Vaccine rollout faces challenges in France's poorest region

Samia Dridi, who was born, raised and works as a nurse in Saint-Denis, fears for her impoverished town, recalling how the coronavirus cut an especially deadly path through the diverse area north of Paris, a burial place for French kings entombed in a majestic basilica.

Dridi and her sister accompanied their frail 92-year-old Algerian-born mother to a vaccination center for the first of two shots to protect against COVID-19 days after it opened last week for people over the age of 75.

While red tape, consent requirements and supply issues have slowed France's vaccination rollout nationwide , the Seine-Saint-Denis region faces special challenges in warding off the virus, and getting people vaccinated when their turn comes.

It is the poorest region in mainland France and had the highest rise in mortality in the country last spring, largely due to COVID-19. Up to 75 percent of the population are immigrants or have immigrant roots, and its residents speak some 130 different languages. Health care is below par, with two to three times fewer hospital beds than other regions and a higher rate of chronic illnesses. Many are essential workers in supermarkets, public sanitation and health care.

The coronavirus was initially widely seen as the great equalizer, infecting rich and poor. But studies have since shown that some people are more vulnerable than others, notably the elderly, those with other long-term illnesses and the poor, often living on the edges of mainstream society, like immigrants who don’t speak French.

Dridi, 56, a nurse for more than three decades, feels relieved there is currently “no significant evolution” of the virus in her town. But she doesn’t forget what happened when the pandemic first hit.

“We had entire families with COVID,” she said. Many have multiple generations living together in small apartments, something experts say is an aggravating factor common in the region.

Despite those grim memories, local officials grapple with special challenges getting out word about vaccines to a population where many don't speak French, lack access to regular medical care and, like in much of France, distrust the vaccine's safety.

Next month, a bus will travel through the region, notably visiting street markets, to provide vaccination information. In addition, about 40 “vaccination ambassadors” who speak several languages are to be trained to reach out, starting in March, about vaccinations as well as “fake news” surrounding them.

A case in point is Youssef Zaoui, 32, an Algerian living in Saint-Denis.

“I heard the vaccination is very dangerous, more than the virus,” said Zaoui, sitting in the shadow of the basilica. His proof that he need not worry about the virus: the butcher down the road and the man selling cigarettes nearby. They were there at the beginning of March “and they’re still here. ... Me, I’m still here,” he said.

Is there a chance the vaccine could turn the tide on the inequality reflected in death statistics for the region?

“Before the vaccine becomes a great equalizer, everyone must be vaccinated,” said Patrick Simon, who co-authored a study last June on the vulnerability of minorities in Seine-Saint-Denis to COVID-19. But he said the challenges for marginalized communities to access health care continues, “so these inequalities will also be reproduced for the vaccine.”

While the French health care system is meant to provide accessible medical treatment for all, the bureaucratic demands and co-payments often scare away new immigrants or the very poor. Government health guidance doesn't always reach those outside the system.

As a nurse at a municipal health center, Dridi sees up front the poverty that translates into vulnerability to the coronavirus.

“I’m giving an injection, a shot, putting on a bandage ... and some say, ‘I live in a car, I’m in the street,’” she said.

That misery was not apparent at the vaccination center where Dridi's mother got her shot — among 17 opened across the region last week and where Saint-Denis' more fortunate, who live in private homes, were seen on a recent visit. Some made their way into the center on canes or held by an arm. One couple showed up on a scooter. All were eager to be vaccinated.

They were among the lucky ones. Appointments were cut back after allotments of doses of the Pfizer-BioNTech vaccine were diminished, like elsewhere in France and Europe.

“I’m lucky to get vaccinated today,” said one woman, who then broke down in tears. She was infected with COVID-19 during treatment at a private clinic in April and lost her mother in October to the virus after she contracted it in a hospital where she was treated after a fall.

The woman, who declined to give her name, told Dridi and her sister to take care of their mother because “she is your treasure.”

For Dridi, seeing people die of COVID-19 can be a game changer.

“Some people say no (to getting vaccinated) because they have no contact with death,” said Dridi. But death, “that’s what makes you react.”