The Himalayas, 1998: My first encounter with anti-vaxxers

Prof. Peschanski shares the tragic story of how, in 1998, he first encountered the anti-vaxxer world. A painful story that he never shared until today, encouraged by the controversies over COVID vaccines.

A young French physician, a family trekking in Nepal and diphtheria

Prof. Peschanski shares the tragic story of how, in 1998, he first came into contact with the anti-vaxxer world. An unbelievable and painful story that he never shared before, but which today, due to the ongoing debates over COVID vaccines, deserves wide difussion and gives a concrete example on the implications of anti-vaxx beliefs.

Made in cooperation with our partners from esanum.fr

Nicolas Peschanski is a professor of emergency medicine and a hospital practitioner at the University Hospital of Rennes (France). His international career, particularly in the USA, has enabled him to become a member of the International Commission of the American College of Emergency Physicians as well as the steering committee of the EMCREG-International (Emergency Medicine Cardiac Research and Education Group). He is also a member of the European Society for Emergency Medicine (Eusem). Professor Peschanski is very committed to the principle of FOAMed (Free Open Access Meducation). He uses social networks (@DocNikko) for educational and knowledge sharing purposes in emergency medicine.

This testimony was originally published on Twitter. Prof. Peschanski, who runs the blog dedicated to Emergency Medicine on esanum.fr, accepted that we translate it.

Prof. Nicolas Peschanski's Testimonial

My first encounter with antivaxxers

It is 1998, in the middle of a monsoon, in Nepal. I am a physician at the French Embassy as part of my national service. Rather than spending twelve months in the barracks, I chose to do a longer civilian service, being dispatched to the Ministry of Foreign Affairs.

I received an alert from the Nepalese army, which had received a call for help from a French family. They were trekking in a remote region of the Nepalese Himalayas, the magnificent Dolpo, the only region of the Nepalese Himalayas that is accessible at this time of year but very isolated. My duties include organising and providing medical assistance in the mountains for French nationals.

The search

Information is sparse but the situation is serious enough - there seems to be a death - that the French consul has authorised me to undertake a search mission with a Nepalese army helicopter. I should point out that the French Embassy's funds allow me to advance the search and rescue costs, at a rate of 1,000 US dollars per hour of flight. I therefore signed a guarantee of 5,000 US dollars, with the agreement of the consul.

In the end, we searched for this family for 37 hours, spread over four days. It is monsoon season, and when a valley is blocked by clouds and you are surrounded by peaks over 8,000 metres high, it is not a matter of flying randomly. The only solution is to land and wait for the sky to clear. Fortunately, we weren't charged the 37,000 dollars immediately, we didn't have that kind of money.

"For the youngest, it's too late"

It is a family of five: The father, the mother and three children aged 11, 7 and 3. For the youngest, it is too late. It is his dead body, all grey, that I discover. There is nothing left to be done, and that already for a long time. I ask the parents: Their young son had a fever and a cough that had been getting worse and worse, before evolving into a state of asphyxia three nights earlier. I examine them one after the other: They all have diphtheritic croup! The same goes for the corpse. I had only seen this in books, fortunately reread before taking up my post because I knew that diphtheria had not disappeared in Nepal (about 500 cases per year).

I take up the questioning again: The parents are anti-vaxxers with conviction and have no remorse about their son's death. They don't regret anything because "it's fate".

Dirty white pseudomembrane classically seen in diphtheria
License: CC BY-SA 3.0 / Photographer: Dileepunnikri

I am still a young physician; inside I am falling apart. I don’t let it show and I treat without any judgment. First the two kids - I only have two 500 mg ampoules of AUGMENTIN (an antibiotic = amoxicillin + clavulanic acid) in my first aid bag. For the parents, I will have to wait for their repatriation to Kathmandu. We charter a second helicopter and land there after more than four hours of flight (a valley blocked by clouds, land, wait, take off again, start again...).

I take everyone to the only university hospital in the country for a check-up and to start treatment with antibiotics. Fortunately, there is no serious damage: The two children remain under observation and the parents are isolated in a hotel. As for me, I go back to the embassy for the compulsory declaration and the administrative formalities. I spend most of the night there. It's 6am in Paris, but I can talk to the Ministry of Health staff on call. We decide on a seven-day isolation for the family before organising their repatriation.

