The Bourgogne – Franche-Comté Ethical Reflection Center (EREBFC) conducted a study among healthcare personnel in the region who were hesitant about vaccination against Covid-19 in order to understand their reasons for reluctance and to identify the associated ethical issues. This vaccine hesitation highlights in particular “ the need to think about the uncertainties inherent in medicine.”
From February to July 2022, the EREBFC hosted Sophie Andréa Lagrange, a Master 2 intern in sociology who conducted this regional study in order to understand the reasons for this vaccine hesitation and identify the ethical issues. The author recalls this in the introduction. The obligation to vaccinate against Covid-19 for healthcare personnel, enacted on September 15, 2021, aroused, as among the general public, disputes and sometimes even a categorical refusal to submit to it. ” It was notoriously stigmatized by public opinion when some of its members expressed their refusal. Decision-making was particularly difficult for many caregivers, oscillating between civic duty and rejection of a measure deemed draconian, professional conscience and personal questions. This vaccine hesitation has evolved in a health context already degraded both by a questioning of our health model for many years but also by the successive epidemic waves of Covid-19. Finally, many reluctant caregivers had no choice but to get vaccinated so as not to lose their jobs, which raises the question of the consent of these health professionals vaccinated under duress.”
For the recruitment of respondents, the choice was made to launch a call for testimonials from caregivers in the region, then to carry out semi-directed individual interviews that can take place by physical meeting or by telephone or videoconference, “ these last two collection tools thus allowing greater anonymity. These choices are justified by the taboo nature of the subject treated. says Sophie Andréa Lagrange. A regional study was thus carried out from February to July 2022. Twelve semi-directed individual interviews with reluctant caregivers, but who finally resolved to be vaccinated, made it possible to identify numerous reasons.
Vaccination, a decision made under financial constraints: the suspension of salary provided for by the law relating to the obligation to vaccinate was a major variable to be taken into account in the choice that caregivers had to make.
The “scientific” reasons put forward by these reluctant caregivers:
– a vaccine that arrived too quickly;
– a vaccine that does not meet the definition of a vaccine;
– the ineffectiveness of this vaccine;
– vaccine science does not exist.
” Why us ? “. For Sophie Andréa Lagrange, “ it would seem that the caregivers sometimes felt taken aback by what they perceived as a form of relentlessness. After having lived through difficult months at the start of the health crisis, they were nicknamed “heroes” before having to face the vaccination obligation. “And to continue, ” the health crisis that occurred at the end of 2019 did not fail to exacerbate the difficulties encountered by caregivers. The resulting obligation to vaccinate has, for many of the caregivers encountered, been a source of suffering. During this study, it seemed important to highlight the loss of trust placed in the institution, which contributed to making the bed of the caregivers’ hesitation about vaccination. Vaccine hesitancy is therefore considered here as a construct, a process placing the carer, his or her suffering – or more – at the heart of the phenomenon.
generally the relationship maintained with his profession – and the context in which he exercises it.”
The obligation to vaccinate caregivers was an opportunity to question, more generally, the free will they have within their practices. : what is adhering to public health protocols? The compulsory nature of vaccination also inevitably introduces the question of free and informed consent, an essential principle of health ethics. ” We met health professionals who shared with us their underlying definition of health, through the caring values that drive them, explains Sophie Andréa Lagrange. This definition of health had in common to refer to the sacredness of health naturally conceived. This point regularly made it possible to introduce their reluctance to vaccination by highlighting its artificiality.”
This is a major result of this study: the metaphors relating to the violence and humiliation caused by this obligation to vaccinate are plethora. Indeed, many of the healthcare personnel met presented the way in which they experienced the obligation to vaccinate by making analogies with rape. Analogies immediately reinforced by the evocation of this non-consensual intrusion. But what does vaccination violate?
One of the two major objectives of this study was to identify the reasons for the reluctance of healthcare personnel to vaccinate against Covid-19. These are numerous and join a certain number of the controversies which vaccination in general is regularly the subject of: these reasons for reluctance relate to the speed with which the vaccine against Covid-19 appeared, question its safety and effectiveness, and question the very definition of vaccination as well as its scientificity. In this sense, it seems that the Covid-19 vaccine cannot be described as a singular vaccine. However, few respondents describe themselves as anti-vaccine. The author emphasizes the importance of the context in which this mass vaccination takes place as well as the way in which it was made compulsory. It was thus a question of insisting on the constructed character of vaccine hesitation apprehended as resulting from a process.
This study was also resolutely part of a comprehensive perspective of the phenomenon under study. The ethical perspective involved in the second objective of this study involving moving away from any moralizing perspective, it was a question of identifying the ethical questions raised by the reluctance of caregivers to vaccinate against Covid-19.
In addition to the contestation of the health measure in terms of freedoms, the context in which this vaccination obligation takes place is marked by distrust of public health policies. If we look at the context in which the Kouchner law supposed to provide answers to a rise in mistrust then growing by building in particular a greater horizontality of the relationship between caregivers and patients and emphasizing the caregiver’s right to information thought as a condition sine qua non of the exercise of free and informed consent, it would seem that twenty years later the context of Covid-19 shows the limits of the Kouchner law. In this sense, the crisis we are going through is twofold: on the one hand, it is illustrated in the contemporary difficulties inherent in the health system; on the other hand, the Covid-19 crisis illustrates the failures of a health democracy whose efficiency was to be reinforced by the law of March 4, 2002. Some therefore see in this crisis a renewed opportunity to think about the future healthy democracy.
• The reluctance of caregivers to vaccinate against Covid-19 – An ethical approach to their reluctance. 2022 study by the Observatory. Sophie Andréa Lagrange, EREBFC intern, sociology student at the University of Burgundy. Summary of the report (PDF).
• Read also : Attitudes and intentions towards the Covid-19 vaccine among healthcare professionals in GuyanaWeekly epidemiological bulletin, February 15, 2022, n°14 – Covid-19 series.