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Vaccine passport: why so much doubt?

Etienne Minvielle
Etienne Minvielle
CNRS Research Director and Professor of Health Management at Ecole Polytechnique (IP Paris)

Accord­ing to a sur­vey by the Eco­nom­ic, Social and Envi­ron­men­tal Coun­cil 1, 67% of French peo­ple are “high­ly unfavourable” to the adop­tion of a “vac­cine pass­port”. How do you explain this opposition?

Éti­enne Min­vielle. The pass­port offers a way to reopen places that are cur­rent­ly closed and to start trav­el­ling again. But many peo­ple see it as a form of infringe­ment of indi­vid­ual free­doms and a poten­tial source of inequal­i­ty. The pass­port is sup­posed to be an incen­tive for vac­ci­na­tion, yet access to vac­cines is still prob­lem­at­ic. So, to gen­er­alise a vac­cine pass­port now would be giv­ing free­doms to those who lucky few who have been able to ben­e­fit from it so far. 

Hence, this would cre­ate inequal­i­ties on both nation­al and inter­na­tion­al lev­els, like­ly to fuel bit­ter­ness of non-vac­ci­nat­ed indi­vid­u­als and sus­pi­cions of enti­tle­ment. The cri­sis is putting social cohe­sion to the test, and the reluc­tance to put this pass­port into cir­cu­la­tion is a tes­ti­mo­ny to this.

Who are those who oppose this passport?

There is wide­spread fear of sur­veil­lance among most French peo­ple and the pass­port, since it increas­es trace­abil­i­ty, increas­es this fear. Many peo­ple also have doubts about the risks and effec­tive­ness of vac­cines. We can see this clear­ly with the con­tro­ver­sy sur­round­ing AstraZeneca’s dos­es: peo­ple are wor­ried about the lack of hind­sight and fear poten­tial side effects.

But it’s not just the clin­i­cal sphere that is con­cerned. Many peo­ple under­stand the med­ical benefit/risk ratio but are still scep­ti­cal about the inten­tions of those who are push­ing for vac­ci­na­tion. There is a social – almost iden­ti­ty-based – rejec­tion of polit­i­cal and med­ical elite. This scep­ti­cism can bor­der on con­spir­a­cy when cit­i­zens come to imag­ine col­lu­sion between elites and phar­ma­ceu­ti­cal lab­o­ra­to­ries. We are there­fore see­ing the emer­gence of a form of resis­tance, based on the rejec­tion of the dis­course of the elite, of which the first and fore­most is the government.

There is wide­spread fear of sur­veil­lance among most French peo­ple and the pass­port, since it increas­es trace­abil­i­ty, increas­es this fear.

How can those peo­ple be con­vinced of the effec­tive­ness of vaccines?

For peo­ple who have doubts about the clin­i­cal effec­tive­ness of vac­cines, med­ical staff sim­ply need to explain the clin­i­cal results, which prove that vac­cines are not dan­ger­ous. In the case of AstraZeneca, for exam­ple, no link between the vac­cine and throm­bo­sis has been demonstrated.

For those whose doubts are based on socio-iden­ti­ty cri­te­ria, the mis­take is to believe that words by doc­tors and author­i­ty fig­ures are enough 2. The vac­ci­na­tion of elites can even send a neg­a­tive sig­nal: the fact that Jean Cas­tex was vac­ci­nat­ed with a dose of AstraZeneca can be inter­pret­ed as proof of his links with the lab­o­ra­to­ries. The response is there­fore not be clin­i­cal, rather it is social. 

We need to devel­op a dif­fer­ent kind of com­mu­ni­ca­tion, based on influ­encers play­ing the role of “trust­ed third par­ties” [Pres­i­dent Macron promised famous youtu­bers McFly and Car­l­i­to to take part in one of their videos if they made a music video on pre­ven­tive mea­sures that reached 10 mil­lion views]. The vac­ci­na­tion of rap­per Boo­ba (sug­gest­ed in a post on his Insta­gram account) is in this sense not entire­ly anec­do­tal, not least because he is fol­lowed and lis­tened to by a some of these con­spir­a­cy the­o­rists. The mixed reac­tion of his fans on social net­works shows the lim­its of this method: peo­ple are not fooled, and often per­ceive this com­mu­ni­ca­tion as an attempt at manipulation.

