Decades ago, the French public was overwhelmingly supportive of vaccination. But a series of health controversies in the 1990s began to chip away at its trust in vaccines and the health officials who promote them. The first consumed the public’s attention for years. The government, a journalist revealed, had knowingly distributed transfusions of blood contaminated with HIV, which resulted in hundreds of deaths; several ministers were charged with manslaughter (only one, the health minister, was convicted). The second concerned a rise in multiple-sclerosis cases, which some in the population feared was linked to the government’s hepatitis B vaccination program. Although no evidence supported this claim, the government sent opposing messages—one minister approved the program, another suspended it—that undermined public confidence.
But the government’s 2009 response to the swine-flu outbreak made vaccine safety a matter of national debate. France embarked on a mass-vaccination campaign to stem the virus’s spread, purchasing more than enough doses to cover its population of 65 million. The problem was that barely anyone was willing to take them. “The French didn’t want to be vaccinated against an illness that didn’t really affect France,” said Laurent-Henri Vignaud, a co-author of a recent history of anti-vaccine sentiment in France. With fewer than 325 swine-flu-related deaths in the country, many resented the government for spending funds on expensive and unnecessary vaccines; pharmaceutical companies, critics pointed out, were the campaign’s prime beneficiaries. “Doubts about the government’s vaccine policy turned into doubts about vaccination itself,” Vignaud told me. In the end, less than 10 percent of the population got a jab.
By the following year, a national survey found that 38.2 percent of the public held an unfavorable view of vaccination in general, up from 8.5 percent in 2000. It was a significant shift, but one that could be misread: Of those who held an unfavorable view of vaccines, just 5 percent said they opposed getting any. The rest cited specific vaccines, including those for hepatitis B (12 percent) and swine flu (50 percent).
Researchers say this distinction is important because not every person who expresses hesitancy about vaccines is necessarily an anti-vaxxer. “Hesitation, by definition, is kind of an undecided state,” Heidi Larson, the director of the Vaccine Confidence Project at the London School of Hygiene and Tropical Medicine, told me. In France, vaccine hesitancy is highest among women, young people, those who are less educated, and those who vote on the political extremes. Common reasons include concerns about vaccine safety and effectiveness, but the biggest predictor of vaccine hesitancy is a lack of confidence in the state. “Trust in government is such a strong variable,” said Larson, “and that’s wobbly in France.”