The lack of vaccines sparks those who should receive the first shots

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

In the United States, where the vaccination effort began early and moved relatively quickly, many states are moving toward immunizing those 65 and older, as well as people with certain health conditions. Following pressure from interest groups, a few have now begun to inoculate teachers or agricultural workers.

In Europe, where vaccination is progressing painfully due to a mix of bureaucracy and vaccine hiccups, it calls for less vulnerable groups to have quick access.

The emerging struggle for what is likely to remain a limited resource for months is the latest challenge for governments that are increasingly pressured to return to a certain level of normalcy after a year of recurring bottlenecks and assorted restrictions.

It is also politically explosive, as it raises harsh moral questions, including whether older people, some bedridden and others over the age of 100, should take precedence over younger cancer patients; or whether groups that no longer play an important role in the economy should have priority over teachers, police officers, retailers, bus drivers and others who are statistically less likely to die, but who sometimes , will contract severe cases of Covid-19.

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

“The concept of setting priorities 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 putting pressure on the government to make it a priority for vaccination.

“More and more teachers are scared to go to work,” said Guislaine David, co-secretary general of the SNUipp-FSU teachers’ union, pointing to data from the education ministry showing an increase in school dropouts due to Covid outbreaks. 19 in early January. “If we want to keep schools open, vaccinating teachers is essential.”

The French Minister of Education recently said that the country will start vaccinating teachers in March. But the launch of vaccines in France has been one of the slowest in Europe, raising questions about whether a teacher could have access to photos in the spring, Ms David said. The unions especially want preschool teachers to be vaccinated urgently, as children under the age of 6 do not wear masks at a school in France.

In Italy, teachers’ unions have also called on 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 in most other European countries.

In the UK, where vaccinations are progressing much faster than in the European Union, government officials have considered whether front-line workers, including teachers and police officers, should be on the list of priorities. A petition from a professor in the north of England garnered almost half a million signatures and sparked a parliamentary debate.

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

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

While people with vulnerabilities are, in principle, a high priority for vaccinations 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 have been forgotten,” said 24-year-old Christian Homburg, who has Duchenne muscular dystrophy, a severe form of muscle loss. means that it currently has only about 20% of its lung capacity.

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

He has now launched a petition to change this. Defense groups defending people with disabilities or illnesses have made similar appeals, while some patients have managed to get priorities by going to court.

Faced with pressure, the standing vaccination committee of the Robert Koch Institute, which advises the government, updated its advice last month, recommending a case-by-case assessment of people whose disease could put them at high risk of dying from Covid cause. -19 even in the absence of statistics to prove it.

Rainer Schell managed to get an exception for his son, who also has Duchenne, can’t breathe without a fan and needs 16 caregivers to take care of him. But it took almost four weeks, with the help of a lawyer and hours of pleading with various authorities to get the vaccination schedule.

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

Priority 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 eliminate the Covra-19 vaccine from AstraZeneca PLC for use in people over the age of 65, releasing potential consumables for adults. younger.

But virologists and epidemiologists say that until there is more clear evidence that vaccines prevent recipients from transmitting the virus – not just getting sick when they are infected – or statistics appear that show an increased risk of illness or death for some essential workers, governments will have problems justifying younger vaccination before age.

“This is a real dilemma we have here,” said Uwe Liebert, a virologist at the University of Leipzig. “Of course, there are many groups in which we can report 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 to [email protected]