Why France was ready for Covid-19 a decade too early

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                Une enquête du quotidien français Le Monde a révélé l'extraordinaire chaîne d'événements qui a conduit les gouvernements français successifs à élaborer une stratégie de riposte à une pandémie ambitieuse, puis à la démanteler presque entièrement, laissant le pays dangereusement exposé à la maladie de Covid-19.
            

Fin 2004, le cardiologue devenu politicien Philippe Douste-Blazy, alors ministre français de la Santé, a dévoilé un plan de réponse à une pandémie lors d'une réunion du cabinet devant un public de collègues ministériels perplexes, distraits et quelque peu amusés.

The plan details a multitude of drastic measures to be implemented in the event of an epidemic threatening France. They included the closing of national borders, restrictions on the movement of people, the prohibition of assemblies, sporting and cultural events, the implementation of rules of social distancing and the national distribution of masks – surgical, for the public, and the more protective type of FFP2 for health workers.

“In a word, the plan contained everything that the current French government hastened to put in place, hastily and without equipment, in mid-March 2020”, write the journalists Gérard Davet and Fabrice Lhomme in a long reconstruction in five parts of the Pandemic of France “disarmament”, published by Le Monde this week.

The extraordinary extension and fall of pandemic planning in France originated in the troubled dawn of the new century, when Western nations obsessed with the threat of terrorism and the hunt for elusive weapons of mass destruction suddenly awake at the risk of deadly epidemics. .

First came the dreaded SARS, which emerged in China in 2002 and intensified the following year, followed by an epidemic of H5N1 avian influenza in Southeast Asia in 2004. Later that year , the deadly chikungunya disease quickly spread to French overseas territories, ultimately threatening the continent.

“Asian countries have been deeply shaken by SARS”, explains Pierre-Yves Geoffard, professor of health economics at the Paris School of Economics (PSE), in an interview with FRANCE 24. “They finally had some luck because the virus has finally disappeared. But they did not lower their guard, ensuring instead that they were ready for the next one. “

Amidst the many unknowns of pandemic planning, Geoffard says that health strategists in Asian countries based their preparations on two certainties: that new pandemics should happen and that no one could anticipate their shape or form. form.

“It means being able to react quickly to epidemics that we know very little about at the start,” he said. “In this regard, the model to follow is Taiwan’s response to the current crisis: detect, isolate and trace cases – but it only works if you do it right away. “

Geoffard says that the French government tried to follow the same model in its initial strategy against the coronavirus. But it was already too late, the virus having spread widely.

“Countries respond to crises and learn that speed is essential, but their memory is fading,” he said. This would not be the only lesson that French decision makers do not know.

French independence

In 2005, Douste-Blazy issued a premonitory warning about “the tendency of our modern western societies to forget” during a hearing before French senators.

The SARS epidemic, said the Minister of Health, “has proven to what extent the sudden onset of an unknown infection – I emphasize the word unknown – capable of spreading across the planet through communication networks modern, can spread fear and destabilize more developed societies and health systems.

A few weeks later, the senators who interviewed Douste-Blazy released a report detailing their recommendations to prepare the country for future epidemics. In particular, they stressed the need to stockpile masks for health workers and the general public, noting that surgical masks would only offer limited protection and should therefore be replaced by more protective equipment.

This “would certainly entail a high cost, but would help limit the country’s paralysis,” they wrote, adding: “From this perspective, the cost must be put in perspective.”

Alarmed by another classified report, unearthed by investigators from Le Monde, who warned that France was unfortunately not prepared for a pandemic, Douste-Blazy’s successor to the Ministry of Health, Xavier Bertrand, went on tour in the countries East Asia in late 2005 to learn from their strategies. Calling in Beijing, he asked his Chinese counterpart if France could order masks from China in the event of a crisis. Although yes, the response warned that “Chinese demands would naturally come first” if the country also needed masks.

Convinced of the need to strengthen France’s strategic independence, Bertrand and his successors would embark on a vast effort to make the country pandemic-proof and autonomous – a strategy that lasted during the last years of the presidency of Jacques Chirac and the start of Nicolas Sarkozy’s mandate. .

One of the cornerstones of the new strategy was the creation of a national mask production capacity, overseen and generously funded by a new entity, known as Eprus, along the lines of the Centers for Disease Control and Prevention ( CDC) from the United States.

At the end of 2006, France could boast a stock of 600 million FFP2 masks, which makes it one of the best prepared countries in the world, according to the World Health Organization. In May 2009, a Senate report indicated that the stock of Cyprus had reached more than 720 million units, supplemented by more than one billion surgical masks.

It’s just as good, because a deadly new epidemic, this one from Mexico, was about to test the value of the arsenal.

Crying wolf

The French government’s zealous response to the H1N1 flu marked the culmination of the precautionary approach advocated by Douste-Blazy and his successors. But in hindsight, it also sounded the death knell.

As the flu spread beyond Mexico in the summer of 2009, the new Minister of Health, Roseline Bachelot, decided to further accelerate the production of masks, resulting in a peak of 2.2 billion units ( and FFP2) by the end of the year. In accordance with government guidelines, companies have been advised to stockpile protective equipment, including high-protection FFP2 masks for workers “in close contact with the public”. Kits containing surgical masks and antiviral treatments have been distributed free of charge in pharmacies across France.

