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Compulsory vaccination against Covid-19: why the debate is premature

Compulsory vaccination against Covid-19: why the debate is premature

 Politicians are calling for making the future vaccine mandatory, but this debate is skewed as there are so many unknowns. Explanations.

Should we make vaccination against Covid-19 compulsory? The debate arose when Pfizer and BioNTech announced very positive interim results regarding the efficacy of their vaccine on Monday, November 9. "It is mandatory" , decided the next day the ecologist Yannick Jadot on Franceinfo . Several other personalities have followed suit since, such as President Les Républicains (LR) of the Senate, Gérard Larcher , or Daniel Cohn-Bendit .

However, the idea is not unanimous. The leader of the National Rally (RN), Marine Le Pen, thus estimated on BFM-TV that the French should remain free "to be vaccinated or not" . The government remains cautious at this stage. If he confided to Le Monde on Saturday that he "feared" that "the French would not be vaccinated enough" , the Prime Minister, Jean Castex, does not plead in favor of compulsory vaccination for the time being.

Behind the proliferation of declarations on this subject actually hides a more complex debate than it appears. And probably premature to date, as there are so many unknowns. Explanations.

1. Not one, but several vaccines

The first limit to the debate on compulsory vaccination as it has been posed in recent days is that there is in reality not one, but several candidate vaccines on the table. Three of these have recently been the subject of very enthusiastic announcements about their potential effectiveness:

  • The candidate vaccine from Pfizer and BioNTech, presented as effective "at 90%" according to intermediate results mentioned in a press release from the laboratory, Monday, November 9;
  • the Russian research institute Gamaleya, which claims for its product a higher efficiency (92%);
  • Moderna's vaccine, which would be effective "at 94.5%" , announced the American biotech, Monday, November 16.

All candidate vaccines have their own characteristics, especially since they were developed using different procedures. Pfizer and Moderna's products are "RNA" vaccines, which use pieces of modified genetic material. While that of Gamaleya is "viral vector", using as a carrier another virus which is modified to adapt it to the fight against the SARS-CoV-2 coronavirus.

“People often talk about the vaccine. In reality, we are likely to have vaccines, with different characteristics , ” summarizes vaccinologist Marie-Paule Kieny in an interview with Le Monde published on November 14 .

2. Questions about the vaccination strategy

The spectacular figures on the supposed effectiveness of candidate vaccines also hide a more complex reality. These are results obtained in the weeks following the second injection of the vaccine, which does not give us, at this stage, any hindsight to know what immunity will be conferred, for example, six months later.

Likewise, it is not known today whether these vaccines only protect the person vaccinated against Covid-19 and its symptoms, thereby reducing the number of severe cases, or whether they also prevent them from transmitting the disease. No more than we know how effective they are on different types of audiences.

So many points that do not fall into detail in the perspective of developing a vaccination strategy. Broadly speaking, we can for example distinguish at least two possible scenarios, among others:

The vaccines available in the near future have characteristics suitable for “mass” vaccination aimed at very greatly reducing the circulation of the SARS-CoV-2 coronavirus, or even eradicating it;

these vaccines do not offer sufficient guarantees to seek collective immunity, but offer interesting individual protection for groups considered to be at risk.

Where we can see that the idea of   imposing a general vaccination would not necessarily make sense in all cases. The Minister of Health, Olivier Véran, did not say anything else on BFM-TV on Tuesday  : it is the high health authority (HAS) which will have to determine the priority audiences in terms of vaccination, he said. But it will only be able to do so “when it has access to scientific data [because] we are talking in a vacuum” today, he said.

3. Serious logistical issues

A possible mass vaccination campaign, a fortiori compulsory, also supposes having adequate logistical resources. For example, the campaign planned for vaccination against the H5N1 virus relied on 1,168 vaccination centers. This made it possible to vaccinate around 6 million people per month, according to the report of the parliamentary commission of inquiry on this issuepublished in 2010. Generalizing the vaccination against Covid-19, by performing two injections for each patient, would therefore require much greater means. This without taking into account the issue of vaccine availability. The European Commission has, at this stage, concluded four contracts to obtain first deliveries of vaccines with the alliance Pfizer / BioNTech, AstraZeneca, Johnson & Johnson and Sanofi-GSK. Another could follow with Moderna.

Be that as it may, these stocks should not make it possible to vaccinate the entire French population from the first half of 2021. To take the example of the Pfizer / BioNTech vaccine, France will initially be able to count on 30 million doses, which would take care of 15 million people (since two injections are needed per patient), according to Olivier Véran.

Especially since other logistical factors are added to the equation. The Pfizer / BioNTech vaccine candidate must therefore be stored and transported at - 72  o C, which requires special equipment . Moderna's vaccine avoids this pitfall, however, according to the company .

However, the fact remains that the delivery of hundreds of millions of doses of vaccine represents an immense logistical challenge, which could nevertheless lengthen the delays. If France is preparing to be able to start vaccination against Covid-19 at the start of 2021, it is premature to imagine extending it to the entire population at its inception.


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