On October 20, 2009, France opened its vaccination centers for the H1N1 influenza vaccine. Of the 63 million citizens in the country at that time, 5,924,267 people were vaccinated. The bill, however, rose to 660 million euros according to the Cour des comptes.
- France ordered 94 million doses of the H1N1 vaccine in June 2009 before its vaccination strategy had even been defined.
- Only 5.9 million people were vaccinated out of 63 million inhabitants, revealing a very low public uptake.
- The Cour des comptes estimated the total cost at 660 million euros, i.e. 111 euros per vaccinated person.
94 million doses ordered during the health emergency
On June 11, 2009, the World Health Organization officially classified the situation as a pandemic. In the wake of this, the French government decided to secure access to vaccines by ordering 94 million doses, acquired from three laboratories, through successive orders of 50, 28, and 16 million doses, allocated according to the production capacities of these manufacturers. A small additional quantity came from a fourth laboratory, deliveries of which had begun. In theory, this volume far exceeded what the campaign would ever manage to distribute.
According to the Cour des comptes, “pharmaceutical companies began pitting states against one another for access to vaccines” as early as May 2009. Negotiations with the laboratories thus began before the vaccination strategy was defined, during June.
Twelve million schoolchildren, from kindergarten through high school, should have been able to benefit from vaccination by November 25.
Vaccination centers open, the French stay at home
The national campaign was rolled out in schools starting on November 25, then in middle and high schools beginning December 2, 2009. Facing limited turnout, the government opened vaccination centers on Sundays starting November 30, extended operating hours, and mobilized around a hundred military doctors. Five thousand people were recruited under assisted contracts by associations to support the teams on site.
An Inserm survey conducted from November 17 to 25, 2009—one week before the pandemic peak—found that only 17% of adults surveyed were already vaccinated or planned to do so. This figure confirmed the low uptake among the French, with vaccination coverage totaling 5.7 million individuals. In the centers, general practitioners were paid 66 euros per hour, retired doctors 33 euros, and private nurses 28.35 euros. The Haut Conseil de la Santé Publique confirmed in January 2010 a total of 5.74 million people vaccinated.
The parliamentary inquiry commission would later settle on the final figure: 5,924,267 people vaccinated, and only 9 million non-expired doses still usable until April 2011.
At the beginning of January 2010, the end of the outbreak was officially announced in France.
660 million euros to vaccinate fewer than one in ten inhabitants
The Ministry of Health announced at the time a much more modest total cost for the campaign. The Cour des comptes upheld a “sum well above the 510 million announced by the health minister,” notably based on the testimony of Roselyne Bachelot before the National Assembly’s inquiry commission. This 660 million euro estimate, however, does not include certain expenses, notably compensation for vaccine side effects, such as narcolepsy.
A portion of this amount corresponds to the rebates paid to the laboratories, totaling 48 million euros. France then applied one of the highest rebate rates among all European countries, at 16% of the sale price of medicines. In addition to these expenses, there were about 90 million euros in invoices managed by the Ministry of the Interior, notably concerning vaccination centers. By the end of the campaign, the public EPRUS retained a stock of 18,915,610 doses valued at 150,351,833 euros including VAT.
Of the 63 million inhabitants in France in 2009, the 5.9 million people vaccinated represented far less than one in ten. A ratio that raises a real question about the scale of resources deployed relative to the population’s actual uptake.
One month after the peak, the State cancels its orders
On January 4, 2010, EPRUS notified the laboratories of the termination of part of the orders not yet delivered. The health minister then announced that very few countries were ultimately interested in buying back the vaccines, while 50 million doses ordered ended up as a large surplus with no buyers. This decision came barely a month after the vaccination campaign’s peak.
Twelve million doses were eventually given to the WHO as part of international solidarity.
The government also organized cost-price exports, to Monaco for 80,000 doses, and to Qatar for 300,000 doses accompanied by 330,000 syringes. These international transfers did not change the essential reality: out of 94 million doses ordered in a rush, a large majority would never have served to vaccinate a single French person.
Sources: legifrance.gouv.fr | presse.inserm.fr | senat.fr
