Vaccination: The French Paradox

Stéphanie Lavaud

June 28, 2019

A worldwide survey into public attitudes on science and medicine shows mixed results in different regions, especially over vaccination.

It reveals that populations in high-income countries are more worried about the potential side-effects of vaccines than those from low-income countries.

In France, 33% disagreed when asked if vaccines are safe.

That compared with 7% in Spain, 9% in the UK and Portugal, 11% in the US, and 13% in Germany.

Worldwide, 7% of respondents disagreed that vaccines are safe.

However, the apparent vaccine sceptical results from France don't correlate with the country's vaccination statistics which show child vaccination uptake is on the rise for both mandatory and optional vaccines. 

Health and Science: 140,000 Respondents Worldwide

The survey published last week, was undertaken by the Wellcome Trust, the UK charitable trust dedicated to medical research. The survey stands out due to its size and coverage.  More than 140,000 people worldwide from 140 countries were questioned  about how they felt about health and science.
 
Among the key findings of this large survey was that more than 8 out of 10 people (84%) stated they trust the medical advice given by health professionals (like doctors and nurses) but no more than 76% felt the same regarding the same advice given by the government.  With regard to science, 18% of the population who were questioned expressed a "high" level of trust, 54% an "average" level of trust, 14% have "little trust" and 13% said they "don't know". 

Are Vaccines Safe and Effective?

The survey also included a series of questions about vaccination.  These answers are especially relevant during a period of scepticism and the resurgence of diseases like measles, which was believed to have partially disappeared, or at least, no longer deemed to be life-threatening in developed countries.  The World Health Organisation (WHO) has cited vaccine refusal or delay in countries where vaccination is available, as one of the top 10 threats to world health in 2019 [2]

To learn more about the attitude of global populations, the survey focused on three questions: are vaccines safe? Are vaccines effective? And, is it important for children to be vaccinated?

Most media reporting on the findings has highlighted that 1 in 3 French people doubt the safety of vaccines. What also emerged was that beyond France, populations from high-income countries, notably in Western  or Eastern Europe, are even more sceptical regarding the safety of vaccines than those from low-income countries. 

Safety of Vaccines Brings Mixed Results

Worldwide, almost 8 out of 10 people (79%) "somewhat or completely agree" that vaccines are safe, whilst 7% "somewhat or completely disagree".

A further 11% neither "agree nor disagree" and 3% "don't know". 

An overwhelming majority of people living in low-income countries think that vaccines are safe, with 95% of people in South Asia and 92% in East Africa agreeing. In stark contrast, in high-income countries, only 72% of North Americans and 73% of people living in Northern Europe agreed with vaccine safety.  In Western Europe this figure is even lower, 59%, and in Eastern Europe it is no more than 50%. 

 

Safety and Efficacy Do Not Necessarily Correlate

However, scepticism regarding the safety of vaccines isn't necessarily reflected in attitudes towards their efficacy.

In Western Europe, for example, only 59% think that vaccines are safe, but on the other hand 77% say they are effective. 

Some people appear to accept that vaccines are effective in preventing some diseases, but also think there may be unwanted side effects.

In Liberia 28% of the population questioned did not think vaccination effective (the highest level among the populations questioned), but only 3% considered vaccines to be unsafe.

This may be explained by that country continuing to battle against infectious diseases, such as yellow fever and tetanus, despite vaccination programmes.

The perception of the lack of efficacy may be due to insufficient vaccination coverage, due to infrastructure issues, the report explains.

Lack of Trust

Bangladesh and Rwanda almost unanimously declare they are in favour of the efficacy and safety of vaccines, and that vaccines are in the best interest of their children (with percentages above 97% for all three questions). France stands out for its level of scepticism.

The French were also among countries most likely to doubt the efficacy of vaccines (19%) and do not agree they are in the child's best interest (10%). 

This level of scepticism is the same throughout the different socio-economic groups, and does not vary significantly according to education, age, gender, urban or rural status, or whether or not respondents are parents.

Among the explanations put forward for this lack of trust, the authors of the report cite the case of avian flu when WHO and government organisations were suspected of colluding with pharmaceutical companies to buy vaccines. 

French Paradox

So why don't opinions always directly correlate with behaviour? 

Of all French parents questioned in the survey, 91% said they vaccinate their children, in line with the global average of 92%. 

"It is the French paradox," Olivier Schwartz, scientific director at the Pasteur Institute in Paris, told ScienceMag [3].  "We doubt a lot of things; we grumble.  But fortunately, the vaccination coverage remains on the increase."

Translated and adapted from Medscape French Edition .

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