Fake DTP vaccination certificates to travel

I also have to organise the repatriation of the young child's body in an airtight coffin, which is essential because of the risk of infection. Few people know this, but it is complicated to repatriate a body. And it costs a lot of money, about 200,000 francs at the time (taking inflation into account, this would represent about 41,000 euros today). The family is back together. Physically they are fine. But the children are stunned: They gradually understand that they have lost their little brother.

The father is silent. When I manage to get a few words out of him, he expresses no remorse. His wife takes me aside and says "If I had known...". I learn that they have obtained false DTP (Diphtheria, Tetanus, Poliomyelitis) certificates in order to travel.

Fortunately for the French Embassy's finances, their insurance covers all the expenses incurred and the repatriation of the family and the body. Indeed, diphtheria, which has been eradicated in France, does not appear in the exclusion clauses of the contract. It is 6am on Saturday morning on the tarmac of Kathmandu's Tribhuvan airport. I arrive with the family and put them in an airbus before all the other travellers. Although not very useful - they are considered cured and not contagious - they have surgical masks for the trip. The airline knowingly accepted this 'constraint' and did not put up any obstacles.

Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Credit: Prof. Peschanski

The controversy

This sad story could have ended there, but eight days later we received a call from the chief of staff of Hubert Védrine, Minister of Foreign Affairs. The Quotidien du Médecin (France's leading medical journal) accused us of having reintroduced diphtheria into France, even though there had been no cases since 1990!

The article drags us through the mud, accuses us of not having taken any precautions and tells us that the family arrived unisolated at Charles De Gaulle airport in Paris. I am directly implicated. My relatives are 8,000 kilometres away, I'm a young professional... I'm having a hard time with these accusations. Fortunately, I have the support of my hierarchy, both civilian - the ambassador, the consul and the Ministry of Foreign Affairs - and military. The zone commander, based in New Delhi, gives me official support.

The ambassador obtained a right of reply which was published three or four days later, but the consequences of this article were already there: The Cnom (Conseil national de l'Ordre des Médecins, the professional body that regulates the medical profession) asked us for a report. The press got involved, the Institut de Veille Sanitaire (the French agency responsible for health risks at the time) asked for further explanations, even though we had already provided them.

We gave the Quotidien du Médecin details of the conditions of the treatment through the intermediary of the consul, without betraying medical secrecy, and at the same time we conducted our own investigation: We learned that on arrival in Paris, the family was not wearing masks and had gone out with the other passengers. The family did remain isolated and masked on the Kathmandu-Bangkok flight, but there was no relay by the health personnel during the stopover. I recall that the family members were considered cured in any case. I was cleared by the editorial staff of the Quotidien du Médecin and by the Cnom, but received no call, no apology, no support.

"I still don't understand"

It has been more than twenty-three years.
I still don't understand. I haven't found the meaning of it all.
Why cheat with the DTP vaccination?
Why not benefit from a proven preventive treatment that is almost 100% effective?
Why accept losing your child?
I simply can't understand it.

Today, in times of the COVID pandemic, this incomprehension is coming back to my face. Under the pretext of all possible evils, we leave room for fear, which may be legitimate, then for anger, which is not, then for violence, which is unbearable. So Master Yoda was right: This is the perfect recipe for turning to the dark side of the Force, a Force that is all the more powerful when politicians get involved and "scientists" proclaim their pseudo-certainties publicly, refusing any debate.

COVID-19 is not a flu. The virus mutates, it is in its nature, and this obliges us to remain humble and vigilant. Vaccines, developed in record time but with all the necessary steps, are effective on an individual level - particularly in the most fragile - and on a collective level.

I am always transparent about my past and present links with industry in the field of clinical and basic research. But I have no links with the manufacturers of vaccines or monoclonal antibodies. Like all the caregivers who have been and are still on the front lines of COVID-19, I have not made any money in the last 18 months, except by taking extra shifts. I have not even received the "COVID" bonus because I arrived in my current hospital during the first wave (this bonus paid by the French government to mobilised carers, ranging from 500 to 1,500 euros, was only paid to those present in their department for at least thirty days between 1 March and 30 April 2020). 

I would just like to say to the anti-vaxxers: I still don't understand you and, in times of the pandemic, I don't excuse you. But as a physician I will treat you without judging you. However, I will not accept any criticism, any complaint other than that of your illness. For the rest, I leave you to take your own look at what you have caused, and at your motives. 

Until now, I had only told this story to a few people close to me and to some colleagues who have worked in developing countries. Today, when the third world needs the vaccine more than ever, I repeat: Being an anti-vaxxer is a privilege of the rich.

Vaccinate yourself.