Since March 2020, France has gradually managed to get its head above water to start building up a new stock of FFP2 and surgical masks, make them available to medical staff and relaunch national production.

Before detailing these different aspects, it is interesting to come back to the reasons that led to the disaster that France experienced between January and March 2020.

In 2009, during the H1N1 flu epidemic, the stock of FFP2 masks was estimated at 723 million units and the stock of surgical masks at 1 billion units.

From 2011 onwards, the stock starts to decrease by administrative decision of the health authorities, notably due to a budget cut, as the priority is no longer to build up a stock and the cost/benefit/risk ratio is considered preferable to using the existing stock. Moreover, the High Council of Public Health (HCSP) has validated a directive which asks to give priority to the surgical mask instead of the FFP2 mask even in a pandemic situation.

In 2013, the ordering and distribution of masks will become the responsibility of employers, including hospitals, and for budgetary reasons, it is quickly becoming clear that case-by-case orders will be preferred over stockpiling.

These successive decisions and administrative orientations which have imposed themselves on all the actors of Healthcare in France: abandoning stocks, reducing budgets, responsibility for orders left to employers, preference of surgical masks over FFP2 masks, explain why between 2012 and 2017, only 100 million masks are ordered.

Also, at the beginning of 2020, at the emergence of the Covid epidemic, there remains in France a stock of 150 million masks, i.e. 3 weeks of use by hospital services alone. This result is unfortunately that of the French doctrine of 0 stock supported and encouraged by the State. 

Obsessed by the economies in the health sector, successive governments have not taken into account the needs necessary in the event of an epidemic, yet the risks of a globalized epidemic have been mentioned for several years, whether by Bill Gates or Jacques Attali in France in 2009 in his book "The Crisis and After". The consequences of the H1N1 flu crisis in 2009 were not severe enough to

to make public health officials aware of the importance of having a large and regular stock of surgical and FFP2 masks. These same officials imagined that it was possible to order and rapidly deliver a phenomenal quantity of masks simultaneously to dozens of countries around the world: reality could only confirm this beginner's mistake in March and April 2020. But rather than assume these errors, French officials preferred to hide the truth about the lack of stock of masks. Thus, it was asserted that the masks were useless if there were no symptoms or if the effectiveness of the mask was not demonstrated. This is to avoid admitting that the real need is for 40 million masks per week for health care workers and 500 million for the whole population, and that the scarce stocks of masks available at that time should be reserved for health care workers.

Faced with the problems of importing and delivering masks, the government reactivates the production of masks by French companies. Before 2020, 4 historical companies share the national production : Kolmi-Hopen, Segetex-EIF, Macopharm and Paul Boyé Technologies, a production of 3 million masks per week. Since the beginning of the pandemic, new players have joined these companies, such as Coverguard in the Ain or BB distributes in the Vosges for example, to allow the national production of surgical masks and FFP2 to increase to 20 million masks per week then 40 million and should t reach 50 million masks per week by the end of 2020.

To this production is added a production capacity of 30 million washable and reusable masks for the general public per week. It is this category of masks that is beginning to be overproduced, with substantial stocks. Indeed, after an exponential need at the beginning of the pandemic, the progressive building up of new stocks by individuals and companies, the traditional import channels which have again been able to meet demand, and a longer lifespan for reusable masks, explain why many manufacturers are beginning to have difficulty selling their production.

It is the whole policy of epidemic management on a national scale that has made France go from under-production, with the choice of 0 stock and the importation of masks at low cost, to an over-production of masks in a few weeks, by making the most of all available production tools without evaluating the real need and by continuing to import the same type of masks as those produced in France.

Unthinkable at the beginning of the pandemic with more than insufficient stocks, the question of free masks is now being raised as soon as the State decides to impose the compulsory wearing of masks.

The State will thus release 40 million masks free of charge for the lowest income and most vulnerable. At the same time, local authorities (Regions, Departments, municipalities) can also decide to provide masks free of charge to the whole population or to a part of it (e.g. high school students for the Regions, as is beginning to be the case). For the rest of the population, and in particular the working population, free of charge is left to the employer's discretion, even though from September 2020, companies will have to build up a stock of masks to cover 10 weeks of use.

The State's decision to allow a certain category of the population to have access to masks free of charge is a societal choice that favours solidarity rather than equality. Not all citizens are equal, for example in terms of taxes, but all citizens are in solidarity with each other, with those who pay taxes allowing, through their contribution, those who do not pay taxes to have free access to minimum health care during the pandemic.

The choice of free health care for part of the population is symptomatic of a State that has chosen to maintain high taxes and redistribute them through various forms of aid in different areas of daily life. The lack of global reflection on the maintenance of this system and these aids leads governments to always favour tax increases, the creation of new taxes or an increase in the public deficit and, consequently, the questioning of some of these advantages generates social movements on the part of a population accustomed to more than 70 years of state assistance. Hence the proposal of some people in the same logic, whether in political or associative circles, to demand free masks for all at the expense of the State, since national production and imports now make it possible to meet daily needs. However, these same people do not address the question of the stocks to be built up by the State before tackling the free distribution of masks, an essential question because it is thanks to the stocks built up that the State will be able to cope with the arrival of a new dazzling epidemic and preserve the health of its population.

Here again, some people prefer to be cicadas rather than ants and to leave the essential issues of deficit reduction, indebtedness, stock management and the organisation of public health in France to future generations, rather than tackling these problems now.

This is still the choice of the cicada that the State has made in recent years by deciding not to stockpile any more (except for an ephemeral parenthesis in 2009). At present, considering the need for 40 million surgical masks and FFP2 week for the medical community and the national production capacity of 40 million masks week, it is possible to meet the needs but it is not possible to build up a stock with only national production or to provide the entire population with surgical masks. Imports of masks and the use of masks made of washable and reusable fabrics therefore remain indispensable.

The State must then decide whether to continue to replenish a stock of masks once the peaks of the epidemic have passed or not.

Louis Tourronde