At the head of Covars, the Committee for Monitoring and Anticipating Health Risks, immunologist Brigitte Autran is surveying the country, to better prepare it for crises. With her team, she has just submitted a report to the executive on the cataclysms that could occur in the next two to five years. Epidemics of animal origin, new viruses, contaminated mosquitoes, climate change, pollution… Is the French healthcare system ready? When the specialist picks up to talk to us about it, she has just shared her conclusions with the government. It’s the turn of L’Express readers.
L’Express: What is the main threat looming over France?
Professor Brigitte Autran: There are several, and of several types, with many possible interactions. In particular, we studied the links between infectious risks and environmental factors which exacerbate these risks. Global warming, atmospheric or chemical pollution represent a groundswell to which the population is permanently exposed and which must be taken into account.
In respiratory infections, avian flu and the emergence of a new coronavirus pose the greatest risk. These diseases circulate in animals, but if they passed into humans, they could generate a new epidemic, as with Covid-19. It is also necessary to monitor arboviruses, viruses which are transmitted by a vector, such as mosquitoes. Dengue fever, but also the West Nile virus, on the continent. To a lesser extent in mainland France: zika, and chikungunya, but much more likely in overseas territories.
There could also be an epidemic of a previously unknown and therefore unpredictable virus. This is what we scientists call “Disease X”. Finally, even though we are used to it, and the fight is progressing, with new vaccines and drugs on the market, acute respiratory infections, such as bronchiolitis, can still pose big problems. We saw this again in recent winters, when we had ample means to reduce this risk.
That makes a lot. What did you insist on when meeting the Minister of Health, Frédéric Valletoux?
On the cumulative effect. And in particular on chronic risks which, by adding one to the other, could end up threatening the entire healthcare system, and generating a crisis. This is also why in this report, our analyzes are systematically linked to environmental factors.
How do environmental crises disrupt the healthcare system?
First, they have direct consequences on health. Take extreme weather events. Heat waves, for example. They kill thousands of people in France every year. As for flooding, we know less, but they cause wastewater to overflow, which spreads bacteria and viruses. Look at the oyster contaminations this winter…
But it is also a chronic risk factor: climate change changes temperatures, forces populations to migrate. These are situations conducive to the spread of diseases. Atmospheric pollution, by clogging the bronchi, aggravates chronic respiratory diseases and the severity of respiratory infections. And chemical discharges, like those from antibiotic factories in India and China, select for more resistant bacteria. This is all that must be taken into account.
The most alarming thing is that unlike the infections I mentioned, these dangers are poorly controlled. We do not yet know how to precisely quantify these risks and their consequences on health. We therefore urgently need to increase research on this subject. And above all, avoid working in silos, with health on one side and the environment on the other. And also, that this work be carried out in collaboration with other countries. Because the threat is globalized.
Multiple threats, increased level of risk… Are we close to disaster?
We are not shouting fire. Even if these risks are very real, that does not mean that the healthcare system will collapse tomorrow. The fact remains that, as Covid-19 has shown us, we must be ready to limit the damage. It is possible to reduce risks. For example by preventing diabetes, obesity, cardiovascular diseases, these conditions which make us particularly fragile. And by strengthening surveillance tools, such as screening or wastewater monitoring.
Especially since there are new avenues to explore: to fight against avian flu and West Nile virus, we can carry out DNA, RNA or fecal analyzes on birds or game; sampling wildlife, in other words, and determining the risk of transmission to farmed animals, which could then contaminate us. We are starting to do it, but we could speed up.
These are medium-term avenues. In the immediate future, would we be ready to face a new epidemic?
We have the capabilities. The French healthcare system is very developed and very strong. But we also reminded the government of its weaknesses. Each year, more than 100,000 positions for nurses and caregivers are to be filled. The number of general practitioners decreased by 11% between 2010 and 2022. The situation is worse in overseas territories, less resourced territories, and sometimes more at risk, because the epidemics circulating there are different from those on the continent.
But we also have new weapons. With Covid-19, surveillance has been strengthened. Risk awareness too. Even if the population expresses a certain fed up, the barrier gestures are now known to everyone. Caregivers and managers are better trained on these issues, although gaps remain. Not to mention that now we now have RNA vaccines.
In the United States, where several cases of avian flu have been detected in cattle, a further step towards humans, “models” of vaccines have been produced. Just like in Europe, and in France. These are sort of rough vaccines, ready to be adapted in the event of an alert. This is enormous progress. They allow us, in theory, to react in a few weeks, where before it took us years.
Do the Paris Olympic and Paralympic Games seem particularly at risk to you?
There is a good level of alert and preparation, whether in ministries or in hospitals. Major sporting events are, in theory, times of health risk, it’s true. The Parisian summer is flu season in the southern hemisphere, for example. Spectators could therefore bring it back to us and restart the epidemic. Or accentuate the circulation of dengue fever in France, which is still very rare. Not to mention the risks of food and sexually transmitted infections, which we have not talked about until now, inherent to the festive side. But, so far, the Games have generally gone pretty well. We have the means to respond to alerts.
The Covars report also emphasizes the increased risks linked to disinformation. For what ?
Remember hydroxychloroquine. For months, millions of people believed in a cure, when in reality it was ineffective and even harmful. Misinformation can turn a controlled health situation into a major crisis. And generate panic: in 2012, 10,000 children suffered food poisoning because of canteens in Germany. The number is scary, but in reality, it was not fatal. These events, and the beliefs around them, can contribute to increasing health skepticism, and therefore the risks.
There must therefore be transparent, substantiated government information that involves the population. The quality of information and sources is very important in health matters. This is where the media has an important role to play. We also need to educate the population about risk and introduce it to education, at school, so that there is awareness. Scientists themselves must also make progress on these subjects, and learn to better communicate their research.
The report mentions a case of cholera in Mayotte which occurred last March… Should we be afraid of it?
This case was imported from East Africa, where there is an outbreak. If Mayotte is unfortunately the least equipped territory in terms of health, also with water management problems, it remains a French territory, and the health level is well beyond the surrounding countries. The resources deployed are considerable and the authorities extremely vigilant. Cholera is a major threat on a global scale, but in France, the risk remains rather measured.
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