SURVEY – The epidemic is coming, but 70% of French people do not intend to be vaccinated against the flu. The anti-vaccine discourse is progressing in the population, fueled by crises such as that of the A H1N1 influenza in 2009. Why actor investigated the reasons for this crisis of confidence which goes beyond the circle of the anti-vaccine leagues and which sows confusion among the doctors themselves.
“How does the guy know the flu shot will work better this year?” »In one tweet, posted the day after the launch of the flu vaccination campaign, the general practitioner from Strasbourg @DocArnica set fire to the powders on the social network. His position sums up the unease within the health professions. Even though they are the main vectors, doctors come to doubt vaccination. Some are even turning to the anti-vaccine leagues. A doubt which inevitably has repercussions on the patient population.
8% of “not very confident” doctors
The proportion of doctors radically opposed to vaccination remains marginal. Unit 912 of the National Institute for Health and Medical Research (Inserm) regularly assesses the attitudes of this profession towards the vaccination act. The latest study reveals that 97% of general practitioners are in favor (80% very favorable, 17% somewhat favorable). But in detail, the positions of these health professionals are much less assertive.
In the review Studies and results, Pierre Verger, epidemiologist at Inserm, distinguishes three professional profiles according to their perception of the risks and usefulness of vaccines. The first, very majority (76%), is “confident” and speaks quite easily about vaccination. The second group (16%), turns out to be more moderate, expresses more doubt as to the side effects and the usefulness of the vaccination in general. The last group (8%), brings together “not very confident” doctors.
Pierre Verger, epidemiologist: ” We know anyway that some doctors do not trust vaccination at all. These doctors are more often found in the ranks of doctors who practice alternative medicine. “
“Counter-fear strategy”
The general practitioner is in an uncomfortable chair, to say the least. Only 43% of general practitioners are comfortable explaining the role of adjuvants in vaccines. Himself an epidemiologist, Pierre Verger recognizes some shortcomings in initial training. “Doctors are not necessarily well informed of the arguments to be put forward to show that such and such an aspect of the controversy is true or false, because it is scientific and complex,” he underlines. However, the training of general practitioners is rather basic on vaccination. Only a few hours are devoted to it. ”
This discomfort, the anti-vaccines play it. Some even publish a “little guide” for patients who wish to ask their doctor. The strategy is detailed in a full report by Anne Bertrand and Didier Torny (1). It begins with the introduction of doubt. The skeptic establishes a dialogue on the prescription of the vaccine, he mentions the adverse effects and controversial scientific studies. Secondly, a “counter-fear strategy” is set up, which consists in signing a more or less far-fetched recognition of responsibility. In particular, the physician must recognize that he is aware of the possible effects of vaccination, including those of adjuvants.
Fear of lawsuits
“Doctors who do not feel confident, this means that faced with patients who ask themselves questions, they will not be in the best position to provide the appropriate answers”, analyzes Pierre Verger. The consequence seems almost inevitable: rather than taking the risk of vaccinating and then being prosecuted, some doctors would prefer to abstain.
Pierre Verger : “ What leads me to think this is that vaccines are contraindicated in severe infectious disease. But the majority prefer not to vaccinate during a low fever. “
Faced with increasing legal cases, doctors are exercising caution. “They are probably wary of the reactions of parents if something happens next,” says Pierre Verger. On the Gardasil case alone, which seems to crystallize tensions, 25 complaints were gathered. What make the doctors tremble … who seem to forget that in France, only a laboratory or the State can be prosecuted when complications arise from a vaccination.
On the one hand, the mistrust of patients, on the other, of health authorities who do not only inspire good feelings. “There is a general attitude of mistrust vis-à-vis good practice guides, an attitude of reaction to the complexity of the vaccination schedule, and perhaps a form of mistrust vis-à-vis health authorities which makes people say to 30% of them that they prefer to trust themselves ”, explains the epidemiologist. And this is the whole paradox of this health profession: despite a lack of in-depth knowledge of the file, they find it difficult to trust their referents.
(1) Individual liberties and collective health, a socio-historical study of the vaccination obligation, Anne Bertrand, Didier Torny, November 2004.
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An international crisis
It is not only in France that vaccination is going through a major crisis. In Germany, Spain, the United States, epidemics or cases of diseases against which vaccines exist punctuated the year 2015. Our Germanic neighbors were confronted with a real outbreak of measles cases in Berlin, revealing a weak vaccination coverage. The death of a baby is to be deplored.
Same situation on the other side of the Atlantic: an epidemic has started at Disneyland located in California. Result: between the 1er and on January 30, 2015, 102 cases are listed in 14 different states.
“What will be typical from one country to another, it will be the controversy and the type of vaccine pointed out”, explains Patrick Peretti-Watel, sociologist at Inserm. In France, the general population is vaccinated very little against hepatitis B. “It’s a Franco-French fiasco, because we wanted to catch up at that time (in 1994, editor’s note), and because we organized a rather clumsy communication campaign, ”explains Patrick Peretti-Watel. Conversely, the measles, mumps, rubella (MMR) vaccine is rather well accepted in France. But in the United Kingdom, a study published in the Lancet in 1998 established a correlation between autism and vaccination and started a lively controversy. The publication was finally withdrawn completely in 2010, the data having been tampered with. “In a number of African and South East Asian countries, there are controversies because part of the population thinks that under the guise of vaccinating them, the WHO doctors are trying to sterilize them”, adds Patrick Peretti- Watel.
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