Compulsory vaccination: who decides and on what criteria?


FOCUS – The Academy of Medicine recommends to impose the serum against Covid-19 on all French people. Who can make this decision? What is it based on?

“Obligation” is not a bad word when it comes to vaccinating against Covid-19“. This is how the Academy of Medicine entitled its shock press release published Tuesday, May 25, well aware of the tensions around the subject. The advisory body recommends there to make the vaccine against Covid-19 compulsory, the only way, according to him, to achieve collective immunity. A requirement that would even extend, in a second step, to children and adolescents. For the Academy, it is obvious that SARS-CoV-2 fulfills all the “conditions that make it possible to resort to compulsory vaccination“.

  • Who decides to make a vaccine compulsory?

If the Academy of Medicine is entitled to express its opinion, it has no decisive role in the choice of the vaccination strategy. It is the High Authority for Health (HAS), through its very discreet Technical Committee on Vaccinations, which alone has a voice. Integrated into the HAS in 2017, this commission made up of 17 scientists, infectious disease specialists, pediatricians, microbiologists and other epidemiologists is at the heart of the process. She is responsible for analyzing the scientific data and the epidemiological context, before submitting her conclusions to the Ministry of Health. He alone then fixes “sets the immunization conditions, sets out the necessary recommendations and makes public the vaccination schedule“.

On this point, the Public Health Code is very clear: whatever the appeals, it is therefore the government that has the last word. “It is actually a political decision», Explains to Figaro Professor Daniel Floret, vice-president of the Technical Commission for Vaccinations at HAS: “A vaccine can only become compulsory from a bill with parliamentary debate“.

This measure has already been applied on several occasions in France: for smallpox (1902-1984), diphtheria (1938), tetanus (1940), tuberculosis (1950-2007), poliomyelitis (1964) and, since 2017 , is extended to 11 vaccines for infants. However, “none is currently required for adults in France», Recalls Daniel Floret. The Covid-19 would therefore be an exceptional case.

SEE ALSO – Didier Raoult: “If we had fun making this compulsory vaccine, you would have a revolution”

  • What are the criteria ?

To become compulsory, a vaccine must meet several criteria. First of all, the disease must be severe, frequent, spreading to a significant extent. “It must also be transmitted from person to person, specifies Professor Floret. Tetanus, for example, could not justify compulsory vaccination, since it is transmitted by animals“.

In addition to the disease, the vaccine must also meet several requirements: it must be tolerated, its efficacy proven, and must “present a very favorable risk-benefit balance», Explains HAS. In the case of the Covid-19 vaccine, this balance, although largely positive in general, varies according to the vaccines, the AstraZeneca having shown slightly higher risks of thrombosis. Finally, for the decision to be consistent, vaccination must provide group immunity. “If the protection is purely individual, it does not make sense to impose it. Everyone is free of their own health», Explains Daniel Floret.

  • Can a vaccine be imposed on only part of the population?

Since the start of the vaccination strategy, the question has been debated: should the vaccine be imposed on health personnel or on vulnerable people, at the risk of infringing freedom and equality? In its statement, the Academy of Medicine, well aware of the limits of vaccine production below demand, proposes to stagger the requirement of the vaccine. First, the professions say “essential», Then those in contact with the public such as catering and cultural places, and finally the rest of the French, up to students for the next academic year. Last March, the same institution already suggested imposing the Covid-19 vaccine on healthcare workers. A proposal which is however not excluded by the vice-president of the Technical Commission for Vaccinations at the HAS, since “it already exists“. “Hepatitis B or polio have already been compulsory for several years in hospitals», He recalls. A requirement that can also be geographical: in French Guiana, the vaccine against yellow fever is compulsory for all residents.

  • Who is for, who is against?

Until now, the government has always been very clear: the vaccine strategy is based on voluntary service. For its part, the HAS attests: the need for the vaccine for all has not been mentioned to date. “We didn’t give an opinion on the subject, we didn’t even think about it», Indicates Professor Floret.

Already last November, the authority had estimated that “vaccination against Covid-19 should not be compulsory, neither for the general population, nor for health professionals“. A little earlier, in July, the Scientific Council shared the same opinion, considering the obligation of the vaccine “Neither desirable nor conceivable”, thanks to a vaccination strategy “based on purely individual choices“.

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