COVID-19: Response of France and Some Lessons for India
By Jojo Jacob
Everybody knows that pestilences have a way of recurring in the world, yet somehow, we find it hard to believe in ones that crash down on our heads from a blue sky. There have been as many plagues as wars in history, yet always plagues and wars take people equally by surprise. Albert Camus in The Plague (1947)
Background – France’s (un)preparedness for a Pandemic
Way back in 2004, France launched an ambitious pandemic response strategy when the then Health Minister, Philippe Douste-Blazy, a cardiologist turned politician warned that ‘… the sudden occurrence of an unknown infection capable of spreading across the planet thanks to modern communication networks, can disseminate fear, and destabilise the most developed societies and health systems’.1 It took more than 15 years for Douste-Blazy’s prediction to materialize, but in the meantime, France had lost its appetite for pandemic prevention.
Alarmed at Douste-Blazy’s dire warnings, a senate report recommended that the country should prepare for future outbreaks and stressed the need for stockpiling masks for health-care workers and the general public. The report added, this ‘would certainly entail a high cost, but would help limit the country’s paralysis… In this light, the cost must be put into perspective’.
Douste-Blazy’s successor, Xavier Bertrand laid out an even more ambitious pandemic response strategy centred on creating self-reliance in mask production, overseen by a newly formulated agency, Eprus, modelled after the US Centres for Disease Control and Prevention (CDC). The thinking was that France could not afford to depend on China to deliver masks in the event of a crisis. By mid-2009, Eprus had a stock of more than one billion surgical masks for the general public and over 720 million units of the more protective FFP2 masks.
The first test of this strategy, costing one billion euros, came in the summer of 2009 when H1N1 influenza threatened to spread beyond Mexico. France, led by the then Health Minister, Roselyne Bachelot, responded by ramping up the production of masks (the French mask stockpile reached about 2.2 billion units – surgical and FFP2 – by the end of 2009); advising businesses to hold stocks of FFP2 masks for workers who came in close contact with the public; distributing free kits containing surgical masks and antiviral treatments through pharmacies, and; launching a controversial nation-wide vaccination campaign. H1N1 influenza, nevertheless, failed to make a major impact, triggering a backlash from the government’s own auditors, politicians, and the media for spending a billion dollars to combat a virus that killed ‘just’ a few hundred people. The pandemic response strategy that was built over several years suddenly lost its credibility, with the sentiment being that public money was squandered on private laboratories. Bachelot was demoted to a junior position and the task of maintaining FFP2 masks were transferred to regional governments and hospitals, many of who were under too much financial stress to invest in procuring masks. François Hollande’s Socialist administration, which came to power in 2012, completed this devolution process, and dissolved Eprus in 2016, merging it with other bodies of the national public health agency. When COVID-19 hit its shores, France only had a stockpile of 150 million masks, compared with over one billion it had in 2010.
Covid-19 in France – Initial response
Although the first case of coronavirus in Europe and the first death from the virus outside Asia occurred in France, the government’s initial response was rather measured, focusing on isolating confirmed cases and then tracing people who had been in contact with them. The government felt that they had the virus under control, with the Health Minister, Agnès Buzyn remarking on January 24 that ‘the risks of propagation of the virus in France are extremely low’ and later assuring that the government had a sufficient number of masks for distribution to the public if necessary. However, with the first 100th confirmed case reported on March 1 and the following days seeing the number of cases surging alarmingly to reach close to 4000 by March 14, it was clear that community transmission was occurring and that strict social distancing measures were necessary to contain the spread of the virus. On March 12, President Macron ordered the closure of all schools and universities from March 16 until further notice. The following two days saw the government banning large gatherings of people (more than 100) and ordering the closure of restaurants, cafés, cinemas and nightclubs. On March 16, Macron ordered home confinement, which lasted for eight weeks.2
Confinement – the good and the bad
Home confinement has had a significant effect in preventing hospitals from being overrun by COVID-19, as happened in Italy and Spain where hospitals experienced acute shortages of beds and equipment. There was, however, a saturation of hospital capacity in two regions (Grand Est and Ile-de-France, which includes Paris), from where patients were transported to other less ‘stressed’ regions. It must be emphasized though that the apparent success of the lockdown might have also helped obfuscate the nation’s limited capacity for testing and the depleting stocks of masks. In fact, government ministers tried to dissuade people from procuring masks and President Macron was even heard saying on February 27 that ‘it is useless to wear masks in the streets’.3 At the same time, efforts were on to ramp up the purchase of masks – the competition among national governments was so high in the international market that at one point, French officials even accused the US of diverting supplies meant for France by outbidding them. Domestically, in order to prioritise the delivery of masks to those most at risk, like the elderly and those with underlying chronic health conditions, the French government issued a decree mandating the delivery of masks directly to the government. This decree, according to a Reuters investigation, has had a devastating impact on France’s retirement homes, many of which had already made orders for thousands of masks.4 Several of these nursing homes, which accommodate around one million residents, therefore, did not have adequate supplies for about 10 days. Reuters attributes the shortage of masks to the spread of the virus in retirement homes. As of May 9, the number of deaths from coronavirus-related illnesses in nursing homes stood at 9,737 people (40% of total deaths in the outbreak). The lack of clarity and consistency on the use of masks eroded public confidence (a necessary condition, according to WHO, for the effectiveness of containment measures), with three in four French believing that the government lied to them about masks.