Controversy, the government ordered 94 million doses of vaccines and requisitioned gymnasiums for its national vaccination campaign, bypassing doctors.

But the health crisis could not materialize, and when state listeners, politicians, and the media began to dive into the cost of the operation, Bachelot was castigated for spending a billion dollars. euros in taxpayers’ money – partly to reimburse pharmaceutical companies. – on a virus that has killed “only” 342 people in France.

“In the event of an epidemic, one is easily accused after the facts of having botched the answer”, explains Geoffard of the Paris School of Economics. “Either we do too much prevention and few things happen, or we do too little and everything goes wrong.”

According to Geoffard, the H1N1 reaction was “one of the main reasons why it later became impossible to justify the maintenance of a very expensive prevention policy”.

Reflecting on his public punishments, Bachelot told Le Monde that the debacle had “led to general disarmament and discredited politicians”. She added, “The public has decided that we have overreacted. And for us politicians, the risk of doing too much has overshadowed that of doing too little. “

Former Minister of Health Roselyne Bachelot speaks to the press after being vaccinated against the H1N1 flu on November 12, 2009.
Former Minister of Health Roselyne Bachelot speaks to the press after being vaccinated against the H1N1 flu on November 12, 2009. © Bertrand Guay, AFP
    
Écrivant dans le même journal fin mars de cette année, le célèbre économiste de la santé Claude Le Pen, qui mourrait du cancer quelques semaines plus tard, a déclaré que les actions de Bachelot avaient inculqué aux hauts fonctionnaires «le sentiment que le gouvernement avait surestimé la crise et, finalement, dilapidé des fonds publics au profit des laboratoires pharmaceutiques ».

In the hope of diverting responsibility for the “disarmament” that left France so dangerously exposed a decade later, the successors to the Minister of Health accused these officials – “the deep state” – and one of the another to gradually get rid of France’s defenses.

After the demotion of Bachelot to a position in the junior cabinet at the end of 2010, Bertrand was put back in the saddle. However, the context has radically changed since his first visit as Minister of Health. These were the twilight years plagued by the scandal of Sarkozy’s presidency. In addition to pandemic fatigue, Bertrand had to face strict belt tightening measures in a context of global economic slowdown and European “debt crisis”.

At the end of 2011, a government directive signaled a change in doctrine, dividing state supplies of protective equipment in two: a “strategic” stock of state-owned surgical masks for the general public, and a “tactical” stock of FFP2 masks for health workers, which will be held and restocked by regional health authorities and individual hospitals.

The change of direction was cemented by subsequent reforms implemented under the socialist administration which came to power in 2012. They actually delegated the management of “tactical” reserves to institutions focused on short-term imperatives and struggling with budget cuts – with the effect that France’s precious FFP2 reserves have expired and have never been replaced.

“In the space of just two years, the state has passed on, in the name of decentralization and above all of budgetary constraints,” write Davet and Lhomme du Monde. As for Cyprus, it has been incorporated and diluted in a much larger structure, known as Public health France, reversing a decade-long policy modeled on the US CDC.

A masks bonfire

France is not the only country to have canceled or “forgotten” its pandemic response plans along the way.

An investigation by the British daily The Times revealed that preparing for a pandemic had been a top priority for the British government for a decade after the September 11 attacks, before falling victim to austerity cuts.

“We were the envy of the world,” an anonymous source in the Prime Minister’s office told the newspaper. “But pandemic planning has become a victim of years of austerity when needs were more urgent.” The source added that preparations for a Brexit without a deal “drew all the blood from pandemic planning.”

De même, des années de négligence ont aspiré le sang de la stratégie pandémique autrefois ambitieuse de la France, laissant l'État largement impuissant à protéger ses citoyens contre le coronavirus.

On March 17 of this year, the day when France started a two-month lockout nationwide, former Minister of Health Agnès Buzyn spoke frankly about the extraordinary twist that had seen her wrested from the ministry a months earlier, despite the worsening of the coronavirus epidemic, to lead President Emmanuel Macron’s Party to the municipal elections in Paris.

“I knew the tsunami wave was coming for us,” she said, referring to the impending pandemic. “We should have stopped the elections, it was a travesty. “

Addressing senators two days later, Buzyn’s successor as Minister of Health, Olivier Véran, summed up the breathtaking hemorrhage of equipment that had left France so desperately exposed.

“In 2010, the state had a stock of one billion surgical masks,” he said. “When I took over the ministry, there were 150 million.”

During his intervention and in the months leading up to the crisis, millions of masks were simply burnt down, assuming they were out of date or ineffective.

According to the French daily Liberation, a Belgian company responsible for testing a sample of masks had concluded that they no longer met certain standards. However, later tests on masks that were saved from the bonfire at the last minute showed that they were perfectly usable.

Officials interviewed by Le Monde suggested that conflicting messages about the usefulness of the masks – with the government at one point arguing that they were of no use to the general public – had helped to seal the fate of the discarded stock.

The result of this astonishing fiasco has been amply documented: a desperate shortage of protection, even for front-line workers, a frantic – and costly – race to fly with masks from China, and a late effort to revive a capability of domestic production which was recently abandoned. years.

“It is disconcerting to plan nothing at all, when everything was ready as of 2004,” said Douste-Blazy, discouraged, at Le Monde, referring to the Covid-19 disaster in France.

He added: “It must be one of the most incredible examples of how the French administration can produce such a plan and then not use it! “