Sparks sparks fight over who should get first shots

As a shortage of Covid-19 shots slows down vaccination efforts in the West, groups that have not been given high priority are increasingly haunted by the right to be immunized first.

In most countries that currently use vaccines, those who are most at risk of dying from the virus or becoming seriously ill – residents of nursing homes and those who care for them, medical workers and the elderly – are at the forefront.

For few months, few people have questioned the wisdom of a strategy aimed at reducing the number of deaths, rather than slowing down the spread of the virus. But as the weeks go by, infections remain high and fears grow about the new variants of the virus. Groups ranging from essential workers to teachers and people with chronic illnesses are becoming increasingly demanding to be next.

In the US, where the vaccination effort started early and moved relatively quickly, many states are immunizing those 65 and older, as well as people with certain health conditions. Following pressure from interest groups, some close teachers or farm workers began vaccinating.

In Europe, where vaccination is progressing painfully slowly due to a mix of bureaucracy and vaccine-producing hiccups, the call is for faster access to less vulnerable groups.

The emerging battle for what is likely to remain a scarce resource for months is the latest challenge for governments, which are increasingly under pressure to bring some normality back to a year of repeated closures and various restrictions.

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

The priority gives the most vulnerable help to protect the public health system, but it also means that some people who are very exposed to their work will have to wait, all at the expense of education or the economy, says Alberto Giubilini, a senior researcher. on ethical distribution of vaccines at the University of Oxford.

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

In France, where schools have remained open during most of the pandemic and where daily cases have been steadily increasing since early December, teachers are pushing the government to become 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, pointing to data from the Ministry of Education showing an increase in school interruptions as a result of Covid-19 outbreaks since early January. “If we want to keep schools open, it is essential to get teachers vaccinated.”

France’s education minister recently said the country would begin vaccinating teachers in March. But the deployment of vaccine in France was one of the slowest in Europe, raising doubts as to whether any teacher would be able to gain access to shots in the spring. David said. Trade unions especially want pre-school teachers to be vaccinated urgently, as children under the age of 6 do not wear masks at school in France.

Protesters gathered in Marseille, France, on January 26 to demand more government support for teachers during the pandemic.


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Daniel Cole / Associated Press

In Italy, teachers’ unions have also called on the government to vaccinate teachers in front of other categories, possibly immediately after the elderly and medical staff, to help reopen schools that have 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 be on the priority list. One petition from a teacher in the north of England received nearly half a million signatures and sparked a parliamentary debate.

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The government currently says it wants to vaccinate everyone over 50 before considering frontline workers such as teachers. Given the rate of rollout, this can only happen in the spring.

British Prime Minister Boris Johnson said last week that taking vaccinations of vulnerable groups could lead to further deaths. Mr. Johnson must draw up a roadmap for future vaccination plans and the gradual removal of closure measures in the week of Feb. 22.

New research could help explain why thousands of Covid-19 survivors have debilitating neurological symptoms months after they initially became ill. WSJ breaks down the science of how the coronavirus affects the brain, and what it can mean for long-distance patients. Illustration: Nick Collingwood / WSJ

Although people with vulnerabilities are in principle given 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, are campaigning for authorities to even get priority.

Christian Homburg strives to put people with serious conditions on the priority list for vaccination.


Photo:

Christian Homburg

“Reducing 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 serious form of muscle loss that means he currently has only 20% of his muscle loss. Long capacity.

Mr. Homburg said doctors warned him he would probably kill him if he caught Covid-19. But because he is young and does not live in a care institution, 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 that. Advocacy groups defending people with disabilities or illnesses have made similar calls, while some patients have managed to gain preference by going to court.

Faced with pressure, the permanent 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 evaluation of people whose disease they are at high risk of to die to Covid. -19 even in the absence of statistics proving it.

Rainer Schell managed to get an exception for his son, who also has Duchenne, cannot breathe without a fan and needs 16 caregivers to look after him. But it took him almost four weeks, the help of a lawyer and hours to plead with different authorities to get the vaccination.

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

Prioritization strategies will change over time as new studies appear at risks for certain populations and new vaccines are approved, health officials say. In Germany, some people in lower-priority groups can now be vaccinated faster after the government decided not to remove the AstraZeneca PLC Covid-19 vaccine for use in people over 65, which could potentially supply young adults. free.

But virologists and epidemiologists say that until there is direct evidence that vaccines prevent recipients from transmitting the virus – not just getting sick if infected – or statistics will emerge that increase the risk of disease or death for certain essentials. workers show, governments will have trouble justifying vaccinating younger before older.

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

Write to Ruth Bender by [email protected]

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