As a shortage of Covid-19 shots slows vaccination efforts in the West, groups that haven’t been given high priority are increasingly jostling for the right to get immunized first.
In most countries that are currently deploying vaccines, those most at risk of dying or getting seriously ill from the virus—nursing home residents and those caring for them, medical workers and the elderly—have been at the front of the queue.
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 roll on, infections remain high and fears grow about the new variants of the virus, groups ranging from essential workers to teachers and people with chronic diseases are growing louder in demanding to be next.
In the U.S., where the vaccination effort started early and has moved relatively fast, many states are moving to immunize those 65 and older as well as people with certain health conditions. Following pressure from interest groups, a few have now started inoculating teachers or farmworkers.
In Europe, where vaccination is progressing painfully slowly because of a mixture of bureaucracy and vaccine-manufacturing hiccups, calls for less vulnerable groups to be given fast-track access are gathering force.
The emerging fight for what is likely to remain a scarce resource for months is the latest challenge for governments that are increasingly under pressure to bring back a degree of normalcy after a year of recurring lockdowns and assorted restrictions.
It is also politically explosive because it raises hard moral questions, including whether elderly people, some bedridden and others well over 100 years old, should have priority over younger cancer patients; or whether groups who no longer play a big role in the economy should take precedence over teachers, police officers, retail workers, bus drivers and others who are statistically less likely to die but will on occasion 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 jobs will have to wait, all at a cost to education or the economy, said Alberto Giubilini, a senior researcher on ethical vaccines distribution at the University of Oxford.
“The concept of prioritization means that we have to sacrifice certain values,” he said. “It’s very hard to strike a balance.”
In France, where schools have remained open throughout most of the pandemic and where daily cases have risen steadily since early December, teachers are lobbying the government to be considered 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 that shows an increase in school shutdowns due to Covid-19 outbreaks since early January. “If we want to keep schools open, getting teachers vaccinated is essential.”
France’s education minister recently said the country would start vaccinating teachers in March. But France’s vaccine rollout has been among the slowest in Europe, raising doubts as to whether any teacher could gain access to shots in the spring, Ms. David said. Unions especially want preschool teachers to get vaccinated urgently as children under the age of 6 don’t wear masks in school in France.
In Italy, teachers unions have also pleaded with the government to vaccinate teachers before other categories, possibly immediately after the elderly and medical personnel, to help reopen schools that have stayed shut longer than in most other European countries.
In the U.K., where vaccinations are progressing much faster than in the European Union, government officials have been looking at whether front-line workers, including teachers and police officers, should be bumped up the priority list. One petition from a teacher in the north of England obtained nearly half a million signatures and triggered a parliamentary debate.
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The government currently says it wants to vaccinate everyone over the age of 50 before considering front-line workers such as teachers. Given the pace of the rollout, this may not happen until the spring.
British Prime Minister Boris Johnson said last week that taking away vaccinations from vulnerable groups could result in additional deaths. Mr. Johnson is due to lay out a road map for future vaccination plans and the gradual removal of lockdown measures in the week of Feb. 22.
While people with vulnerabilities in principle take high priority for vaccinations in most countries, some complain they have been overlooked.
In Germany, people with disabilities, some with chronic rare illnesses and cancer patients are lobbying—even suing—authorities to obtain priority treatment.
“Reducing deaths is the main goal of our current vaccination strategy yet somehow people like me were forgotten,” said Christian Homburg, 24, who has Duchenne muscular dystrophy, a severe form of muscle loss that means he currently only has some 20% of his lung capacity.
Mr. Homburg said doctors warned him that catching Covid-19 would likely kill him. But because he is young and doesn’t live in a care facility, where vaccinations are already happening, and because his condition isn’t explicitly mentioned in Germany’s vaccine regulation, Mr. Homburg isn’t entitled for priority treatment.
He has now launched a petition to change that. Advocacy groups defending people with disabilities or diseases made similar appeals, while some patients succeeded in obtaining prioritization by going to court.
Faced with pressure, the Robert Koch Institute for infectious diseases’ standing vaccination committee, which advises the government, last month updated its advice, recommending a case-by-case assessment of people whose disease might put them at a high risk of dying from Covid-19 even in the absence of statistics proving it.
Rainer Schell managed to obtain an exception for his son, who also has Duchenne, can’t breathe without a ventilator and needs 16 caregivers to look after him. But it took him nearly four weeks, the help of a lawyer and hours of pleading with 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 on the level of risk for many rare diseases, such case-by-case decisions will be difficult to make.
Prioritization strategies will change over time as new studies appear on risks for certain populations and new vaccines get approved, health officials say. In Germany, some people in lower-priority groups could get vaccinated faster now after the government decided not to clear AstraZeneca PLC’s Covid-19 vaccine for use in people over 65, potentially freeing up 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 from falling ill when infected—or statistics emerge that show an increased risk of illness or death for certain essential workers, governments will have trouble justifying vaccinating younger before older.
“That’s a real dilemma we have here,” said Uwe Liebert, a virologist at Leipzig University. “Of course there are many groups where we can relate why they should be prioritized, but from a pure 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
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