Injection of a potential vaccine against the Covid-19, research Institute on health Kaiser Permanente Washington, Seattle. TED S. WARREN / AP
is it Necessary to make vaccination against the Covid-19 mandatory ? The debate has arisen from the announcement by Pfizer and BioNTech intermediate results to be very positive about the effectiveness of their vaccine, Monday, November 9. “It is compulsory “, to be contrasted the next day the environmentalist Yannick Jadot on Franceinfo. Several other celebrities have followed suit since, as the president of The Republican (LR) of the Senate, Gérard Larcher, or Daniel Cohn-Bendit.
The idea, however, is not unanimous. The leader of the Rassemblement national (RN), Marine Le Pen, has estimated on BFM-TV that the French would remain free to ” to vaccinate or not “. The government continues to be at this point prudent. If he put it Saturday in the World to have the “fear” that ” the French do not have enough to vaccinate “, the prime minister, Jean Castex, does not plead in favour of a compulsory vaccination for the time being.
Behind the proliferation of statements on this theme, actually hides a debate more complex than it seems. And probably premature at this day, as the unknowns are many. Explanations.
1. Not one, but several vaccines
The first limit on the debate on compulsory vaccination as it has been asked these past few days, it is that there is in reality one, but several vaccine candidates on the table. Three of them have recently been the subject of announcements very excited about their potential effectiveness and efficiency :
The candidate vaccine, Pfizer and BioNTech, presented as an effective “90 %” depending on the intermediate results mentioned in a press release from the laboratory, Monday, 9 November ;the research institute of the Russian Gamaleya, who claims for his product a higher efficiency (92 %) ;the vaccine Moderna, which would be efficient, ” 94.5 % “, announced the biotech american, Monday, November 16.
” All candidates-vaccines have their own characteristics, especially as they have been elaborated according to different processes. The products of Pfizer and Moderna are vaccines ” in messenger RNA “, which uses pieces of genetic material altered. While that of Gamaleya is ” viral vector “, using as support a another virus that has been modified to adapt to the fight against the coronavirus SARS-CoV-2.
” The people speak often of the vaccine. In reality, we will likely have vaccines, with different characteristics “, summarizes the vaccinologue Marie-Paule Kieny in an interview with the World published on 14 November.
2. Questions about the vaccination strategy
The spectacular figures on the effectiveness of supposed vaccine candidates hide otherwise a more complex reality. It is the results obtained in the weeks following the second injection of the vaccine, which does not give us, at this stage, not hindsight to know what will be the immunity conferred, for example, six months after.
similarly, it is not known today if these vaccines only protect the person vaccinated against the Covid-19 and its symptoms, reducing the number of serious cases, or if they also prevent transmission of the disease. We do not know at what point they are proving to be effective on different types of public.
so Many points that are not in the detail in the context of the development of a vaccine strategy. Has large features, for example, we can distinguish at least two possible scenarios, among others :
The vaccines available in the near future have characteristics tailored to a vaccination “mass” to reduce very strongly the movement of the coronavirus SARS-CoV-2, or to eradicate it ;these vaccines do not offer sufficient guarantees to find a herd immunity, but offer an individual protection interesting for the public 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 Veran, didn’t say anything else on BFM-TV on Tuesday : it is the high authority of health (HAS), which will determine the public priority in the area of vaccination, he said. But she can’t do that “when she will have access to data scientists [because] they are talking in a vacuum” today, he estimated.
Decryption : The 90 % efficiency of the vaccine of Pfizer, an “extraordinary result” that asks questions 3. Serious logistical issues
A possible mass vaccination campaign, let alone mandatory, is also assumed to have the logistic means to be adequate. For example, the campaign scheduled for the vaccination against the virus H5N1 was based on 1 168 vaccination centre. This led to the vaccination of around 6 million people per month, according to the report of the parliamentary investigation commission on this issue published in 2010. Generalize vaccination against the Covid-19, by making two injections for each patient, presupposes, therefore, far greater resources. That is besides the question of availability of vaccines. The european Commission has, at this stage, entered into four contracts for the first deliveries of vaccines with the alliance Pfizer/BioNTech, AstraZeneca, Johnson & Johnson and Sanofi-GSK. Another may follow with Moderna.
Whatever it is, these stocks should not be permitted to vaccinate the whole of the French population as early as the first half of 2021. To take the example of the vaccine Pfizer/BioNTech, France, may, in a first time, count on 30 million doses, which would take over 15 million people (since it takes two injections per patient), according to Olivier Véran.
all the other factors of logistics are added to the equation. The vaccine candidate, Pfizer/BioNTech must be stored and transported at a temperature of – 72 ° c, which requires specific devices. The vaccine Moderna, we avoid this pitfall, according to the company.
Still, despite all that the delivery of hundreds of millions of doses of vaccine represents a logistical challenge of immense, who could nevertheless extend the time limits. If France is preparing to be able to start the vaccination against the Covid-19 at the beginning of the year 2021, it is premature to imagine the extend to the entire population in its infancy.
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