The former Minister of Health Roselyne Bachelot judges, in light of the management of the H1N1 crisis in 2009, that the government is not doing too much.
Now an editorial writer on LCI, Roselyne Bachelot, who was Minister of Health at the time of the H1N1 flu epidemic in 2009, analyzes the current crisis in terms of that of eleven years ago. At the time, he was criticized for having done too much. Only 5 million French people had been vaccinated while the government planned to acquire 94 million doses of vaccine. the ex-minister maintains that one cannot “play Russian roulette with the health of the population”.
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Is the crisis well managed?
It is difficult to manage an epidemic well. Not technically, because the scientific community supports the government. A Minister of Health does not take decisions alone, leaning on her chimney, seized by a sudden inspiration. I was well advised by the director general of health, learned societies, orders of health professions, etc. We have the expertise. The real difficulty is to manage the affair politically and in the media. Today – it was the same during the H1N1 flu epidemic in 2009 -, two-penny “coronologists” talk about what they do not know. While the subject should transcend the cleavages, certain political or union leaders are using the crisis to make their small shops prosper. The palm of the most absurd speech goes to Marine Le Pen, who pretends to believe that closing borders can stop the circulation of a virus. In France, the second difficulty is the distrust of the population which constantly questions the word of power. And fake news that thrives as fast as viruses! In 2009, it was said that I had not been vaccinated against the flu, that I had been given physiological saline. A power must know how to deal with this kind of harmful campaign.
Olivier Veran, who has just taken office as Minister of Health, is he cut out for this difficult job?
He is an excellent Minister of Health in substance and form. He has the right tone. I do not judge its action at the political level but in terms of public health and governance.
In an emergency, the budgetary issue should not be taken into account.
Is the government doing too much?
In this kind of crisis, playing Russian roulette with the health of the population is not an option. In 2009, the Polish Minister of Health said it was okay, but in the end, the H1N1 flu killed at least 100,000 more people on the planet in addition to the 650,000 deaths from seasonal flu. Such a strategy is medically and ethically untenable. The challenge is to put yourself in a position to be able to provide an appropriate response to a danger that you do not know, if things get worse. When the danger has passed, wallowing in a posterior lucidity certainly has charms. Why do we never wonder if the nuclear warheads on the Albion plateau are used for something? The question: “Are we doing too much?” is absurd. We all hope that this epidemic will end in fine weather, but nobody knows anything about it. As one infectiologist told me at the time, “Viruses are facetious.” The men are too: the same people who reproached me, in the summer of 2009, for not doing enough attacked me, the following fall, on the grounds that I had done too much. A green deputy ordered me to buy millions of coveralls from painters and swimming pool goggles to protect the French!
Why do we agree to spend without counting to fight against an uncertain danger when we have been tightening the screw of hospitals for years?
In an emergency, the budgetary issue should not be taken into account. A deep reflection, led by CCNE [Comité consultatif national d’éthique] in 2009 on the questions raised by an influenza pandemic, had concluded that in the event of an epidemic the protection of all French people should be ensured whatever the cost. In 2009, in all the interministerial crisis meetings that were held around Nicolas Sarkozy and Francois Fillon in the green lounge of the Élysee Palace, the only thing that mattered was the health of the French.
You have been criticized for purchasing too many vaccines. Do you regret it?
On the contrary, I wonder if I have done enough. The British bought 125 million and it was no problem there! I often hear that 94 million vaccines have been ordered. In fact, you have to divide by two because we were talking about doses and it took two to be immunized. So we bought 47 million vaccines. At best, this could have covered two-thirds of the population. I have thought a lot about this controversy and the only criticism I have is that I have underestimated the number of people who, in the event of a serious epidemic, would not be vaccinated. At the time, it had been estimated at 33%; we were too optimistic.
A society cannot wait, arms in hand, for an epidemic that may not come
Eleven years ago, general practitioners criticized the vaccination centers. As soon as stage 3 of the epidemic is reached, they will be on the front line. Could some drag their feet?
In 2009, some practitioners played a funny game. The law that bears my name provided for coercive measures to force city doctors to settle in medical deserts; professional elections were to be held among the Liberals. Unions took advantage of the situation to raise the price. Francois Fillon did not arbitrate in my favor; the only union to have supported our initiative was strangled in the elections. This whole controversy overshadowed two facts: 40% of the doctors refused to vaccinate and we had to get around this difficulty; from a logistical point of view, by setting up vaccination centers, we avoided sending healthy people to waiting rooms in contact with flu patients.
In 2009, were we ready to manage a very serious pandemic, if H1N1 had not been less virulent than expected?
Following the 2006 H5N1 avian flu episode, an interdepartmental system had been put in place, but no epidemic resembles another. We must both use and be wary of feedback from previous epidemics. One of our obsessions in 2009, which we kept silent, was to avoid disturbances to public order. We feared a lack of space in intensive care, panic attacks in case of non-delivery of vaccines; it was imagined that centers could be besieged. There was a week in November when dose deliveries did not arrive. We were able to pool stocks, no one knew.
Do you dread the upcoming phase 3?
There are healthy carriers throughout society; you have to get used to it. Thursday evening, I spent an hour in an art gallery in Paris. I refused to kiss those who wanted to kiss me saying that a former health minister could not do that. This epidemic is our concern, we can fight against it by respecting the barrier measures. And seeing the good sides of the crises: in 2009, thanks to hand washing, gastro and bronchiolitis struck much less strongly. A society cannot wait, arms in hand, for an epidemic that may not come, like the hero of Tartar Desert de Buzzati waited in vain for the war before having to face his own death in the end. An epidemic is a sudden and undesirable event, society mobilizes all the better since it has not used up its strength by panicking in sterile expectation.