France Hired McKinsey to Help in the Pandemic. Then Came the Questions.

https://www.nytimes.com/2021/02/22/business/france-mckinsey-consultants-covid-vaccine.html

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PARIS — As France raced to complete a complex blueprint in December for vaccinating its population against the coronavirus, the government quietly issued millions of euros in contracts to the consulting giant McKinsey & Company.

The contracts, which were not initially disclosed to the public, were intended to help ensure that millions of tiny vaccine vials would make their way quickly to distribution points for nursing homes, health care providers and the elderly. Additional contracts were hastily awarded to other consultants, including Accenture and two other firms.

But within weeks, France’s vaccination campaign was being derided for being far too slow. In early January, France had vaccinated only “several thousand people,” according to the health minister, compared with 230,000 in Germany and more than 110,000 in Italy.

As the consulting contracts began to come to light, McKinsey has become a magnet for controversy in a country where an elite civil service is expected to manage public affairs, and private sector involvement is viewed with wariness.

The contracts — totaling 11 million euros ($13.3 million), of which €4 million went to McKinsey — were confirmed by a parliamentary committee this month. The government of President Emmanuel Macron, which has been under fire for months for stumbling in its handling of the pandemic, was forced to admit it had turned to outside consulting firms for help managing the response.

On Wednesday, 18 lawmakers from the conservative party Les Républicains sent a letter to President Macron seeking further answers as to why McKinsey, a consultant to corporations and governments worldwide, was hired to support French agencies charged with rolling out the vaccine.

The letter cited McKinsey’s recent agreement to pay nearly $600 million to authorities in the United States to settle claims that it contributed to “the devastating opioid crisis” as a concern for its involvement in French health matters.

A spokesman for McKinsey declined to comment.

France is hardly the only European country to involve the private sector in public affairs. Governments from Britain to Greece have tapped advisory firms for years to help streamline big bureaucracy. As governments have downsized, many have grown more dependent on outside contractors for even basic public services.

Mr. Macron, a former investment banker, came into office promising to operate one of Europe’s biggest governments with greater efficiency. Its response to the coronavirus has been criticized inside France for being the opposite, with repeated lockdowns, supply shortages and a failure last summer to put in place a critical triptych of testing, tracing and isolation. The missteps provided a fresh opportunity for McKinsey and other consultants to step in.

No one is accusing McKinsey of wrongdoing. The company has strategically rolled out its pandemic consulting services in a swath of other countries worldwide, including Britain, where it secured 1.1 million pounds (about $1.5 million) in contracts to advise the Covid-19 task force and to determine the National Health Service’s testing capacity. In the United States, the firm has been awarded over $100 million in Covid-19 contracts by federal, state and city agencies.

In France, health agencies contracted with McKinsey and other consultants for help in executing its vaccine rollout, scheduled for Dec. 28, after the European Union secured a belated deal with pharmaceutical companies for millions of vaccine doses for member countries in mid-November.

The health minister, Olivier Véran, defended the decision after the contracts, first reported by Politico, came to light in January.

“It’s not the first time that we have called on private partners,” he told the French Senate. He added that McKinsey was helping with “the practical, operational and logistic challenges of our vaccine strategy” but played no role in policy decisions.

Most of McKinsey’s work in France is with corporate clients. Even so, McKinsey has maintained close ties to a succession of French governments, and some officials have previously worked for McKinsey.

France ramped up its use of consultants in recent years, creating dedicated budgets that agencies could tap to call in outside advisers as needed. In 2018, McKinsey was selected as one of several go-to consultants available for hire by French agencies, in a pooled €100 million contract. That meant any of the agencies could select one of the firms without being required to seek bids on the work.

The December contracts, and another in mid-January, totaling €4 million, were from that pooled agreement. It called for McKinsey to help define distribution routes for the Pfizer and Moderna vaccines, which must be kept as cold as minus 80 degrees Celsius during transport and storage. The company would benchmark France’s performance against other European countries. McKinsey experts would also help coordinate a vaccination task force of officials from numerous agencies, with some decision chains involving up to 50 authorities.

Other contracts provided for Accenture, the global information technology consultant, to roll out the campaign’s monitoring systems, while Citwell, a French consultant, and the French arm of JLL, a firm based in Britain, were brought on to help with “logistical support and vaccine distribution.”

The government’s strategy focused on delivering the vaccines to 1,000 distribution points in France, from which the doses would be sent in supercooled trucks to nursing homes, clinics and local mayors’ offices. The local distribution was considered a way to overcome the wariness of up to 40 percent of the population about being vaccinated.

In Germany, the program was simpler: Authorities decided to administer the vaccine in 400 regional centers.

By the first week of January, France had one million vaccine doses in hand, but the delay in getting them into people’s arms was becoming public knowledge. The campaign continued to lag as Pfizer and Moderna temporarily slowed additional supplies.

The pace has recently picked up. More than three million people out of France’s population of 67 million have now received at least one dose of vaccine, and over 923,000 have been fully vaccinated. But with 4.7 doses administered per 100 people, according to a New York Times database, France still trails neighbors like Germany and Italy.

To critics of the government’s strategy, the performance raises questions over the value that consultants add to the process.

Frédéric Pierru, a sociologist and researcher at the French National Center for Scientific Research, has worked for 15 years at French hospitals and regional health agencies and studied the impact of consulting firms called in to improve efficiency. He said that the companies tended to import operating models used in other industries that weren’t always effective in public health.

“Afterwards, the government doesn’t go back to evaluate whether what the consultancies did worked well or not,” Mr. Pierru said. “It’s too early to tell if McKinsey and others are adding value in this campaign,” he added. “But I think we’ll never really know.”

Lawmakers are pressing for more information.

Véronique Louwagie, a Les Républicains deputy and the French Parliament’s rapporteur for the national health budget, told the finance committee that numerous additional private-sector contracts to combat the pandemic have been awarded by other agencies, the amounts of which are not public.

While the costs may pale in comparison to the billions France is spending to support the economy, “what bothers me is that the government is not being transparent,” Mrs. Louwagie said in an interview.

The larger concern, she said, is whether the government’s apparently growing reliance on consultants is displacing the expertise that civil servants used to provide.

“I’m not necessarily shocked that the government is calling in consultancies,” Mrs. Louwagie said. “But in France, this is a testament to a loss of savoir faire and expertise in the health administration that is supposed to be managing the crisis,” she said.

“If a country’s health authority needs to run after support from consultants,” she added, “we need to ask why.”

Gaëlle Fournier contributed research.