Covid-19 vaccinations: why are the French defiant?

Interview with Charles-Clemens Rüling, director of research at Grenoble Ecole de Management, a professor of organizational theory and head of the Public Trust in Health Chair."

What lies behind the French defiance of vaccination campaigns?

France is divided in its perspective of science and medicine. On one side, there is very strong trust in scientific progress and the evolution of medicine. On the other side, there is growing mistrust of experts and traditional medicine.

Vaccinations are even more complicated because the pharmaceutical industry is relatively unknown and its mechanisms are hard to understand. This facilitates doubt concerning conflicts of interests and the high profitability of pharmaceutical companies. Unlike medicine, vaccines are delivered to healthy people. The fact a healthy person must intake a pathogen can create a feeling of insecurity and this can transform into defiance.

The French defiance of vaccinations is not new. It has existed since the first vaccinations for smallpox in the 19th century.

However, this defiance greatly increased in the 90s due to the controversy surrounding the Hepatitis B vaccination in France. By stopping the school vaccination campaign in 1998 while continuing to recommend individual vaccinations, defiance was further nourished because this decision put group logic and individual logic at odds. And this tension continues to this day.

How can key health actors such as the government, pharmaceutical companies or doctors earn the trust of anti-vaccine populations in order to achieve herd immunity?

Mistrust grows from past experiences. As part of the Covid-19 effort, it's essential to communicate clearly and transparently with the French population because trust can quickly disappear.

Trust can be built in terms of a specific challenge and it is based on the perception of facts and their interpretation. Long-term trust can be established through three vectors: the skill of the involved party, their integrity, and their being well-intentioned. Having recognized skill in an area also means being able to admit mistakes. That's one of the issues at stake concerning the management of the start of the Covid-19 crisis. Today, Olivier Veran appears to be skilled in terms of health questions because he is a hospital doctor and he understands the pressure of working in intensive care units. Ensuring integrity means being transparent, in particular in terms of contracts that are established with laboratories and their ties to health authorities. Being well-intentioned is finally a matter of perception, or how one can be perceived to be acting in the best interests of concerned populations.

What can be said about individual perceptions of the actions taken to manage this crisis?

The difference between individual interests and group interests is what economists call "the tragedy of the commons" and it is at the heart of this crisis management. For governments, it is very difficult to unite individual and group interests when acting on issues of public health.

The crisis has a tendency to accentuate this divide and each person interprets governmental measures according to their own logic, which then leads to a feeling of competence or incompetence. While it is easy to point out the absurdity and contradictions inherent in certain rules, the current mission for politicians is to maintain a direction that builds on the collective interest and public health.