Friday, November 20, 2009

Grippe Porcine

The H1N1 influenza pandemic was declared in France before the WHO made its formal statement. That willingness to openly confront the potential for a very devastating pandemic has marked France’s reaction to the disease. Warning posters went up and a vigorous public awareness campaign started early in 2009. There seems little concern that any overreaction would cause political harm. In contrast, commentators snipe at the US federal response for embarking on another “swine flu” folly.

This month the general population in France started receiving vaccinations after medical personnel received the first doses in October. The newspaper Figaro called November 12, “D-Day” for vaccinating the general public and carried a picture of the smiling Minister of Health, Roselyn Bachelot getting a jab from a medical worker and declaring herself “not a typanophobe”—a person with an intense fear of getting a shot.

France has prioritized their vaccinations putting three groups at the head of the queue: nursing children under 6 months, healthcare personnel, and “fragile” persons—especially those with respiratory conditions. To serve them, the Ministry has opened 1,000 centers where vaccinations are available. The Ministry also supports a web site “Info’ pandemie grippale” ( this site is not unlike the US web site a rish array of links and information and advertises a free phone number for people to call in to get further information about influenza in general and the H1N1 in particular. The web site carries the latest “news” which is focused heavily on the Minister’s exhortations as well as descriptions of symptoms, prevention and treatment advice, as well as data on the global situation. A clickable regional map returns information on places to go for H1N1 vaccine. These centers are carefully regionalized and residents of each commune (township) are directed to their local centers. Interestingly, physicians’ offices were not originally included in the vaccination program.

In response to the exclusion of doctors, Professor Antoine Flahault, Dean of the EHESP and an infectious disease specialist, argued in support of several medical groups for opening up the process saying that “The population ought to have a choice” in where to go for a vaccination. On November 18, the Minister announced their inclusion in the program, but they wouldn’t receive vaccine until sometime in December.

Still, the demand for vaccinations in France has been slow in marked contrast to the situation in the US where the delayed build up in the vaccine supply has created long lines of people waiting for their shots or inhaler doses. In France, in the first 12 days that vaccinations have been available, 250,000 people got them according to the ministry of health. According to, the US has “allocated” 49.8 million doses and shipped 44.1 million as of November 18. Actual vaccination number won’t be available for some time.

Despite this extensive campaign, an October survey found that only 17% of the French intended to get a shot when the vaccine became available. This is in contrast to US surveys that indicate up to half the population will get a shot. But the numbers are adding up, today, Reuters is reporting that 56 deaths were attributed to H1N1 in France since the start of the pandemic and 8 in the last two days. This is in sharp contrast to the US where the death toll is estimated to be 3,900 and characterized as “no greater” than the impact from seasonal influenza.

Resistance to vaccination is being reported in both countries but it appears that France is more sensitive to adverse events and has been a bit more public in soliciting information about them. On November 19 the Agence francaise de sécurité sanitaire des produits de santé ( issued a bulletin describing their adverse events surveillance system. The bulletin indicated that 200,000 doses of PANDEMRIX had been administered to health professionals and 107 persons reported negative indications including pain at injection site, inflammatory reactions, fever, visual difficulties and “flu” syndrome.

The contrast between the US and France appears to be of one nation trying hard to motivate their population to the pandemic and creating a centralized structure to respond in contrast to the larger nation diffusing its efforts but generating a more vigorous demand.

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