In late 2004, the cardiologist-turned-politician Philippe Douste-Blazy, then France’s health minister, unveiled a pandemic response plan at a cabinet meeting before an audience of puzzled, distracted and somewhat amused ministerial colleagues.

The plan detailed a host of drastic measures to be implemented in the event of an epidemic threatening France. They included the closure of national borders, limits on people’s movement, a ban on gatherings, sports and cultural events, the implementation of social distancing rules, and the nationwide distribution of masks – surgical, for the public, and the more protective FFP2 type, for health workers.

“In a nutshell, the plan contained everything the current French government scrambled to put in place, in a hurry and without the equipment, in mid-March 2020,” write journalists Gérard Davet and Fabrice Lhomme in a lengthy, five-part reconstruction of France’s pandemic “disarmament”, published by Le Monde this week.

The extraordinary rise and fall of pandemic planning in France was rooted in the troubled dawn of the new century, when Western nations obsessed with the threat of terrorism, and the hunt for elusive weapons of mass destruction, suddenly woke up to the risk of deadly epidemics.

First came the fearsome SARS, emerging in China in 2002 and escalating the next year, followed by an outbreak of H5N1 bird flu in southeast Asia in 2004. Later that year, the deadly chikungunya disease spread rapidly in France’s overseas territories, eventually threatening the mainland.

“Asian countries were deeply shaken by SARS,” says Pierre-Yves Geoffard, a professor of health economics at the Paris School of Economics (PSE), in an interview with FRANCE 24. “They were lucky in the end as the virus eventually disappeared. But they didn’t lower their guard, making sure instead that they would be ready for the next one.”

Amid the many unknowns of pandemic planning, Geoffard says health strategists in Asian countries based their preparations on two certitudes: that further pandemics were bound to occur and that no-one could anticipate their shape or form.

“This implies being capable of reacting quickly to outbreaks of which very little is known in the beginning,” he says. “In this respect, the model to follow is Taiwan’s response to the present crisis: detecting, isolating and tracing cases – but it only works if you do it right away.”

Geoffard says the French government tried to follow the same model in its initial strategy against the coronavirus. But by then it was already too late, the virus having spread far and wide.

“Countries react to crises and learn that speed is of the essence, but then their memory fades,” he says. It would not be the only lesson unlearnt by France’s decision makers.

French independence

Back in 2005, Douste-Blazy had given a prescient warning about “our modern Western societies’ tendency to forget” during an audition before French senators.

The SARS epidemic, the health minister said, “has proven to what extent the sudden occurence of an unknown infection – I insist on the word unknown – capable of spreading across the planet thanks to modern communication networks, can disseminate fear, and destabilise the most developed societies and health systems.”

Weeks later, the senators who auditioned Douste-Blazy released a report detailing their recommendations to prepare the country for future outbreaks. In particular, they stressed the need to constitute stocks of masks for both health workers and the general public, noting that surgical masks would offer only limited protection and should therefore be replaced by more protective gear.

This “would certainly entail a high cost, but would help limit the country’s paralysis,” they wrote, adding: “In this light, the cost must be put into perspective.”

 Alarmed by another classified report, exhumed by Le Monde’s investigators, which warned that France was woefully unprepared for a pandemic, Douste-Blazy’s successor at the health ministry, Xavier Bertrand, set off on a tour of East Asian countries in late 2005 to learn from their strategies. Calling in Beijing, he asked his Chinese counterpart whether France could order masks from China in the event of a crisis. Though affirmative, the answer cautioned that “Chinese demands would naturally come first” should the country need masks too.

Convinced of the need to strengthen France’s strategic independence, Bertrand and his successors would embark on a vast effort to make the country pandemic-proof and self-reliant – a strategy that spanned the final years of Jacques Chirac’s presidency and the start of Nicolas Sarkozy‘s tenure.

A cornerstone of the new strategy was the establishment of a national mask-production capacity, overseen and generously funded by a new entity, known as the Eprus, modelled on the US Centers for Disease Control and prevention (CDC).

At the end of 2006, France could boast of a stock of 600 million FFP2 masks, making it one of the world’s best prepared countries, according to the World Health Organization. By May 2009, a Senate report said the Eprus stock had reached more than 720 million units, supplemented by more than a billion surgical masks.

It was just as well, because a new deadly epidemic, this one coming from Mexico, was about to test the arsenal’s worth.

Crying wolf

The French government’s zealous response to the H1N1 influenza marked the climax of the precautionary approach championed by Douste-Blazy and his successors. But in hindsight, it also sounded its death knell.

As the influenza spread beyond Mexico in the summer of 2009, the new health minister, Roseline Bachelot, decided to further ramp up the production of masks, leading to a peak of 2.2 billion units (surgical and FFP2) by the end of the year. Under government guidelines, businesses were advised to constitute stocks of protective gear, including the high-protection FFP2 masks for workers “in close contact with members of the public”. Kits containing surgical masks and antiviral treatments were distributed freely in pharmacies across France.

