Public health, a "field of ruins" after two years of epidemic

Public health, a “field of ruins” after two years of epidemic

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Are we finally going to take stock of the political management of the health crisis, two and a half years after the outbreak of the epidemic? With “Public health year zero”, published in March in the Gallimard Tracts collection, Bordeaux residents Barbara Stiegler and François Alla hoped to fuel the debate in the midst of the presidential campaign. This will not take place, overshadowed by the war in Ukraine. But their text remains a valuable tool for understanding what is currently at stake in the collapse of our healthcare system, subject to neo-liberal doxa. Second selection of our 2022 summer series “Beach Pages”

A reference to Rossellini’s film, the title of this short (58 pages) but robust pamphlet indicates where our public health is two years after the start of the health crisis: in a “field of ruins”, like Germany in 1945, say the authors.

Professor of philosophy at the University of Bordeaux Montaigne, Barbara Stiegler, and François Alla, head of the prevention department of the CHU of Bordeaux, draw up a grim assessment of the political management of the epidemic, centered on “the questioning of freedoms individual and collective”: “confinement decreed throughout the territory, forced telework, curfews, ban on gatherings, closure of shops and public places, isolation, imposition of a binding pass to vaccination to keep the right to participate in social life…”

Taken in the name of “the health of all”, these restrictions have, according to the authors, proven to be counterproductive “for the populations most exposed to severe forms” of Covid: nursing homes and the most disadvantaged geographical areas have experienced “record rates of infection and mortality”, the oldest were exposed to the “slip syndrome” and the most fragile to the collateral effects (physical, psychic and socio-economic) “which necessarily accompany any measure of isolation” .

A blackboard

Subsequently, and despite the establishment of the health pass, “the poorest French citizens, the furthest from digital and the most fragile in terms of health are still today the least screened and the least vaccinated”, while that the oldest are still “the least vaccinated in Western Europe”.

But that’s not all: the successive confinements, white plans and deprogramming of health interventions have also aggravated the breaks in care on the front of chronic diseases, and “accelerated the collapse of the health system, by disorganizing the work of the care and pushing carers, already exhausted by decades of austerity, into discouragement and resignation”.

France is also recording developments in indicators that are among the worst in Western Europe in terms of mental health, and the results in terms of child health of social consequences – one million additional people “condemned to poverty” in France are “equally damning”.

Also, the two Bordelais wonder about the causes of this blackboard, in total rupture with the health policy of the last decades, affirming the centrality of freedoms for health itself. Thus, in 2002, the Kouchner law recognized in France the right of groups of patients and citizens to assemble, as well as their right to participate in health decisions. It was a legacy of the AIDS years, which had consecrated in France “the idea of ​​a “health democracy””:

“Spurred on by the “revolt of the sick” (Editor’s note: recounted in particular in the cinema in “120 beats per minute”), a new generation of doctors who often felt very close to their young patients understood that they were forced to share with them the latest scientific information collected by patient communities. »

When one virus sweeps away another

While the 2002 law obliges caregivers to respect the patient’s consent for all decisions that concern him, “it now seems normal to exclude from the health system those who refuse to give their consent [NDLR : le débat sur le « triage » entre vaccinés et non-vaccinés à l’hôpital] and it seems legitimate to deprive all patients (whether they are sick or simply at risk of being contaminated) of any ability to contest”.

How “could a virus sweep away what another virus had imposed”, wonder the philosopher and the practitioner? “It is obviously neither the epidemic situation nor the comparative mortality of the two viruses (5 million deaths for Covid in two years, nearly 40 million deaths for AIDS in forty years), but the social and political transformation of our societies, which alone can account for this shift”.

Going beyond the controversies over the orders and counter-orders given at different stages of the crisis – like the masks first deemed “dangerous” before becoming compulsory –, the authors demonstrate that these decisions form a system. They are part of the currently dominant political vision, neo-liberalism, according to the historical and philosophical definition drawn up by Barbara Stiegler of this current born in the 1920s, and the subject of Barbara Stiegler’s research: an authoritarian economic liberalism, breaking with the classical liberalism of the 18th century, which had faith in the capacities of men to govern themselves.

