Tribune. The recent aggressive declarations of Emmanuel Macron vis-à-vis non-vaccinated people against the SARS-COV-2 virus have generated a lot of comments. 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 initiatives that promote feasibility and acceptability of prevention measures. It aims to maximize the benefits of actions and minimize their disadvantages. It starts from the observation that health risk is not just a medical object: it is a sociotechnical notion. There are many examples of public health actions of demonstrated medical efficiency, but the results are not at the rendezvous for lack of an adequate strategy. Screening for breast and uterus cancer in women and colorectal cancer for both sexes are striking examples. If we apply this to the question of non-vaccinated 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 care system.
First, you have to know who are non-vaccinated people and what are their motivations. It is obvious that this category is not homogeneous. Between the antivax itself, those with medical contraindications, those who hesitate and those who are suspicious, the postures are different and call different answers. In each situation, the risks attached to the contagion and the benefits of prevention tools are perceived differently. What do we know? Where are the scientific surveys that allow knowledge? Without this understanding, public health is blind.
Secondly, for each of these groups, the available intervention tools should be launched and questioning their effectiveness. There are tools to try to convince. And tools to constrain. This goes from health education, until the repression, or even the obligation. What do we know about their interest, only or in association? And if the evaluation data is missing, where is the necessary democratic debate?
Third, it is essential to identify favorable actors and opponents. Here, there is an obvious political dimension, but not that. The question of trust in the authorities and scientists is crucial, which recent work of the economic analysis council have shown well. How do we strengthen this indispensable confidence in an eminently uncertain context? By accusing opponents, in the inviting, contempting them? It’s too easy and ineffective.
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