Professor Jean-Paul Moatti is an important voice in public health. He is Professor of Health Economics and former President of the Institut de Recherche pour le Développement (IRD). He has chosen the prestigious medical journal The Lancet to launch, in a short but scathing article, a critical analysis of the French response to the COVID-19 epidemic.
The French response to COVID-19: intrinsic difficulties at the interface of science, public health and policy
In the face of criticism, the French authorities say their policy on the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic is evidence-based - they have appointed an advisory board of 11 scientists to help manage the crisis. However, in situations where decision-makers face radical uncertainty, sticking to conventional approaches could jeopardize the science-policy interface.
1- Politicians cannot learn lessons in real time
Simply looking at the evolution of confirmed cases does not allow us to draw any conclusions from the live lessons for politics.
Although the epidemic started simultaneously in South Korea, Italy and France on February 1, 2020, the number of confirmed cases of coronavirus 2019 (COVID-19) was 12 in South Korea, six in France and three in Italy - South Korea was able to control the epidemic. six weeks laterwhile a rapid increase in cases was evident in Italy and started in France. Despite WHO recommendations1France and Italy did not adopt a South Korean strategy of mass screening, contact tracing and physical removal, and the biggest step was the lockdown of the country on 9 March in Italy and 17 March in France.
France did not have the logistical capacity to promote mass testing, due to the limited number of accredited laboratories (only 45 in public establishments) and the limited availability of SARS-COV-2 reagents for RT-PCR. However, rather than explicitly setting the objective of scaling up testing according to priorities (health professionals, vulnerable groups) until capacity becomes sufficient, the authorities argued that routine testing was not necessary once the epidemic had become widespread (Phase 3 of the national guidelines). This policy was only reversed on March 28th, in order to manage an escape from confinement.
2- Dissonant incentives
The maintenance of the first round of national elections on 15 March, while imposing the closure of schools, contrasts with the social science literature, which states that disaster communication must avoid confronting the population with a situation of double constraint through dissonant incentives.2.
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3- Parasitism of ethical and medical controversies
The preliminary findings - although inconclusive - regarding the use of hydroxychloroquine and azithromycin for the treatment of COVID-19 have fuelled ethical controversies in the biomedical community with extensive media coverage. Referring only to randomized clinical trials to prove the efficacy of treatment without considering other methods of evaluation to provide evidence more quickly in an emergency context.3 reduced the ability of authorities to mitigate the effect of irrational online rumours4 and to regulate the prescribing practices of health professionals.
On 24 March, a second expert committee was held namedin addition to the first one. This Research and Expertise Analysis Committee comprises 12 experts, ten of whom are different from the members of the Scientific Council, and is chaired by Françoise Barré-Sinoussi, virologist and winner of the Nobel Prize for Medicine in 2008. The second committee seems to be an implicit recognition of the intrinsic difficulties of using science directly in the political management of a health crisis.
Jean-Paul MoattiProfessor of Health Economics, Université Aix-Marseille, President of the Institut de recherche pour le développement (IRD) until 2019
- COVID-19: what science advisers must do now. Nature 579: 319–20.
- Lagadec P, A new cosmology of risks and crises: time for a radical shift in paradigm and practice. Rev Policy Res. 2009; 26: 473-486
- Frieden TR, Evidence for health decision making - beyond randomized, controlled trials. N Engl J Med. 2017; 377: 465-475
- Cowper A, COVID-19: are we getting the communications right?. BMJ. 2020; 368: m919
The translation, titles and headings are from the editorial staff of UP' Magazine.
This article was first published by The Lancet