CONTEXT AND GOALS
The consultation on vaccines was part of the action plan to overhaul the vaccination policy launched by Marisol Touraine, Minister for Social Affairs and Health, in January 2016. This plan is based on the 20 recommendations formulated by Sandrine Hurel, a former member of parliament mandated by the Prime Minister to lead a mission on the vaccination policy. The report confirmed that vaccination is still a sensitive topic for people, requiring far-reaching consultation with all stakeholders. The plan to overhaul the vaccination policy therefore aimed to fully include French citizens in the debate. This consultation occurred in a specific context where there had been a fall in vaccine coverage in France, a crisis of confidence in the public powers and health authorities, health scandals, controversies and so on.
“Vaccination is a pillar of the health policy. It’s an issue for all of society, a topic that everyone should be able to address. If the French people are struggling to make sense of it, then we clearly need to change things.
Political scientist and professor of political science
To allow a debate in the best possible conditions, the strategy adopted was inspired by that of the Institut national du cancer (INCa) when it ran a citizen’s consultation on the issue organized breast cancer screening. Citizens’ consultations open the debate to everyone and get each participation involved in the decision-making process. After running two opinion polls and an online participatory forum, Missions Publiques provided Public Health France with support for the in-person consultation, organizing and facilitating the mirrored juries (one for citizens and the other for professionals). The jury members benefited from diverse high-level training sessions and were able to request additional hearings to get the information they needed. They then debated the issue together to form an informed, well-argued opinion. After two weekend sessions, each jury drafted a joint opinion responding to the questions they were asked:
- In your view, how do French people perceive vaccines as regards their value and benefits, and their risks and drawbacks?
- How can we facilitate vaccination (conditions for refunds, free provision, information, education, tracking vaccination, training health professionals, other ways)?
- Under what conditions would it be acceptable to make certain vaccinations compulsory?
- What do you expect from research into vaccination?
- What recommendations would you make to improve vaccine cover?
The juries’ opinions were presented to the steering committee, made public and debated at the post-consultation feedback session.
OUR ADDED VALUE
One of the goals was to boost the French people’s confidence in vaccination by responding to their worries and concerns in a transparent manner, without seeking to convince them and calling on a multi-stakeholder, independent steering committee.
With this debate, the ambition was to better understand the fears and criticisms that remain over vaccination and to listen to their expectations concerning an overhaul of the vaccination policy, in order to come up with relevant responses.
The consultation with the two mirrored juries was very productive, because it led to a constructive comparison of an informed non-expert opinion with the views of practitioners, after giving them all access to the same information (health practitioners are not necessarily experts in vaccination) and letting them explore the social and scientific controversies over vaccination, from their respective viewpoints and roles. Through this discussion, the professionals were able to forge a better understanding of the issues, stakeholder system and viewpoints, in the presence of the participants. Meanwhile, users were able to contribute to the professionals’ discussions by working as a group, with their joint, well-argued layperson’s approach, to question the practices and opinions of the professionals, which can sometimes be very compartmentalized.
This consultation showed that we can approach divisive subjects while ensuring high quality information and dialogue. Vaccination is a theme that raises ethical and educational issues and can therefore be a source of controversy and heated debate. The consultation – a dual consultation in this case – and the hearings meant every opinion could be expressed and represented.
In this case, the consultation was not intended to be a debate for or against vaccination but instead aimed to grasp citizens’ expectations and perceptions to improve understanding and acceptability of the issue. It was a real exercise in education and support on an issue of public utility and health. The different forms of consultation (surveys, juries, online platform) also made sure the message reached as many people as possible.
- Red book of vaccination information.
- 2 citizens’ opinions.
- A general report (from the steering committee).