This is one of the first burning issues for the new government. Hospitals are in crisis due to lack of staff, particularly in emergencies, to the point of causing the temporary closure of certain services. Nine unions and collectives call for a day of mobilization and strike, Tuesday June 7, a week after Emmanuel Macron’s announcement of the launch of a “flash mission”. On the initiative, the CGT notably asks for the abolition of a measure which had somewhat disappeared from the debates: the vaccination obligation. Introduced on September 15, it remains in force in hospitals, but also nursing homes or fire stations. And deprives them of a small part of their staff.
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On April 12, the President of the Republic, then campaigning for his re-election, had half-opened the door to a return of non-vaccinated caregivers: he then mentioned the possibility of reintegrating them. if the circulation of the virus continued “on this trend” down to “return to an endemic phase”, that is to say the end of the succession of waves of contamination. Since then, his speech has not changed but his tone may have cooled the enthusiasm: the lifting of the vaccination obligation “is absolutely no answer to the problem [de manque de soignants] that we pose today”he judged on May 31.
While the Minister of Health Olivier Véran promised on May 12 on BFMTV to seize the High Authority for Health for an opinion, the latter assures franceinfo that it has not yet been. And Brigitte Bourguignon, who succeeded her on avenue de Ségur, declared on May 25 on RTL that “this vaccination obligation will remain for the necessary time”. Contacted, his cabinet did not respond to franceinfo. In abeyance, the lifting of the vaccination obligation raises irremediable questions.
Is it risky from a health point of view?
It’s no secret: being vaccinated is no guarantee of never being contaminated by Covid-19, nor of never transmitting it. An observation that the non-vaccinated caregivers interviewed by franceinfo put forward as proof, in their eyes, of the uselessness of this vaccination obligation. But in reality, the vaccine still makes it possible to better fight against the infection. In a vaccinated person who is contaminated, “the data suggests that the viral load will not necessarily be the same, and neither will the duration of the infection”, explains epidemiologist Emmanuel Rusch, president of the French Society of Public Health. Logically, if the disease is less intense and shorter, the chances of transmitting the virus decrease.
In contrast, “Vaccination-induced antibodies decline quite rapidly”notes epidemiologist Pascal Crépey, researcher at the School of Advanced Studies in Public Health. “Protection against contamination becomes very limited after a few months.” Caregivers had to have received their booster dose before January 30: their most recent injection therefore dates back more than four months. The more time passes, the more the risk that a vaccinated caregiver will transmit the virus increases, and approaches that of a non-vaccinated person.
The debate on the reintegration of the non-vaccinated is also resurfacing in a period of slowdown in the epidemic (before a slight rebound in early June). “Today, whether non-vaccinated caregivers are reinstated or not will not change anything in the epidemic dynamics in France”, believes Pascal Crépey, recalling that they represent a tiny part of the population. But “the epidemiological argument was true and could become so again” in the event of a new wave, he warns. “That’s when the risk of these people being infected is high. And if they are in contact with fragile patients, we put these patients at risk.”
In his various statements, Emmanuel Macron referred to the possible lifting of the obligation when the Scientific Council would declare that the virus is “endemic”, a vague criterion but which implies the end of the risk of a strong resurgence of contamination. However, the appearance of new, more contagious variants, BA.4, BA.5 and BA.2.12.1, is already raising fears of a new wave in the summer or fall. “If we reintegrated non-vaccinated caregivers, we should be able to ask them to leave in the event of a rise in contamination”warns Emmanuel Rusch.
Would they be enough to meet the needs?
According to the Samu-Urgences de France union, at least 120 emergency services, in 60 departments, have had to or are preparing to limit their activity due to lack of staff. Faced with this observation, it is difficult to establish how many employees are prevented from working because of the vaccination obligation. In mid-October, a study by the general directorate of health among a sample of hospitals estimated the share of suspended workers at 0.6% of the workforce, or around 16,000 people across the country. On October 20, Brigitte Bourguignon, then Minister Delegate for Autonomy, only reported 7,930 suspended caregivers, while Olivier Véran affirmed that two-thirds of non-vaccinated caregivers on September 15 had taken the plunge since .
What about more than seven months later? No new count has been communicated. It is not known in particular how many suspended finally accepted the injection, but also how many caregivers in good standing refused the booster dose, which became compulsory on January 30, and were suspended as a result. Some situations further complicate the count. Having tested positive for Covid-19 entitles you to a health pass, which allows suspended caregivers to return to the workforce for four months. Other opponents of vaccination escape these statistics, assures franceinfo Elsa Ruillière, spokesperson for the United Collectives, which brings together suspended health personnel: “There are all the people who have been laid off from the public service, or even those who have broken down nervously and are on sick leave”sometimes since a date prior to the vaccination obligation, and are therefore not suspended.
