Handling the COVID‐19 crisis in France: Paradoxes of a centralized state‐led health system

Abstract

France was one of the European countries that was most severely affected by the COVID‐19 pandemic in the first half of 2020. Despite the effective capacity of crisis management often ascribed to majoritarian democracies, the French centralized state‐led health system is subject to rising critiques for the measures it has adopted and for the strategies it deployed to fight COVID‐19. The identified policy failures question the central government’ capacities in crisis management more generally. This article sheds light on the policy responses to COVID‐19 taken by the French executive and emphasizes that to understand the link between crisis and policy change, the policy trajectories prior to the crisis, the degree of politicization of the crisis, and the actor constellations existing throughout the crisis play a major role. National crisis reactions thus were far more driven by policy actors and political constellations, than by scientific advice or functionality.

Review of COVID-19 epidemiology and public health response in Europe in 2020

“… 13 The experience of Asian countries like Japan and South Korea provides direct evidence toward the benefit of facemasks. 14 …”

“…In mid-April, France was testing 5.1 people per 1000 people in comparison to 17 in Germany and 15 in Organization for Economic Co-operation and Development (OECD) countries due to underutilization of public laboratories and lack of necessary material and equipment, and denounced the lack of protection to health workers. 14 In UK, medical staff reported huge shortage of PPE kits which forced them to triage potential COVID-19 patients with paper facemasks and plastic aprons than visors, gowns, and appropriate masks. 26 In Italy, hospitals were overcrowded and doctors were left with no choice but to lay their patients on floor mattresses.…”

COVID-19 and Territorial Policy Dynamics in Western Europe: Comparing France, Spain, Italy, Germany, and the United Kingdom

“…The government quickly adopted a decree-based national strategy underpinned by a “wartime rhetoric” ( Yan et al 2020 , 767). The main decisions were taken by the “Defence council,” led by the French president and including the Prime Minister and the ministers discretionarily selected by the President ( Hassenteufel 2020 , 174). Following a “ dirigiste ” logic, patients on life-support machines were transferred from more to less affected regions ( The Economist 2020 ; Onishi and Méheut 2020 )—often using high speed trains.…”

“…As highlighted by Hassenteufel (2020 , 174), the préfets and the ARS opposed a number of local initiatives, including local decrees introducing a curfew or the compulsory wearing of masks. ARSs, directly linked to the national health ministry, were primarily involved in local steering, while local and regional authorities, lacking competencies in the area of healthcare were largely excluded.…”

Evaluation of health system resilience in 60 countries based on their responses to COVID-19

“…France was one of the most strongly affected European countries due to the limited number of ICU beds and a severely under-prepared health system. 8,9 As of 27 October 2020, the number of COVID-19 deaths reached 35,018 (https://www.worldometers.info). The performance of these health systems in responding to COVID-19 was far below the level their health systems should have been able to attain.…”