September 20, 2021

Covid-19: in France, the most vulnerable remain insufficiently vaccinated

Regarding the number of people vaccinated daily, France set its record on Tuesday, July 13, with nearly 800,000 doses administered, according to the government. A strong progression which follows the speech of Emmanuel Macron: the Head of State ordered the obligation of vaccination, from the start of the school year, for “all professionals or volunteers in contact with the elderly or frail” and announced the extension of the health pass to places of leisure and culture from July 21.

“We must aim for the vaccination of all French people,” said the president, in the face of the rapid progression of the Delta variant, stressing the importance of protecting those at risk. However, while the vast majority of nursing home residents are now vaccinated, this is not the case for all of the most vulnerable.

Elderly people, the splits

In December 2020, France launched the first phase of its vaccination campaign, reserved for people in nursing homes – they then represented nearly half of the 60,000 victims of Covid-19. Public Health France estimates that on July 6, 88.8% received ‘at least one dose’ vaccine and 83.1% are ‘fully vaccinated’.

However, in this age group – over 80 years – the average in the general population drops by 10 points, with 79.8% partially vaccinated and 73.8% having completed the cycle. “There are many reasons that can explain this significant gap between seniors in institutions and others”, suggests Professor Jean-Daniel Lelièvre, specialist in vaccinology and head of the immunology department at Henri-Mondor hospital in Créteil, contacted by France 24. “Some people have reservations about vaccination or sometimes have difficult access to centers because they live in isolation. We are also paying the price for strategic errors: for too long, treating physicians have been kept out of the vaccination campaign while they have a privileged relationship of trust with patients, especially the elderly. Now we have to catch up. ”

Disparities among pathologies

Priority audiences for vaccination also include a series of serious and / or chronic pathologies such as cancer, multiple sclerosis, diabetes or even asthma as well as transplant recipients.

As of June 27, 71.4% of people aged 18 and over with at least one serious and / or chronic condition had received a first dose of the Covid-19 vaccine, according to Health Insurance. A ratio well above the national average of 52%. However, strong disparities persist: for some categories, progress has been slower. This is the case, for example, of HIV patients , 61% vaccinated with a first dose, but mostly obese people, of whom it is estimated that barely half are partially vaccinated.

Read also: Concerns emerge over the low vaccination of obese people in France

‘Vaccination has raised concerns among people with illnesses due to their particular conditions, this was particularly the case for some of my patients with HIV,’ explains Jean-Daniel Lelièvre. “With the lockdowns and increased hospital activity, it took time to review them all and discuss the vaccine issue with them before they took the plunge. In general, there is a lack of support for fragile populations that urgently needs to be filled. This is even more true for obese people, who are difficult to identify by health insurance if they do not have complications related to their condition. Take a seriously overweight 40 year old on the street … I’m not sure they know they are at risk … Mandatory vaccination can’t be the solution for everything. The government must do a lot of communication work to mobilize these categories of people.

Psychiatric patients lagging behind

Ahead of the vaccination campaign, the National Association of Psychiatrists had demanded that their patients treated in specialized institutes be considered a priority public. ‘The life expectancy of patients with chronic psychiatric pathology is reduced by ten years compared to the general population, due, among other things, to frequent somatic comorbidities and poor general health. This particular vulnerability must lead to its being taken into account as a risk factor for a severe form of Covid-19 ‘, then alerted the association . However, it will be necessary to wait until March 2021 for the High Authority of Health adds people with psychiatric disorders to the priority list for immunization.

If the vaccination coverage rate within this population has since increased, “it remains insufficient with regard to the risk of developing a severe form of Covid-19 ‘, underlines the Health Insurance in a recent study. ‘As of June 27, people with a psychiatric disorder that began in childhood, i.e. around 12 million French people, are only 51.5% to have received a first injection and 31.5% with a completed vaccination schedule’ , indicates the report. ‘The vaccination of this type of population is all the more important as it is sometimes very difficult to make them apply barrier gestures, just like mobile people with dementia in nursing homes’, points out Jean-Daniel Lelièvre.

Aware of these disparities and shortcomings, Health Insurance launched a study program in June to better raise awareness and support people at risk in their vaccination course.