After a week of casting doubt on the efficacy of the AstraZeneca vaccine, the French government spent the weekend barely bothering to administer the Pfizer and Moderna ones to its population. On Sunday 31 January, 4,560 people received a dose of a coronavirus vaccine in France, according to data from the health ministry. The day before, 598,389 people – 131 times as many – were given their first doses of the vaccine in the UK, a country of similar population, size and wealth.
France’s vaccination figures have dropped off drastically at weekends since the vaccination campaign began in late December 2020. On the weekend of 16-17 January, for instance, just 27,000 people were vaccinated over two days, compared to an average of 55,000 people per day during the preceding five days. An over-centralised bureaucracy, accustomed to political decisions being taken in Paris and rapidly implemented across the country, has found coping with the multi-layered logistical challenge of getting doses to patients difficult, according to a doctor I spoke to.
France’s pace is too slow, even without the weekend drop-off. At the current rolling seven-day rate, it would take until 2025 to vaccinate the entire adult population of France, according to calculations by Covidtracker.fr, a data tracker. The sharp drop-off at weekends is, in effect, prolonging the time it will take to achieve full coverage by more than a quarter, as two days of every seven are almost wasted.
Many countries vaccinate fewer people at weekends, because of logistical issues around transporting doses, as well as workers and volunteers taking days off. Rolling rates in Germany and France have also tapered off in recent days, in part because those countries are reserving doses for second injections after three weeks, as they have chosen not to extend the gap between doses as the UK has. Supply from Pfizer has been disrupted, limiting the number of doses available.
Another weekend of low vaccination numbers in France also comes after a chaotic week, during which President Emmanuel Macron cast doubt on the effectiveness of the Oxford/AstraZeneca vaccine among the elderly.
Macron’s comments on Friday were based on either a misguided or “bad faith” reading of the data provided by the pharmaceutical giant to regulators. “The real problem on AstraZeneca is that it doesn’t work the way we were expecting it to,” the president said to a group of journalists, adding that “everything points to thinking it is quasi-ineffective on people older than 65, some say those 60 years or older”.
In the same way that the German press made inaccurate claims about AstraZeneca’s vaccine, Macron’s comments conflated incomplete data with data pointing to ineffectiveness. In essence, he suggested that because the data for over-65s provided by AstraZeneca was very limited, it showed that the vaccine does not work on the elderly.
In fact, much of the available evidence suggests that AstraZeneca’s vaccine works well on over-65s, prompting the European Medicines Agency to approve the vaccine for over-18s, although France’s regulator has since said the data for the elderly was too incomplete to approve it for over-65s. In any case, new data should be available shortly giving an idea of its effectiveness among all age groups, as it has now been given to millions of people in the UK.
France already has some of the highest rates of vaccine scepticism in the world, and Macron’s ill-judged comments are likely to fuel this further. But more importantly, his remarks also reflect a widespread misunderstanding of what the headline “efficacy” figure actually represents.
The “efficacy” figure refers to the number of people who develop symptomatic Covid-19 in a group which has received a vaccine versus those who develop symptoms in a placebo group. Yet those symptoms can be mild, such as a fever or cough. What is more important is that vaccines prevent hospitalisation and death, as Pascal Soriot, AstraZeneca’s CEO, told the Italian newspaper La Repubblica last week. “If you can stop people from being severely sick, and importantly, if you stop them from going to the hospital, the whole thing becomes completely manageable,” he said, adding that vaccinated people “may cough a bit, or maybe run a little bit of fever, but they get on with their lives, as with the flu”.
The encouraging news is that the data available shows all the vaccines that have reported clinical trial results are 100 per cent effective at preventing hospitalisation and death, irrespective of what Macron might claim. But with France’s vaccination campaign continuing at such a slow pace, misinformation about vaccines is only a part of the challenge facing the country.