On May 11, when France finally introduced a partial relaxation of the lockdown, the number of patients in intensive care had fallen below 3000, well within the system’s capacity to cope, compared with a peak of over 7000 in April. While the easing of restrictions appears to have popular support, the decision to reopen schools has raised concerns, especially in the Paris region, from several teachers who consider it too early. In fact, there are some who wonder whether this belies a government strategy that is aimed at achieving ‘herd immunity’ and that prioritises economic recovery over people’s lives. This fear was lent some credibility by the apparent disagreement of the government’s own scientific advisors with the school-reopening decision. On its part, the government has been trying to prevent the number of new cases from exploding and causing a second wave by increasing testing and making it compulsory to wear masks in public transport and at work.
Economic impact & policy support
The lockdown has caused the economy to shrink by 6% during the first quarter of 2020.5 Banque de France, the French central bank, estimates that GDP for 2020 would be minus 8% and that each fortnight of confinement would reduce annual growth by 1.5 percentage points. However, Banque de France, along with the IMF, remains bullish about France’s economic recovery next year. The French government and Banque de France have taken several steps to minimize the economic impact of COVID-19 and to engineer a recovery. These include loans guaranteed to businesses by the government worth 300 billion euros, deferral of charges and taxes, 1,500 euros to small businesses experiencing a fall in turnover of more than 50 percent, and up to 10, 000 euros to businesses threatened with bankruptcy.6 As for employees who are affected by the shutdown, France’s celebrated social security system has practically ‘nationalized wages’ through ‘partial unemployment’ in which employees’ salaries are paid by the government, instead of by their employers. The French banks too have been instrumental in supporting the government, rolling out loans on a massive scale, handling about 20,000 additional daily requests worth about three billion euros. These interventions, according to the governor of Banque de France, would have contributed to absorbing two-thirds of the shock to households and businesses. These support measures also meant that France has eased itself out of confinement without generating too much public resentment, in fact, Emmanuel Macron, whose image was battered by the Yellow-Vests Movement and pension reforms, saw his approval rating soar during the confinement period.7
Key lessons for India
France’s COVID-19 experience offers some important lessons for India. First and foremost of these is the long-term importance of establishing a welfare system that can protect people against the financial cost of social risks, such as pandemics (but also other illnesses or unemployment). During the lockdown, the French welfare system insulated the population from the economic hardships induced by COVID-19. The French government provided direct financing to individuals and businesses but also offered loan guarantees to encourage banks to extend credits to the unemployed and to businesses, in particular, small businesses that suffered as a result of the pandemic.
President Macron also urged insurance companies to allow businesses to claim damages caused by COVID-19. So far two insurance companies have agreed to do so. The French government’s measures to support businesses were aimed at helping them keep their employees, rather than laying them off as in the United States where the unemployment rate has currently reached its highest level since the Great Depression. For India, these lessons offered by the French welfare system could serve as a model for providing financial security to its citizens and small businesses in times of financial distress, such as during the current COVID-19-induced lockdown.
Although France’s health system weathered the storm unleashed by the coronavirus outbreak, the crisis exposed the cost of abandoning its erstwhile long-term pandemic response strategy. While that strategy drew ridicule for pouring in one billion euros of taxpayer money for stockpiling masks and testing tools, two months of lockdown has cost 120 billion euros in lost revenue. The dearth of masks and testing tools caused the spread of the coronavirus among healthcare workers and in retirement homes. In fact, as of May 14, France has the fifth largest death toll in the world from coronavirus, at more than 27, 000 deaths.8 Therefore, for India, which too stands accused of failing to provide enough masks to its healthcare workers and was caught off guard by the spread of the virus, establishing a pandemic response strategy that can help mitigate the effect of a future outbreak must be a high priority.
As essential to preventing a second wave of infection is identifying people who have contracted the virus, a systematic process of testing is required. In this respect, France has been performing rather poorly compared with other advanced countries (as of May 5, the number of tests per 1000 people was 12.7, compared with, for example, 34.7 in Spain and 28.8 in Italy).9 To address this shortfall, France has launched an AI-based virtual service called, AlloCovid, created by France’s National Institute of Health and Medical Research (INSERM).10 AlloCovid will listen to the caller’s symptoms and assess whether she or he is likely infected or not. This service is also expected to gather real-time data on how and where the pandemic is spreading. The government has also created a ‘brigade’ from its social security workforce who would talk with those diagnosed with COVID-19, including by AlloCovid, in order to identify who they may have passed the infection to. India, where the number of tests is rather abysmal (a little over one test per 1000 people) may particularly benefit from launching a similar AI-based service.
Finally, the post-COVID-19 world in which countries around the world might likely start stockpiling protective gears and testing kits presents huge opportunities for India. The country’s pharmaceutical companies are already top suppliers of several key vaccines and essential medicines used worldwide. The Indian Government could, therefore, pursue a pandemic response strategy that leverages and advances domestic capabilities and helps enable domestic businesses to tap into the potential surge in global and domestic demand for not only masks, testing tools and vaccines, but also AI-based diagnostic devises.
AUTHOR
Jojo Jacob is an Associate Professor of Strategy and Entrepreneurship at Grenoble Ecole de Management, France. He is thankful to Dr Thomas Gillier for his thoughts.
Disclaimer: The views and opinions expressed in this article are those of the author/s and do not necessarily reflect the official policy or position of Azim Premji University or Foundation.
