The vaccination campaign must not forget the most vulnerable

The vaccination campaign must not forget the most vulnerable

In a vaccination center against Covid-19 in Lyon, this Thursday.

© Laurent Cipriani
In a vaccination center against Covid-19 in Lyon, this Thursday.

Between expulsions and lack of support, the pressure on the most needy makes it more difficult for them to access the vaccine. These precarious situations must be taken into account if we wish to conduct a fair and effective health policy.

Tribune. Will the most vulnerable have access to the vaccine against Covid-19 in the same way as the rest of the population? We can worry about it.

In recent history, smaller-scale epidemic episodes have been observed in France requiring emergency vaccination campaigns, mainly aimed at vulnerable populations. Humanitarian associations, which are on the front line in this type of operation, have had the painful experience of inequalities in access to vaccination. This did not, however, generate outrage or mobilization to defend the basic principles of preserving life, protecting vulnerabilities – in short, public health and humanity.

The example of measles

Populations with precarious socio-economic conditions are more exposed to infectious diseases and their deleterious complications. This is the case with the Roma. From 2008 to the end of 2011, a measles epidemic raged in Europe, and particularly in France, with a predominance in the South-East. Associations such as Médecins du Monde had then carried out a vaccination campaign aimed at families living in unsanitary camps in Marseille, without access to water and hygiene, and where vaccine coverage sometimes did not reach the 20% threshold.

The campaign provided for two injections of the trivalent measles / mumps / rubella vaccine one month apart for all young people born since 1980 and over one year of age, regardless of the history of the three diseases. The twenty-four sites selected, for a target population estimated at 720 people, had been the subject of an awareness visit and a letter had been sent to the prefecture to inform it and request a moratorium on evictions from places of life identified.

Between May 15 and September 15, 2011, 326 primary immunizations were performed during 34 patrols, reaching 45.3% of the target population. During the same period, almost all of the land had been evicted, forcing the teams to interrupt the vaccination campaign. The second injection had only covered 37 people.

Knowingly, the authorities continued the evictions from places without alternative housing with incomplete immunization, revealing in fact a contempt for public health issues and endangering children exposed to the serious complications of measles for the benefit of ‘an assumed security policy.

Evictions are going well

This brief historical reminder takes place in a current context where expulsions and pressure on precarious migrants from outside the Community in the region of Calais and Grande-Synthe are going well. Intentional and recurrent police violence accentuates the deterioration of the living conditions of people particularly exposed to the risks of life outdoors and experienced by migratory trajectories that are often traumatic from a physical and psychological point of view. In Paris, in the medical raids of Médecins sans frontières, we also find these more or less young adults weakened by hunger, infections and an uncertain future. One could have imagined a relaxation on evictions without an alternative of rehousing on the part of a government so inclined to want to limit mortalities by worrying about the vulnerable, elderly or not. But it is clear that this is not the case.

However, an INSEE survey this summer recalls that the excess mortality linked to Covid-19 concerns the elderly, those with comorbidities such as diabetes, obesity and hypertension among others, but also precarious populations often of foreign origin working in our territory. This virus, a catalyst for inequalities, therefore does not spare the most vulnerable, in addition to those in precarious administrative situations.

In the face of a historic health crisis, and when the turn comes for the most needy to benefit from a vaccination that is hoped to be rapid, it will be necessary to ensure that the pace of expulsions is reduced to facilitate the work of the actors ground. A double hope for precarious migrants, that of being protected from serious forms of Covid-19 and that of being able to benefit from a possible respite between the two doses. One more uncertainty in the complex management of this epidemic.

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