, are so recalcitrant?

Several explanations emerge from the interviews conducted by the researcher.

"The one that comes up most often, and which is common to paramedics and doctors, is that they are not afraid of being sick because they think they are immune from being in contact with the sick," explains he.

The second reason is that it would be absurd to want to inoculate a disease, especially since the vaccine is not always effective.

Finally, a third justification, which rather comes up with nurses and nursing assistants: as the hospital encourages people to be vaccinated, it is suspected that they want to limit sick leave ”.

Two major differences, however, prevent this report from being transposed to the coronavirus influenza vaccine.

The first is effectiveness: we know that the flu vaccine, which must be repeated each year, is only 60 to 70% effective.

The second point concerns safety: we do not know at all what the side effects of the Covid-19 vaccines would be, unlike that against the flu, known and mastered for decades.

A lever to restore confidence

The game is going to be tight for the government.

"There is the combination of two things in France: we are the champion country of mistrust towards political elites and towards vaccination," continues Alexis Spire.

In addition, contradictory injunctions since March in the face of the coronavirus have further fueled this mistrust.

The French people we interviewed, caregivers or not, can understand that there was a part of surprise, unpreparedness in the face of the epidemic.

What is very frowned upon is the lie and the fact that the mistakes were not recognized.

This is why, in this rather tense context, the vaccination campaign will not be able to be carried out without or against the caregivers.

Beyond the responsibility incumbent on them, there is also an issue of exemplarity.

"One of the results of our survey is that for there to be a form of trust in this vaccine, intermediaries are needed between the public authorities who send a message and the people who set up this campaign," Alexis insists. Spire.

The caregivers are very attentive to the doctors, the heads of clinics in their department, with whom they are in direct contact.

Convincing the doctors at the hospital is crucial for reaching the caregivers.

Just as convincing general practitioners is crucial to reassure the general population.

The more so as the government wants at all costs to avoid the fiasco of the vaccination campaign against the H1N1 in 2009. The many stocks had indeed not found takers… “We did at the time of the vaccinodromes and we completely ousted general practitioners, recalls Alexis Spire.

Vaccinating in the chain, it is not conducive to allay fears ... "

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For general practitioners, the expectation is the same.

"You can imagine that if we are not in maximum safety conditions and only 5% of caregivers are vaccinated, the population will not be vaccinated, warns Luc Duquesnel, general practitioner in Mayenne and president of the Les Généralistes-CSMF union.

If I get vaccinated, that I put on a badge "your doctor is vaccinated", that my colleagues do the same, just like the pharmacist, the nurse, that will have an impact, because the French trust us.

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