Tribune. Emmanuel Macron’s recent aggressive statements about people not vaccinated against the SARS-CoV-2 virus have generated a lot of comment. However, the main point was not underlined: the President of the Republic presented his words as a “strategy”. Hence the question: what is a public health strategy?
A strategy covers all the initiatives promoting the feasibility and acceptability of prevention measures. It aims to maximize the benefits of actions and minimize their disadvantages. It starts from the observation that the health risk is not just a medical object: it is a socio-technical notion. There are many examples of public health actions of proven medical efficacy, but the results of which have not been achieved due to the lack of an adequate strategy. Screening for breast and uterine cancer in women and colorectal cancer screening for both sexes are striking examples. If we apply this to the question of unvaccinated people, what does it mean? There is no doubt that this is a crucial issue for the evolution of the epidemic and the functioning of the healthcare system.
First, you need to know who the unvaccinated people are and what their motivations are. It is obvious that this category is not homogeneous. Between the actual antivax, those who have medical contraindications, those who hesitate and those who are suspicious, the postures are different and call for different responses. In each situation, the risks attached to contagion and the benefits of prevention tools are perceived differently. What do we know? Where are the scientific investigations that allow us to find out? Without this understanding, public health is blind.
Second, for each of these groups, it is advisable to list the intervention tools available and to question their effectiveness. There are tools to try to convince. And tools to constrain. This ranges from education to health, to repression, even obligation. What do we know of their interest, alone or in association? And if evaluation data is lacking, where is the necessary democratic debate?
Third, it is essential to identify the favorable actors and the opponents. Here, there is an obvious political dimension, but not only. The issue of trust in authorities and scientists is crucial, which the recent work of the Economic Analysis Council has clearly shown. How do you reinforce this essential confidence in an eminently uncertain context? By accusing opponents, by insulting them, by despising them? It’s too easy and inefficient.
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