“I’m afraid that we focus on the foam”warns Emmanuel Rusch, the president of the French Society of Public Health, who “do not think that this reinstatement brings a solution to the problem for this summer”with the exception of certain overseas territories where the vaccination rate is much lower. “It is certain that when we see the disaster looming, even by bringing them all back, we will not solve the problem”also believes Mireille Stivala, secretary general of the CGT Santé, yet a fervent supporter of the end of the vaccination obligation.
Do these caregivers want to come back?
Suspended for almost nine months, the people interviewed by franceinfo do not all have the same expectations. “I am good at my job and I like my team”maintains Aurélie *, rehabilitator in a hospital in Drôme, who was able to return to work for four months after having “everything to have the Covid”, but will soon return to its suspension. Coraline, a nurse in an establishment in Ardèche, does not “can’t see himself doing another job” after 15 years of career.
“With both my hands, I don’t know how to do anything else.”Coraline, suspended caregiver
Financial difficulties have also forced the choices of some, such as Stéphanie, nurse anesthetist in a large hospital in Paris, who “does not want to work again with a hierarchy that [l’a] mistreated”she believes, but will resume work as a temporary worker “to earn money and eat”if the vaccination obligation is repealed.
To cope with the loss of their salary, while still refusing vaccination, others have changed course, permanently. “I found subsistence work at the factory”, explains Emilie *, on availability from her nursing position in Sarthe. If she has “divided by two” her salary, she no longer hopes for the end of the vaccination obligation: “I’ve been gone too long. I’ve done my job of grieving from the hospital.”
Like other caregivers interviewed by franceinfo, she also describes a loss of “trust” towards the health authorities which goes beyond the question of vaccination against Covid-19. “If we come back, we have no guarantee that we won’t be imposed something else in a year”, she fears. Aurélie* says to herself for example “suspicious” vis-à-vis vaccination against monkeypox, yet reserved for the moment for contact cases and carried out with vaccines known for a long time.
The deterioration of working conditions in the health sector also comes up among suspended caregivers as another reason to change paths. “I know what a mess it is right now, my ex-colleagues tell me”testifies Charline, whose disenchantment with the hospital had begun before its suspension. “I can no longer work in these conditions, triaging patients, with colleagues who keep people waiting in the emergency room because they think they are playing comedy…” Reasons not so far removed from those that explain the staff shortage as a whole.
How would they be received?
The prospect of reintegrating non-vaccinated caregivers has sparked mixed reactions, particularly from hospital media figures. Patrick Pelloux, President of the Association of Hospital Emergency Physicians of France, called in The Parisian (paid item) at “pass the sponge” despite their “mistake”to deal with the crisis “historical” of the hospital. “While more and more colleagues want to leave this job, they cling to this job”pleads for his part Mireille Stivala, of the CGT Health.
“It’s incomprehensible to push them out.”Mireille Stivala, general secretary of the CGT Santé
But other figures express their discomfort at the idea of this step back. “It’s a question of ethics: there are protection rules, I don’t see why we would compromise on that”, believes Jean-Michel Constantin, deputy secretary general of the French Society of Anesthesia and Resuscitation. Mathias Wargon, who directs the emergency department of the Delafontaine hospital in Saint-Denis (Seine-Saint-Denis), protested on franceinfo at the idea of having to work again with “those who do not believe in contemporary medicine, those who believe that vaccines kill”.
These contrasting discourses foreshadow certain tensions if this hypothesis materializes. Even suspended caregivers agree, and have sometimes already experienced it. “Colleagues are happy to see us come back, because it’s difficult”testifies Elsa Ruillière, assistant secretary of the CGT Health at the hospital of Montélimar (Drôme) and returned from her suspension in February after a positive test. “But others look askance at us, and think it’s our fault that the schedule is so tight.”
Hospital managements, for their part, are careful not to take too clear-cut positions on this subject. “We will see what the government decides, if it decides that they need to be reinstated, we will reinstate them”, was content to comment on the boss of the AH-HP Martin Hirsch on France Inter. The French Hospital Federation responds to franceinfo that the question “subject to the opinion of the Scientific Committee”. Enough to send the debate back to an uncertain future.
* The first names followed by an asterisk have been modified.