Lack of vaccine causes fights over who should get the first vaccines

For months, few questioned the wisdom of a strategy focused on reducing the number of deaths instead of slowing the spread of the virus. But as the weeks go by, infections remain high and fears about new variants of the virus increase, groups ranging from essential workers to teachers and people with chronic diseases are increasingly demanding to be next.

In the United States, where the vaccination effort started early and advanced relatively quickly, many states are moving to immunize people aged 65 and over, as well as people with certain health conditions. Following pressure from interest groups, some have now started vaccinating teachers or rural workers.

In Europe, where vaccination is progressing painfully slowly because of a mix of bureaucracy and hiccups in vaccine manufacturing, calls for less vulnerable groups to have quick access are gaining momentum.

The emerging struggle over what is likely to remain a scarce resource for months is the ultimate challenge for governments that are increasingly under pressure to bring a degree of normality back after a year of recurring blockages and varying restrictions.

It is also politically explosive because it raises difficult moral issues, including whether the elderly, some bedridden and others over the age of 100, should take priority over younger cancer patients; or whether groups that no longer play an important role in the economy should take precedence over teachers, police, retail workers, bus drivers and others who are statistically less likely to die but occasionally contract serious cases of Covid-19.

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

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

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

“More and more teachers are afraid to go to work,” said Guislaine David, co-secretary general of the teachers union SNUipp-FSU, pointing to figures from the Ministry of Education that show an increase in school closures due to Covid outbreaks -19 since early January. “If we want to keep schools open, vaccinating teachers is essential.”

France’s education minister recently said the country will start vaccinating teachers in March. But vaccine distribution in France is among the slowest in Europe, raising doubts as to whether any teachers will be able to access vaccines in the spring, David said. Trade unions especially want pre-school teachers to be vaccinated as a matter of urgency, as children under the age of 6 do not wear masks in schools in France.

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

In the United Kingdom, where vaccinations are progressing much faster than in the European Union, government officials have been examining whether frontline workers, including teachers and police, should be added to the priority list. A petition by a professor in northern England obtained nearly half a million signatures and sparked a parliamentary debate.

The government currently says it wants to vaccinate everyone over 50 before considering frontline employees as teachers. Given the pace of the launch, this may not happen until spring.

British Prime Minister Boris Johnson said last week that withdrawing vaccines from vulnerable groups could result in additional deaths. Mr. Johnson is expected to outline a roadmap for future vaccination plans and the gradual removal of blocking measures in the week of February 22.

Although people with vulnerabilities in principle have a high priority for 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 prosecuting – the authorities for priority treatment.

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

Homburg said doctors warned him that taking Covid-19 was likely to kill him. But because he is young and does not live in a health center, where vaccinations are already taking place, and because his condition is not explicitly mentioned in Germany’s vaccination regulations, Homburg is not entitled to priority treatment.

He has already launched a petition to change that. Advocacy groups that defend people with disabilities or illnesses have made similar appeals, while some patients have managed to get priority by going to court.

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

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

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

Prioritization strategies will change over time as new studies on the risks for certain populations emerge and new vaccines are approved, say health officials. In Germany, some people in low-priority groups could be vaccinated faster now, after the government decided not to release the AstraZeneca PLC Covid-19 vaccine for use in people over 65, potentially releasing supplies for young adults.

But virologists and epidemiologists say that until there is more evidence that vaccines prevent recipients from transmitting the virus – not just get sick when infected – or statistics emerge that show an increased risk of illness or death for certain key workers, governments will have problems justifying vaccinating younger ones before older ones.

“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 because they should be prioritized, but from a purely epidemiological and virological perspective, the current strategy is right.”

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

Write to Ruth Bender at Ruth.Bender@wsj.com