Written by Benjamin Mueller and Rebecca Robbins
The good news came first. The European Union authorized a third vaccine.
Then the bad news. Regulators in country after country suggested restricting it to the youngest until further testing was done.
The decisions ushered in a delicate new phase of vaccination campaigns, one in which a growing menu of coronavirus vaccines was accompanied by contentious debates over who should receive which injections.
Those debates are a testament to the good luck of the world in having several potent vaccines just one year after the pandemic. But each vaccine has its own idiosyncrasies, including gaps in data from clinical trials. And that has sparked agonizing options for countries already struggling to give injections, forcing health officials to weigh their scruples about certain vaccines against the need to inoculate people before dangerous variants are established.
After the European Union authorized the AstraZeneca-Oxford vaccine last week, adding a third injection to the bloc’s arsenal, Germany, Italy, France, Belgium, Lithuania, Poland, Austria and Sweden said they would either restrict it to the very young or that they were considering doing it. then, citing the paucity of data on the vaccine’s efficacy in older people.
Under those plans, older people would be scheduled to receive the Pfizer-BioNTech or Moderna vaccines, which could leave them unvaccinated for a period, even when younger people are inoculated with the AstraZeneca vaccine.
But those strategies, tangled as they are, will at least make a new vaccine available to the very young, the scientists said, a far better scenario than anyone receiving the AstraZeneca vaccine.
Some scientists are now urging the United States to take the same approach, as the country remains without an alternative to the hard-to-store Pfizer and Moderna vaccines. Its regulators are refusing to authorize the injection of AstraZeneca until another clinical trial generates more data, including on how it works in older people.
In the absence of such data, targeting the vaccine at those known to be effective was an urgently needed stopgap solution, the scientists said, and even more so now that the virus is rapidly acquiring dangerous new mutations.
“This is a pragmatic solution to a desperate situation,” said Dr. Peter Hotez, a vaccine scientist at the National School of Tropical Medicine at Baylor College of Medicine in Texas. “Everything has changed. The whole Biden plan made perfect sense until about three or four weeks ago, when we realized the pace of the emerging variants and therefore you have to adapt.”
The confusion arose in Italy after regulators said AstraZeneca’s vaccine should, with a few exceptions, “preferably” be used in adults under 55 years of age. Injections from Pfizer and Moderna, both mRNA vaccines that have shown approximately 95% efficacy in preventing COVID-19, should be given to the most vulnerable people, they said.
FILE – A dose of vaccine is prepared at a hospital in Piacenza, Italy, on December 27, 2020 (Alessandro Grassani / The New York Times).
AstraZeneca’s vaccine was 62% effective in two full doses in clinical trials, but it protected all participants against serious illness or death.
In Italy, rumors quickly began to spread about who would get which vaccine. News reports suggested that the AstraZeneca injection would be reserved for younger essential workers such as soldiers, teachers and janitors.
But the Italians spotted a gap in the plan: a few hundred thousand public workers are too old to receive an AstraZeneca injection, but too young to still qualify for an mRNA vaccine.
Salvatrice Alario, 65, a primary school art history and Italian teacher in Catania, Sicily, is among those who now fear being one of the people caught in the middle, with little chance of being vaccinated anytime soon.
“If I had a choice, I would like to get the safest one, but more than anything, I would like to get vaccinated as soon as possible,” Alario said. “I’m scared, like everyone else.”
Age limits have also changed vaccination plans in Germany, where an immunization committee authorized the AstraZeneca vaccine only for adults under 65. Given the limited supply in Germany, those vaccines are likely to be reserved for younger medical workers and nursing home aides.
Still, some people resisted getting the AstraZeneca injection, rather than Pfizer’s, a sign that people may become more selective as more vaccines are licensed.
Scientists have largely advised people to accept the first vaccine offered, given the widespread protections against serious diseases and the societal need to curb the emergence of new variants.
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FILE – People wait after being vaccinated as a precautionary measure for allergic reactions at a stadium in Berlin on December 30, 2020 (Lena Mucha / The New York Times).
But for governments, questions about how to target vaccines to different groups “are never easy decisions,” said Dr. William Schaffner, an infectious disease expert at Vanderbilt University in Tennessee. US officials have given no indication that they are considering such a plan.
Until now, countries have largely tailored vaccine offerings based on where injections can be stored and transported. MRNA vaccines must be kept at very cold temperatures, making access difficult for older people in rural areas.
The AstraZeneca vaccine, which can be stored in normal refrigerators, would be of great help to older and harder-to-reach residents. But limiting it to the youngest would undo those advantages.
And despite the embarrassing shortage of the AstraZeneca vaccine in Europe that created a rift with the company, countries are still counting on it, especially since Pfizer shipments have also been lower than expected.
“What if one of these countries now has a situation where they are running out of mRNA vaccines, they are not going to give any vaccines to the elderly?” asked Dr. Ofer Levy, director of the Precision Vaccine Program at Boston Children’s Hospital, a project to tailor vaccines for vulnerable people.
Researchers at AstraZeneca and Oxford have said their data points to similar levels of protection in the elderly and young. That question could definitely be answered in a few weeks, when AstraZeneca reports the results of an advanced-stage clinical trial in the United States that recruited many older people. Those findings could open the door to authorization in the United States and changes to the launch of the vaccine in Europe.
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