Controversially, the government ordered 94 million vaccine doses and requisitioned gymnasiums for its nationwide vaccination campaign, bypassing doctors.

But the health crisis failed to materialise, and when state auditors, politicians and the media started to delve into the cost of the operation, Bachelot was lambasted for splashing out a whopping one billion euros in taxpayers’ money – part of it to reimburse pharmaceutical labs – on a virus that killed “only” 342 people in France.

“When dealing with epidemics, one is easely accused after the facts of having botched the response,” says Geoffard of the Paris School of Economics. “Either one does too much prevention and little happens, or one does too little and everything goes wrong.”

According to Geoffard, the H1N1 backlash was “one of the key reasons it later became impossible to justify maintaining a highly costly prevention policy.”

Reflecting on her public castigation, Bachelot told Le Monde that the debacle had “led to a general disarmament and decrediblised politicians.” She added: “The public decided we had overreacted. And for us politicians, the risk of doing too much came to dwarf that of doing too little.”

Writing in the same paper in late March of this year, the renowned health economist Claude Le Pen, who would die of cancer only weeks later, said Bachelot’s actions had instilled among high-ranking civil servants “a sense that the government had overestimated the crisis and, ultimately, squandered public funds for the benefit of pharmaceutical laboratories”.

Hoping to deflect responsibility for the “disarmament” that left France so dangerously exposed a decade later, the health minister’s successors have blamed those civil servants – the “deep state” – and each other for gradually stripping France of its defences.

After Bachelot’s demotion to a junior cabinet role in late 2010, Bertrand was put back in the saddle. But the context had changed dramatically since his first stint as health minister. These were the scandal-plagued twilight years of Sarkozy’s presidency. On top of pandemic fatigue, Bertrand had to grapple with stringent belt-tightening measures amid a global economic downturn and a European “debt crisis”.

In late 2011, a government directive signalled a change of doctrine, splitting the state’s reserves of protective gear into two: a “strategic” stock of surgical masks for the general public, held by the state, and a “tactical” stock of FFP2 masks for health workers, to be held and replenished by regional health authorities and individual hospitals.

The change of direction was cemented by subsequent reforms implemented under the Socialist administration that came to power in 2012. They effectively devolved the management of “tactical” reserves to institutions focused on short-term-imperatives and struggling with budget cuts – with the effect that France’s precious FFP2 reserves expired and were never replaced.

“In the space of just two years, the state had passed on the baton, in the name of decentralisation and, above all, budgetary constraint,” write Le Monde’s Davet and Lhomme. As for the Eprus, it was incorporated and diluted in a much larger structure, known as Santé publique France, reversing a decade-long policy modelled on the American CDC.

A bonfire of masks

France is not the only country to have rolled back or “forgotten” its pandemic response plans along the way.

An investigation by British daily The Times found that preparations for a pandemic had been a top priority of the UK government for a decade after the September 11 attacks, before falling victim to austerity cuts.

“We were the envy of the world,” an unnamed source in the prime minister’s office told the newspaper. “But pandemic planning became a casualty of the austerity years when there were more pressing needs.” The source added that preparations for a no-deal Brexit “sucked all the blood out of pandemic planning”.

Likewise, years of neglect sucked the blood out of France’s once ambitious pandemic strategy, leaving the state largely powerless to protect its citizens from the coronavirus.

On March 17 of this year, the day France began a two-month nationwide lockdown, former health minister Agnès Buzyn spoke candidly about the extraordinary twist that had seen her plucked out of the ministry a month earlier, despite the worsening coronavirus outbreak, to lead President Emmanuel Macron’s party in Paris mayoral elections.

“I knew the tsunami wave was coming for us,” she said, referring to the looming pandemic. “We should have stopped the elections, it was a travesty.”

Addressing senators two days later, Buzyn’s successor as health minister, Olivier Véran, summed up the bewildering haemorrhage of equipment that had left France so desperately exposed.

“In 2010, the state had a stock of one billion surgical masks,” he said. “When I took over at the ministry, there were 150 million.”

As he spoke, and in the months preceding the crisis, millions of masks were simply being torched, based on the assumption that they had expired or were ineffective.

According to French daily Libération, a Belgian company tasked with testing a sample of the masks had concluded that they no longer met certain standards. However, subsequent tests carried out on masks that were saved from the bonfire at the last minute showed that they were perfectly usable.

Officials interviewed by Le Monde suggested that contradictory messages on the utility of masks – with the government at one point arguing that they were of no use to the general public – had helped seal the fate of the discarded stock.

The result of this stunning fiasco has been amply documented: a desperate shortage of protection for even frontline workers, a frantic – and costly – race to fly in masks from China, and a belated effort to revive a national production capacity that was abandoned in recent years.

“It’s baffling that nothing at all was anticipated, when we had it all ready as early as 2004,” a dejected Douste-Blazy told Le Monde, reflecting on France’s Covid-19 disaster.

He added: “This must be one of the most mind-blowing examples of how the French administration can produce such a plan and then fail to use it!”

Source:france24.com/