Voluntary servitude

This policy, which acts on the State’s disengagement from public services in favor of the private sector, asks citizens to become “patient actors”, “all in competition against each other for access to the rare resource that healthcare has become. and all enjoined to themselves become producers of health”. It is based on the voluntary servitude of each “for the good of all”, from the “self-attestations” of exits during confinement to the filtering currently in force in the emergency room, through tracing via the QR codes of health passes and vaccines. .

The system is thus based on data, which have become the only compasses for managing the crisis, starting with that of the hospital system, the shortage of beds (100,000 beds eliminated in 25 years) “making the measures of confinement and isolation”. Then, the models of infectiologists and epidemiologists proved to be “the alpha and omega of this crisis management”, writes the Bordeaux pair:

“Considering that the populations were composed of interchangeable individuals, whose probability of being contaminated was identical for all, [elles] have, by nature, contributed to making social and territorial disparities invisible. (…) Those who suffered the most from the epidemic were also those who suffered the most from undifferentiated general measures such as confinement and who benefited the least from individual measures, such as screening or vaccination. »

“Huge regression”

This Jacobin policy of figures therefore led to the confinement of an entire country “purely and simply ignoring geographical factors and treating in exactly the same way the areas where the sick were concentrated and those where the viral circulation was very low, even existing”.

Barbara Stiegler and François Alla describe these first measures as a “huge regression”, a return to “triumphant hygienism which believed it could cure by eradicating pathogens with authoritarian measures”, and to “soft paternalism”, supposed to respond to the “cognitive biases” of citizens:

“Instead of collecting the free and informed consent of individuals, it is a matter of manufacturing the consent of populations through a series of “nudges” pushing them in the “right direction” that they are deemed incapable of. to perceive and to desire by themselves. In complete rupture with the heritage of the AIDS years, it is this new anthropology which was already triumphing almost everywhere in the world at the time of the eruption of the Covid. In France, it led the government to bypass all the official public health institutions in favor of private consultancies paid at high prices with a view to setting up, as a matter of urgency, this new “factory of consent”. “” – MacKinsey and BVA.

The health crisis was indeed piloted directly by the Head of State and his defense council, relying – or not – on the opinion of the health authorities. Moreover, point out the authors of the Tract, “victims of a veritable Stockholm syndrome vis-à-vis this power, [les experts sanitaires] did not hesitate to anticipate its wishes to accompany the political discourse with “recommendations”, which were in reality alibis, thereby misrepresenting their own evaluation procedures and all the rules of methodology”.

This applies, for example, to the vaccination booster for adolescents, recommended by the National Agency for the Safety of Medicines and Health Products (ANSM) when it acknowledged that it did not have all the data. While the health pass had been extended to those over 12 years old, taking into account the risk of myocarditis caused by messenger RNA vaccines, although known, then led to modifying the conditions of use for those under 30 years old…

“The French choice to instrumentalize minors in the service of the “vaccine strategy”” [NDLR : contraindre les adultes à se faire vacciner à leur tour] went for the authors against a major ethical principle in public health, “the imperative of justice” – an equal distribution of the benefit/risk ratio within the population

Enemies within

Last but not least, the President of the Republic designated “enemies from within” in this minority of “refractory” to vaccination whom he intended to “piss off”, while the Ministry of Health encouraged young people to denounce their “provirus friends”.

For Barbara Stiegler and François Alla, Emmanuel Macron thus took the risk of “liquidating the fundamental principles of our Republic”, and threw hundreds of thousands of anti-pass demonstrators into the streets in the middle of summer.

Authors of forums (in Médiapart and Liberation) and of a petition entitled “Let’s get out of the pass and the health impasse” (which collected more than 15,000 signatures), the people of Bordeaux believed that the presidential campaign would make it possible to confront in a framework republican “the scientific, ethical and political assessment of two years of health crisis”. Barbara Stiegler was personally involved in the Popular Union Parliament, behind Jean-Luc Mélenchon.

But the debate on the epidemic, overshadowed by the war in Ukraine, will not take place. It will undoubtedly bounce back to the National Assembly, where the government will find it difficult to have the health measures taken at the top validated without difficulty. And this Tract can be a useful tool, even if it is regrettable that it does not offer a broader perspective, studying for example state policies that would have better guaranteed health democracy during the epidemic, s ‘it is.

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