Reintegrate unvaccinated caregivers? Forget science, this is a political question

A year after the eclipse, will antivirals ever be able to return to hospitals? The soap opera could still last longer. At the end of an agreement reached Thursday between the National Assembly and the Senate, caregivers who have been suspended for refusing a vaccine against Covid-19 can be reinstated. Once the medical conditions are met, It is up to the High Authority of Health to decide on this point. What I did Friday is by considering that in the context of the current pandemic and given the uncertainties about the future, a commitment to vaccination has remained essential. In response to this decision, the Minister of Health, François Browne, immediately issued an opinion ” Negation “.

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In the midst of a tense summer in health institutions, alarmed by staff shortages, the question of reintegrating caregivers has been invited back into the political debate. The return of the exiles is a long-standing request from La France Insoumise and the National Rally, who led the fight in the Assembly, during the passage of the health bill, and with the help of the Republicans were able to enforce the topic. In an unscripted text.

But did the parliamentarians understand what they voted for? By emphasizing only the health conditions, they miss the main issue of this decision. With vaccines that poorly prevent transmission against Omicron, it is no longer a matter of protecting patients from the virus as a precaution against the spread of the conspiracy in hospitals. How can this controversy be viewed by limiting it to a technical question decided by the Supreme Health Authority, without taking a measure of what the anti-fax movement was like during this epidemic?

The government depends on science

The government, embarrassed by this poisonous subject, began calling in its refusal to engage in politics to rely on the wisdom of science. “We must first of all rely on scientific rationality,” François Brown informed the deputies. “I will therefore consult the scientific and ethical bodies in the coming days, in particular the High Authority for Health and the National Advisory Ethics Committee.”

For a minister who seemed in favor of not reintegrating caregivers, this is a baffling statement. Because if we put ourselves on a strict level “scientific wisdom”, It now appears that suspension of unvaccinated individuals is unnecessary. Each new Omicron sub-variant pushes the boundaries of immune escape backward and the vaccine forms less and less of a barrier against infection – on the other hand it retains all its advantages to prevent dangerous forms.

Vaccine efficacy against Omicron drops to 0% after 6 months

What does science say? In the current situation – caregivers are generally vaccinated three times, with a booster dose taken more than 6 months ago – staff are no longer protected against Covid-19 infection. According to UKHSA, the English health agency, protection against Omicron drops to 0% after 6 months. There will still be residual protection against transmission estimated by the Occupational Health and Safety Services Authority (UKHSA) between 0 and 15%.

In other words, a 6-month-old booster no longer prevents contamination but can slightly reduce the ability to transmit the virus to others (which is the primary goal of caregiver vaccination). It should be noted that a potential adherence to the fourth dose would make it possible to boost caregivers’ immunity for a few months and thus protect patients – but this is not currently on the agenda. Moreover, new variants can change the situation in the future and impose new specific vaccines.

In an intervention in the National Assembly, rebel Mathilde Baneau summed up the paradox of the situation: “Caregivers lost their jobs because they were not vaccinated, but due to our lack of caregivers, I decided that caregivers with Covid should continue to go to work, while caregivers who were negative, who were not vaccinated, did not have the right to do so. . »

Avoid infection thoughts antivax

But the weakness of the scientific argument does not prevent other factors from being taken into account, no doubt of equal importance – which the government and the national representation clearly did not grasp. in loud notice
Posted on Tuesday, the Academy of Medicine did not practice medicine but politics, came out firmly against reintegrating the unvaccinated, believing it would be a matter of ” Error ” : “Any refusal to vaccinate out of personal convictions is respectable, but it is against the profession of the caregiver.”

The debate is framed: the question is no longer to prevent infection but to prevent ideas of antivirals from contaminating treatment rooms. “Reintegration of unvaccinated healthcare professionals into the healthcare team would compromise the climate of trust and cohesion that must exist among its members and with patients. It would put vulnerable patients at risk,” The Academy of Medicine writes again.

A measure of professional ethics

in Her last opinion before it was resolved
The Scientific Council has taken the same reading network to oppose the return of unvaccinated people: scientific arguments less than human resource considerations. “Reintegration of unvaccinated caregivers can raise rejection issues within teams from other caregivers, who will not understand this reintegration process.”

The vaccine is shown here as a measure of professional ethics. Regardless of its effectiveness that has developed over time, it is one of the necessary gestures for practicing the profession: “The caregiver must prioritize all gestures and actions so as not to contaminate the often fragile patients he cares for.” “The notion of the model and the values ​​associated with care remain fundamental to the majority of caregivers,” The Scientific Council writes again.

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The question that arises implicitly can we move away from the science of a place, the hospital, where it controls, which is the basis of professional practices? A vaccine may not be strictly scientifically justified, but in the name of faith in science doctors keep asking for it within their walls.

“It will be the victory of obscurantism over science.”

The question has become highly symbolic and many practitioners suggest: “These anti-fax people refused to receive the vaccination at a time when it was important to our patients, us and the maintenance of the general hospital. Next time, they will again refuse vaccination, whether against Covid or against influenza,” Appeal to emergency doctor Matthias Wargon on the France Info website. Epidemiologist Mahmoud Zureik goes further by appreciating this “The victory of obscurantism over science!”: “Once they are brought back, the anti-vaccinators will achieve victory by saying that they were right on this point because they are right on all the other points.”

These considerations may seem secondary if reintegrating caregivers can save a public hospital on the verge of stroke. But in reality, the numbers of exiles are few. “Making people believe that reintegrating these caregivers” He will save the hospital “completely wrong” François Brown argued at the LCI. Government spokesman Olivier Veran detailed the numbers: only 600 nurses out of the 240,000 affected by the suspension, as well as 75 doctors and pharmacists in the hospital, out of a total of 85,000.

Suspended, but not released

If the numbers seem too low, it’s because the rebels are fewer and fewer in number over time. “The number of suspended professionals was divided by 4 between September 15, 2021 (implementation of the vaccination commitment) and spring 2022. It now represents only 0.3% of the total founding agents,” the French Hospital Federation detailed, considering that there was no group of professionals to look for among the suspended agents for not vaccinating them.

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There are still considerations in labor law, which are clearly not accidental. The Senate Health Bill Rapporteur, L.R. Philippe Bas, summed up the problem: “The suspension of an employment contract is temporary by definition. All our colleagues who think we can never bring these employees back know this well: the law excludes them from remaining permanently suspended.” We almost forgot about it, but these employees weren’t fired, they were suspended. Their fate risks being chased by the government.