So, there is no mir­a­cle solu­tion for con­vinc­ing peo­ple who doubt?

It is extreme­ly dif­fi­cult to con­vince peo­ple who do not want to be con­vinced. To take just one exam­ple, one study showed that par­ents who were reluc­tant to vac­ci­nate their chil­dren became even more scep­ti­cal when they were pre­sent­ed with data that shat­tered the myth of autism risk due to vac­cines 3. Although coun­ter­in­tu­itive, this posi­tion does not reflect a lack of intel­li­gence. It demon­strates that sci­en­tif­ic evi­dence is reject­ed when it dis­turbs beliefs.  It is there­fore not the con­clu­sion that counts, but who pro­duces it.

The trans­mis­sion of infor­ma­tion is not just a sender/receiver rela­tion­ship! It requires tak­ing into account the whole social con­text: peo­ple are not just clin­i­cal cas­es. In can­cer patients, for exam­ple, the rate of non-adher­ence to pre­scrip­tions is close to 20% in dif­fer­ent clin­i­cal con­di­tions 4 5. This results in con­sid­er­able loss of oppor­tu­ni­ty and is inex­plic­a­ble from a strict­ly clin­i­cal point of view. In the work we are cur­rent­ly doing, this non-adher­ence seems to be explained by social phe­nom­e­na: the rela­tion­ship to life, the lev­el of iso­la­tion, las­si­tude or the dete­ri­o­ra­tion of the pro­fes­sion­al sit­u­a­tion. This social dimen­sion must be tak­en into account to opti­mise care. The same approach must be adopt­ed to under­stand the reluc­tance of cit­i­zens to be vac­ci­nat­ed and the health passport.

Interview by Juliette Parmentier and Clément Boulle
1In French : https://​par​ticipez​.lecese​.fr/​p​a​g​e​s​/​r​e​s​u​l​t​a​t​s​-​d​e​-​l​a​-​c​o​n​s​u​l​t​a​t​i​o​n​-​s​u​r​-​l​e​-​p​a​s​s​e​p​o​r​t​-​v​a​c​cinal
2Rosen­baum, L. (2017). Resist­ing the sup­pres­sion of sci­ence. New Eng­land Jour­nal of Med­i­cine, 376(17), 1607–1609.
3Nyhan B, Rei­fler J, Richey S, Freed GL. Effec­tive mes­sages in vac­cine pro­mo­tion: a ran­dom­ized tri­al. Pedi­atrics 2014; 133(4): e835-e842.
4 http://​www​.blood​jour​nal​.org/​c​o​n​t​e​n​t​/​1​1​3​/​2​2​/​5​4​0​1​.​a​b​s​tract
5Pis­til­li, B., Paci, A., Fer­reira, A., Di Meglio, A., Poinsignon, V., Bardet, A., … & Vaz-Luis, I. (2020). Serum detec­tion of non­ad­her­ence to adju­vant tamox­ifen and breast can­cer recur­rence risk. Jour­nal of Clin­i­cal Oncol­o­gy, 38(24), 2762–2772


Etienne Minvielle

Etienne Minvielle

CNRS Research Director and Professor of Health Management at Ecole Polytechnique (IP Paris)

A former intern at the Paris hospitals, a graduate of ESSEC and holder of a doctorate from the Ecole Polytechnique, Etienne Minvielle is also Director of Quality, Risk Management and Patient Relations at the Gustave Roussy Institute.
*I³-CRG: a joint research unit of CNRS, École Polytechnique - Institut Polytechnique de Paris, Télécom Paris, Mines ParisTech

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