The shortage of vaccines provokes struggles over who should get the first shots

For months, few questioned the wisdom of a strategy focused on reducing the number of deaths rather than slowing the spread of the virus. But as the weeks go by, infections continue to rise and fears about new variants of the virus grow, groups ranging from essential workers to teachers and people with chronic illnesses increase in demand to be next.

In the United States, where the vaccination effort began early and has progressed relatively rapidly, many states are moving to immunize people over 65 and people with certain health conditions. After pressure from stakeholders, a few have begun to inoculate teachers or agricultural workers.

In Europe, where vaccination is progressing painfully slowly due to a mix of bureaucracy and vaccine-making hiccups, less vulnerable groups are being asked to have quick access.

The emerging struggle for what is likely to remain a scarce resource for months is the latest challenge for governments that are increasingly pressured to regain some degree of normalcy after a year of recurring blockades and various restrictions.

It is also politically explosive because it raises tough moral issues, such as whether older people, some bedridden and others over 100, should have priority over younger cancer patients; or whether groups that no longer play a major role in the economy should have priority over teachers, police officers, retail workers, bus drivers, and others who are statistically less likely to die, but that they will sometimes contract severe cases of Covid-19.

Giving priority to the most vulnerable helps protect the public health system, but it also means some people who are highly exposed because of their work will have to wait, all at a cost to education or the economy, Alberto said Giubilini, senior researcher on ethical vaccine distribution at Oxford University.

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

In France, where schools have remained open for most of the pandemic and where daily cases have risen steadily since early December, teachers are pressuring the government to make it a priority for vaccination.

“More and more teachers are afraid to go to work,” said Guislaine David, co-secretary general of the SNUipp-FSU teachers ’union, who pointed to data from the education ministry showing an increase in layoffs schoolchildren due to Covid-19 outbreaks since early January. “If we want to keep schools open, it’s crucial to vaccinate teachers.”

France’s education minister recently said the country would start vaccinating teachers in March. But the deployment of vaccines in France has been one of the slowest in Europe, and has raised doubts about whether any teachers could gain access to gunfire in the spring, Ms. David. The unions especially want early childhood education teachers to be vaccinated urgently, as children under the age of 6 do not wear masks in school in France.

In Italy, teachers’ unions have also urged the government to vaccinate teachers before other categories, possibly immediately after the elderly and medical staff, to help reopen schools that have remained closed longer than most other European countries.

In the UK, where vaccines are advancing much faster than in the European Union, government officials have been studying whether front-line workers, including teachers and police officers, should top the list of priorities. A petition from a professor in the north of England garnered nearly half a million signatures and sparked a parliamentary debate.

Currently, the government says it wants to vaccinate everyone over the age of 50 before considering front-line workers as teachers. Given the pace of the launch, this may not happen until spring.

British Prime Minister Boris Johnson said last week that removing vaccines from vulnerable groups could lead to additional deaths. Johnson is set to set a roadmap for future vaccination plans and the phasing out of blockade measures the week of Feb. 22.

While, in principle, people with vulnerabilities have the highest priority in vaccines in most countries, some complain that they have been overlooked.

In Germany, people with disabilities, some with rare chronic diseases and cancer patients are lobbying, even suing, the authorities for priority treatment.

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

Homburg said doctors warned him that capturing Covid-19 would probably kill him. But because he is young and does not live in a care center, where vaccines are already being produced, and because his condition is not explicitly mentioned in German vaccine regulation, Mr Homburg is not entitled to priority treatment.

He has now launched a petition to change it. Advocacy groups advocating for people with disabilities or illnesses filed similar appeals, while some patients managed to get prioritization by going to court.

Faced with pressure, the Standing Vaccination Committee of the Robert Koch Institute for Infectious Diseases, which advises the government, last month updated its advice and recommended a case-by-case assessment of people whose illness could lead to a high risk of dying for Covid. -19 even in the absence of statistics to prove it.

Rainer Schell got an exception for his son, who also has Duchenne, can’t breathe without a fan and needs 16 caregivers to take him into account. But it took almost four weeks, with the help of a lawyer and hours of advocacy to different 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 of the level of risk of many rare diseases, these decisions on a case-by-case basis will be difficult to make.

Prioritization strategies will change over time as new risk studies appear for certain populations and new vaccines are approved, health officials say. In Germany, some people in lower priority groups could be vaccinated faster now after the government decided not to clean AstraZeneca PLC’s Covid-19 vaccine for use in people over 65, potentially releasing more adult supplies. teens.

But virologists and epidemiologists say that until there is more evidence that vaccines prevent recipients from transmitting the virus — not just getting sick when they are infected — or statistics appear that show a higher risk of illness or death for certain essential workers. , governments will have trouble justifying vaccinating younger than older.

“This is 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 relate to why they should be prioritized, but from a pure 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 to [email protected]