The current epidemiological situation and the performance of the COVID-19 vaccine do not justify a generalized vaccination obligation. An in-depth debate for vaccine adherence, restoration of trust and constructive exchanges are crucial to help overcome the crisis.
“Since last July, the socialist parliamentarians have advocated the progressive obligation of a universal vaccination, for all (except medical contraindication), in a public health approach aiming at obtaining a collective protection […] The objective of this collective protection of the whole society, in the state of our scientific and medical knowledge, can be reached by a generalized vaccination obligation (except medical contraindication) (cf. Senate Bill).
In reaction to this bill, 500 scientists (including 170 doctors) have sent a letter to elected officials (senators, deputies, French members of the European Parliament, mayors), to the Scientific Council COVID-19 and to the National Consultative Ethics Committee (CCNE) to address the subsidiary issues around vaccination.
Reduction of vaccine-associated mortality in targeted populations
The effectiveness of the vaccine in reducing morbidity and mortality, particularly in elderly patients and/or those with co-morbidities (obesity, hypertension, diabetes, etc.), is not in question. According to these experts, the data are consistent in all countries. This observation is confirmed by the EPI-PHARE analysis (ANSM and CNAM) and the regular technical reports of Public Health England (PHE).
A favorable epidemiological situation
However, the signatories consider that the level of viral risk in October 2021 and the vaccine performance do not justify the application of massive measures.
These scientists note, based on data from the “sentinel network”, that the epidemic threshold of COVID-19 has not been exceeded for more than 10 months and that the lethality associated with circulating Delta virus is low.
Vaccine versus natural immunity
Current vaccines do not effectively prevent contamination and do not succeed in eliminating all severe forms of the disease and deaths. It has also been demonstrated that high vaccine coverage does not prevent transmission, carriage or the emergence of variants (see references in the letter to elected officials). The objective of vaccinating to reduce viral circulation remains, according to the signatories, difficult to achieve with these vaccines, not legitimizing the use of a generalized compulsory vaccination, which would make France an exception.
The immunity of recovered persons is today demonstrated to be broader (multiple antigens) and longer lasting than vaccine immunity: it is therefore not justified to systematically vaccinate all recovered persons, even beyond the 6-month period.
First figures of short-term benefit-risk balance
Finally, the signatories point out that the post-vaccination adverse events recorded to date (deaths and hospitalizations) are more frequent and more serious than with the usual vaccines and that, as the CCNE concluded, “vaccination of children under 12 years of age does not appear to be ethically and scientifically acceptable”.
Many Nordic countries have in fact recently suspended the Moderna vaccine following the occurrence of myocarditis in young people under the age of 30. The Astra Zeneca and Janssen vaccines have been reserved for people over 55 years of age due to the risk of cardiovascular and neurological adverse events.
The time has come to create trust and support
Finally, these scientists believe that, at a distance from the viral emergence, the emergency and the trauma suffered, the time has come for quality studies and research, in accordance with the usual requirements before marketing authorization (MA). Trust and respect for free and informed consent through rigorous information and education are, according to them, the guarantees of a large adherence to vaccination. The measures should not be different from what has been successfully practiced for years, for example for influenza, with targeted vaccination.
These reactions echo the words of the President of the Scientific Council and the Minister of Health, who stated that they “believe in the fundamental debate and will listen to the proposals”.
On July 22, 2021, Olivier Véran explained to the Senate Social Affairs Committee: “Compulsory vaccination only makes sense to protect the most fragile” – “I believe in the fundamental debate and I hear the proposals, I confirm that compulsory vaccination is not our choice, including for the elderly.” “Compulsory vaccination (…) for adults is much more complicated, and no country has chosen compulsory vaccination: would you fine an adult every time he or she leaves home? And to the elderly, would you tell them that they are no longer allowed to leave their homes?
Prof. Jean-François Delfraissy, president of the Scientific Committee during the same session in the Senate, stated: “My thoughts have evolved with regard to compulsory vaccination for health care providers – I remain, however, on the sidelines with regard to compulsory vaccination for the general population. As public health decisions must be acceptable in order to be effective, I remain convinced of the need to convince even the most at-risk populations to be vaccinated. In view of the tensions already observed around the health pass, we would not be able to get a message of mandatory vaccination across.”
Finally, the signatories consider that deciding today on a general vaccination obligation would be tantamount to forcing the free and informed consent of individuals, for vaccines still under conditional MA. Such a decision would have the consequence of deteriorating the already weakened social cohesion and of further diminishing the confidence of the French in their political and health/scientific institutions. This trust, which is based on the respect of an informed choice, is essential to public health policies as well as to the functioning of a democratic society.
The signatories propose to be heard soon by the elected officials to engage in a “fundamental debate” and contribute to constructive exchanges in order to help the exit of this crisis, together.
References:
Letter to elected officials: Should mandatory vaccination be generalized in the COVID-19 context?
Complete list of signatories updated on October 11, 2021