There is little chance that this will close the debate, but the subject is now settled. The Minister of Health, François Braun, announced on Friday July 22 that caregivers not vaccinated against Covid-19 would not be reinstated in their services for the moment. This decision follows a long-awaited opinion from the High Authority for Health (HAS)issued a few hours earlier, recommending maintaining the obligation to vaccinate staff working in health establishments and medico-social structures. “The Academy of Medicine, the Scientific Council and the High Authority for Health have a convergent opinion. (…) It is negative” and “We follow the advice of scientists”, announced the Minister during a trip to Seine-et-Marne. He said he would meet “from the beginning of next week the trade unions to explain the situation to them”.
In its opinion of July 22, the HAS considered that “in the context of a seventh wave, given the effectiveness of vaccines and the uncertainties regarding the continuation of the epidemic, (…) the data are not such as to call into question this vaccination obligation today”. The experts of the independent authority specify that these recommendations may possibly change in the future. “depending on the new data available”. “Our opinion really depends on the epidemic situation, which is still not very good, especially since we have no visibility over the next few months”specified to World the president of the HAS, Dominique Le Guludec.
A position that has taken on a particular dimension due to the lively debates around the health bill examined in Parliament. Since July 11, the maintenance of the vaccination obligation for caregivers has crystallized the tensions around this text, which must determine the mechanisms to fight against Covid-19, destined to continue after the end of the state of health emergency. , scheduled for July 31. The Minister of Health, who had initially assured that the question of the reinstatement of personnel suspended for non-vaccination was not “not up to date”finally announced that he “would bend to the opinion of the scientific authorities” on this topic.
The text, adopted by the joint committee on Thursday July 21 by the deputies and senators, also provides for an article 2 bis specifying that if the opinion of the HAS is that the vaccination obligation is no longer justified “in view of the evolution of the epidemiological situation”then the suspended nursing staff could be reinstated.
In its opinion, the HAS particularly insists on the safety of the vaccines currently available in France (all based on messenger RNA technology, apart from the protein vaccine from Novavax, which is very little used). The latest data, which were the subject of a previous notice on July 13show “renewed protection against infections thanks to the booster dose (for most people this means a third injection). “The vaccine protection is between 45% and 55% against symptomatic infections and around 80% against severe forms in the three months following its injection”, specifies the authority. After these three months, “residual effectiveness is likely to persist over the longer term”. In conclusion, a complete vaccination schedule reduces the risk of being infected and transmitting the disease. An element which must condition, according to the HAS, any obligation of vaccination.
“Ethical issue”
In a previous notice published on July 16, 2021the HAS considered that the decision to make vaccination compulsory should also be based on two other points: ” TO DO the balance between several fundamental rights” what are the freedom of choice, the preservation of people and the right to health, and to take into account “compelling public health considerations”such as the health situation, the dynamics of the epidemic and the anticipated effectiveness of the measure.
By taking these elements into account, she had already decided on the special status of caregivers by highlighting the“an ethical issue as much as a public health issue” vaccination of healthcare professionals, “and more broadly of those who have frequent and close contact with vulnerable people”. The vaccination of caregivers serves both to protect these professionals from serious forms of Covid-19, but also and above all to to limit the risk of transmission (…) to the people they take care of, in particular the most fragile and the elderly residing in nursing homes and USLDs [unité de soins de longue durée] ». In the background, the experts insist on this important idea of preserving the proper functioning of the health system by limiting absenteeism.
In the notice published on Friday, no reminder is made of these ethical issues. “These issues did not make us decide”assures Dominique Le Guludec. “Certainly, caregivers have a special responsibility, but this is not a moral opinion, it is an opinion based on facts. And our course of action, today as since the start of the epidemic, is that we must protect the most fragile.she adds.
While this recommendation has important political consequences, it does not clash with the positions taken by other scientific bodies. Earlier in the week, Tuesday, the academy of medicine considered that ” reintegrating caregivers not vaccinated against Covid-19 would be a fault ». “Any refusal to be vaccinated motivated by personal convictions is respectable, but incompatible with the profession of caregiver », she judges. The Scientific Council, in its 75e and last opinion given on July 21, for his part said ” Reserve on such reintegration, arguing in particular about the seventh wave still very present.
For its president, Jean-François Delfraissy, if there are some scientific arguments − such as protection, although partial, against infection and contamination − it is nevertheless above all a question “ Politics ».
Beyond the health aspect, several figures have been put forward by the government to defend the maintenance of the device, and to dismiss the arguments of the defenders of a reinstatement of unvaccinated caregivers. This could thus be brandished as all the more necessary with the crisis that many hospitals are going through in recent months, faced with a shortage of caregivers.
It is only 0.53% of the staff concerned by this obligation, i.e. a little less than 12,000 people (caregivers, but also administrative and technical staff), who are to date suspended, said François Braun at the start. parliamentary debates. The emergency doctor then reported more specifically, before the senators, of 2,605 suspensions in the health sector.
The government spokesman, Olivier Véran, spoke for his part “600 nurses who remain suspended, out of 240,000 employees”, “over the entire hospital park, public and private”as well as “75 doctors and pharmacists out of a total of 85,000” and 100 nurses in retirement homes, i.e. “on average one for 70 nursing homes”.