Coronavirus: France’s stark comparison with Germany hits hard
Huge disparity in mortality figures and testing reveal two very different approaches
In Europe’s greatest health crisis in a century, the youth and vigour of French president Emmanuel Macron have been outshone by German chancellor Angela Merkel’s age and experience. Photograph: Ludovic Marin /POOL/AFP
France’s near obsession is matched by German discretion. For fear of appearing arrogant, or tempting fate before the crisis is over, German officials do not boast and commentators are cautious.
In the early stages of the pandemic, the disparity between French and German mortality figures as a percentage of cases was explained by the fact that Germany was conducting far more tests, and thus identified more cases.
But as of Wednesday, France had reported more than 3.5 times as many Covid-19 deaths as Germany, according to Worldometer.info, for a smaller population of 67 million, compared to Germany’s 83 million.
There have been 25,531 fatalities for 170,551 cases in France, compared to 6,993 deaths for 167,007 cases in Germany.
France ranks fifth in the world in terms of Covid-19 deaths per 100,000 inhabitants, at 37.63, while Germany ranks 8th, at 8.43 deaths per 100,000, according to statista.com.
The stark comparison is traumatic for the French, because of historic rivalry with Germany, and because France long believed its healthcare system to be the best in the world.
France spends 11.3 per cent of GDP on healthcare, compared with 11.25 per cent in Germany, according to the OECD.
“The German example proves that the efficiency of a system does not depend only on means,” the lawyer and conservative deputy in the National Assembly Jean-Louis Thiériot wrote in Le Figaro. “It depends above all on organisation, a state of mind and authority that is well-calibrated, at the right level.”
In France, 35.2 per cent of hospital staff do administrative work, compared to 24.3 per cent in Germany. France often gives the impression of a country paralysed by bureaucracy. “Liberate hospitals from the bureaucratic curse!” said a petition signed by 20 eminent medical professors, published by Le Figaro on May 3rd. “This crisis has seen a drastic reduction of administrative procedures,” the doctors wrote. “We were able to break out of paperwork hell. We must not fall back into it.”
Germany has 4.3 doctors per 1,000 inhabitants, compared with 3.4 in France. German hospital staff work 40 hours per week, compared with 35 hours in France. As private sector employees, the Germans enjoy less job security, but their salaries are 20 per cent higher. The wages of German nurses are 13 per cent higher than the average salary; those of French nurses 5 per cent lower.
In Germany, the federal government determines general policy orientation, but the states – the länder – distribute funds and take investment decisions. In France, the regional health agencies (ARS) have concentrated on reducing spending. Stories of local communities fighting to keep medical facilities are legion.
When the pandemic started, Germany counted 28,000 beds in intensive care units, compared to 5,000 in France. That has since risen to 40,000 beds in Germany, compared to 14,000 in France.
Because Germany has retained greater industrial capacity, it has encountered far less difficulty than France in producing the chemical reagents for tests, personal protective equipment and ventilators required to treat Covid-19 patients.
At the outset of the pandemic, Germany was conducting half a million tests weekly, when France was still questioning the necessity of testing, doubtless to mask a severe shortage. The slogan of the World Health Organisation has been “test, test, test”. The WHO wanted governments to isolate the virus, not the population.
The different management styles of the French president Emmanuel Macron and Germany’s chancellor Angela Merkel have also been a factor. Macron has used war-like rhetoric and, in the tradition of France’s monarchical presidency, delivers half-hour-long televised speeches at 8pm.
Merkel, by contrast, met for four hours with the minister-presidents of German länder before explaining her policies in a press conference.
German political institutions work through consensus; French institutions through confrontation. “Obviously, French political leaders have many lessons to learn from German resistance to Covid-19,” an editorial in Le Monde said.
Polling by Cevipof, Ipsos and Sopra Steria in several EU countries found that 62 per cent of French respondents were dissatisfied with their government’s handling of the crisis, compared to 26 per cent in Germany.
“Fundamental characteristics of our country, its pessimism, fragmentation, more radicalised opinions, the fact that one expects everything from the state, amplify criticism of the executive,” the political scientist and director of Ipsos, Brice Teinturier, told Le Monde.
France predicts an 8 per cent fall in GDP because of the pandemic; Germany a 6.3 per cent reduction.
Since his election three years ago, Macron has dominated the European stage. In Europe’s greatest health crisis in a century, his youth and vigour have been outshone by Merkel’s age and experience. A rebalancing of their respective influence could be a consequence.