Vaccine shortage leads to fights over who should get the first shots

For months, few questioned the wisdom of a strategy aimed at reducing deaths rather than slowing the spread of the virus. But as the weeks go by, infections remain high and fears of the new variants of the virus grow, groups ranging from key workers to teachers and those with chronic illnesses are getting louder and demanding to be next.

In the US, where the vaccination effort started early and has moved relatively quickly, many states are in the process of vaccinating people 65 and older and those with certain health conditions. Under pressure from interest groups, a few have now begun to vaccinate teachers or farm workers.

In Europe, where vaccination is progressing painfully slowly due to a mixture of red tape and hiccups in vaccine production, calls for less vulnerable groups are rapidly gaining access.

The emerging battle over what is likely to remain a scarce commodity for months is the latest challenge facing governments increasingly under pressure to bring back some measure of normalcy after a year of recurring lockdowns and various restrictions.

It is also politically explosive as it raises harsh moral questions, including whether the elderly, some bedridden and others over 100 years old, should take precedence over younger cancer patients; or that groups that no longer play a major role in the economy should take precedence over teachers, police officers, shop workers, bus drivers and others who are statistically less likely to die, but who occasionally contract severe cases of Covid-19.

Prioritizing the most vulnerable helps protect the public health system, but it also means that some people who are heavily exposed because of their jobs will have to wait, all at the expense of education or the economy, said Alberto Giubilini, a senior researcher . on the distribution of ethical vaccines at the University of Oxford.

“The concept of prioritization means that we have to sacrifice certain values,” he said. “It’s very difficult to find a balance.”

In France, where schools have remained open throughout most of the pandemic and where daily cases have steadily increased since early December, teachers are lobbying the government to be considered a priority for vaccination.

“More and more teachers are afraid of going to work,” said Guislaine David, co-secretary general of the SNUipp-FSU teachers’ union, pointing to data from the Ministry of Education showing the number of school interruptions due to Covid-19 outbreaks since early January. “If we want to keep schools open, it is essential to have teachers vaccinated.”

France’s Education Minister recently said the country would start vaccinating teachers in March. But vaccine roll-out in France has been one of the slowest in Europe, raising doubts as to whether a teacher could access shots in the spring, Ms. David said. Trade unions especially want kindergarten teachers to be vaccinated urgently, as children under 6 do not wear masks at school in France.

In Italy, teacher unions have also advocated for the government to vaccinate teachers for other categories, possibly right after the elderly and medical staff, to help reopen schools that have been closed longer than in most other European countries.

In the UK, where vaccinations are progressing much faster than in the European Union, government officials have looked at whether front-line workers, including teachers and police officers, should move up the priority list. A petition from a teacher in the north of England got nearly half a million signatures and sparked parliamentary debate.

The government currently says it wants to vaccinate everyone over 50 before considering frontline workers such as teachers. Given the pace of the rollout, this cannot happen until spring.

British Prime Minister Boris Johnson said last week that removing vaccinations from vulnerable groups could lead to additional deaths. Mr. Johnson will draft a roadmap for future vaccination plans and the gradual removal of lockdown measures in the week of February 22.

While people with vulnerabilities are a high priority for vaccinations in most countries, some complain that they have been overlooked.

In Germany, people with disabilities, some with chronic rare diseases and cancer patients, lobby the authorities to get right of way with the authorities.

“Reducing the number of deaths is the main goal of our current vaccination strategy, but somehow people like me have been forgotten,” said Christian Homburg, 24, who has Duchenne muscular dystrophy, a severe form of muscle loss, meaning he currently only about 20% of its lung capacity.

Mr. Homburg said doctors warned him that catching Covid-19 would likely kill him. But because he is young and does not live in a healthcare facility, where vaccinations are already taking place, and because his condition is not explicitly mentioned in the vaccine regulation in Germany, Mr Homburg is not entitled to priority treatment.

He has now launched a petition to change that. Advocacy groups defending people with disabilities or illness filed similar appeals, while some patients managed to get priority by going to court.

Faced with pressure, the Robert Koch Institute of Infectious Diseases’ Standing Vaccination Committee, which advises the government, updated its advice last month and recommended a case-by-case assessment of people whose disease could put them at high risk of death from Covid. -19 even if there are no statistics to prove it.

Rainer Schell managed to make an exception for his son, who also has Duchenne, cannot breathe without a ventilator and needs 16 caregivers to take care of him. But it took him nearly four weeks, the help of a lawyer, and hours of pleading with various authorities to get the vaccination appointment.

The problem, said André Karch, an epidemiologist at the University of Münster, is that because there is little evidence about the level of risk for many rare diseases, such decisions are difficult to make on a case-by-case basis.

Priority strategies will change over time as new studies emerge about the risks to certain populations and new vaccines are approved, health officials say. In Germany, some people in lower priority groups could now be vaccinated more quickly after the government decided not to purify AstraZeneca PLC’s Covid-19 vaccine for use in people over 65, potentially releasing supplies for younger adults.

But virologists and epidemiologists say that until there is more hard evidence that vaccines prevent recipients from transmitting the virus – not just because they get sick when infected – or statistics appear showing an increased risk of illness or death for certain essential workers, governments will have problems. justifying vaccination younger than older.

“That’s a real dilemma we have here,” said Uwe Liebert, a virologist at the University of Leipzig. “Of course there are many groups where we can explain why they should be prioritized, but from a purely epidemiological and virological perspective, the current strategy is correct.”

—Max Colchester in London and Giovanni Legorano in Rome contributed to this article.

Write to Ruth Bender at [email protected]