Deputies and senators managed to agree, Thursday, July 21, 2022, on the content of the bill extending certain measures for managing the health crisis, the termination of which was initially scheduled for the end of the month. If the parliamentarians validated the major part of the text proposed by the government, they voted two measures absent from the bill adopted at first reading by the National Assembly: the possibility left to the government to restore a virological test control at the entry into the national territory (with a specific provision for overseas territories) and that of reintegrating unvaccinated caregivers if the High Authority for Health (HAS) gives its agreement.
Originally strongly opposed to this latest measure, the government seems to have changed slightly in recent days. After having affirmed in the hemicycle that the subject was still “not relevant”, the Minister of Health François Braun announced last week in the Senate the referral of several authorities on this “thorny subject”. Pending the opinion of the HAS and the final vote on the text scheduled for early next week, L’Express gives the floor to two points of view on the question.
No / “A real risk of jeopardizing the cohesion of the teams and the confidence of the patients”
By Yves Buisson
It would be a decision as incomprehensible as it is unacceptable. Worse, a capitulation. We do not decide on a mandatory measure to go back a few months later. This debate is back on the table thanks to the examination of the bill maintaining a monitoring and health security system in the fight against Covid-19 which is currently passing through Parliament. After the debates in the National Assembly, several voices were raised in favor of this reintegration of non-vaccinated caregivers into hospitals, but it is above all a question of political postures because nothing has changed on the scientific level: no one disputes that vaccines have lost their effectiveness especially in the face of new variants and sub-variants. The fact remains that they remain the best defense against severe and prolonged forms. Let’s not forget that caregivers paid a heavy price at the start of the epidemic, some lost their lives there, when they lacked everything – masks, gels, gowns. And completely without their knowledge, they transmitted the disease since it is estimated that a third of the contaminations in the hospital came from the staff. Fortunately, they were among the first as soon as the vaccines began to be available to receive a first dose, which automatically lowered the number of nosocomial infections.
At the Academy of Medicine, we remain firmly opposed today to a reversal. Especially since the question concerns only a tiny part of health professionals, that is to say 0.3% of the whole, according to the French Hospital Federation. It is difficult to have an exact figure, but it would concern three to five thousand people. And still, some have given up on the job. Now imagine the headache for a department head if he had to reinstate some of them, especially compared to those who stayed behind and who fight daily. There is a real risk of jeopardizing the cohesion of healthcare teams as well as trust with patients within the hospital. Unvaccinated caregivers are not people you can count on. In other professions where vaccination has become compulsory, those who refused it walked out. Finally, let’s project into the future: what will happen if other variants arrive and it will be necessary to get vaccinated again? Should we backtrack by imposing the vaccination obligation again? These round trips would be counterproductive and dangerous.
Yves Buisson is president of the Covid-19 unit of the Academy of Medicine.
YES / “We must rehabilitate a principle of mutual trust”
By Emmanuel Hirsch
Reintegrating professionals who have not accepted compulsory vaccination is a political choice, since the scientific authorities do not consider this measure incompatible with the current health situation. It would in no way be a question of rehabilitation, and the public authorities would not lose their credibility by imposing such measures tomorrow if the constraints imposed it. From an ethical point of view, several considerations can enlighten public authorities. Is this professional ban necessary today and proportional to the health risks as they are assessed? We note that they have not so far justified specific measures despite an epidemic rebound… On the other hand, is it not justified, for any measure adopted in an emergency, to assess its relevance and therefore its reversibility?
I fully understand the argument presented by the National Academy of Medicine, but I do not consider as “a fault” or “a reversal” the possibility of allowing them to resume their activities. If this decision is taken, it must be accompanied by a personal reintegration interview promoting substantive dialogue. It will also be necessary to explain this decision to the professionals who, rightly, considered that accepting vaccination was an act of responsibility and solidarity which fell within their code of ethics. Having exchanged with them in recent days, I understood that like society as a whole they aspire to renounce the register of vindictiveness, opprobrium and opposition to each other, because it damages democratic life and professional relations. The National Academy of Medicine rightly evokes a necessary “climate of trust” as well as “cohesion”. I share this concern, adding to it a requirement for consistency and appeasement on which the acceptability of measures from which we cannot exempt ourselves will depend tomorrow.
The mistrust that has grown over the past two years between civil society and government authorities must now be met by rehabilitating a principle of mutual trust. Such an aim is built on the essential consultation, as expressed by the National Consultative Ethics Committee (CCNE) in an opinion of September 2021, on consent. Let us not forget that many of the professionals who have been banned from practicing were, from February-March 2020, on the front lines in hospitals and nursing homes, without benefiting from protective devices. They defended the values of care to the point of being considered, for a given time, as our heroes! I therefore testify to my concern for them without endorsing a personal choice tainting the exemplarity required of good professional practices.
Emmanuel Hirsch is Professor of Medical Ethics, University of Paris-Saclay