Mandatory vaccines 'economically catastrophic' says MP
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The new Chancellor, Olaf Scholz, has set a goal of 30 million vaccination doses by Christmas on Tuesday. To reach this goal, more than a million doses would have to be administered every day. On Thursday, the Ministry of Health then corrected its pledge, arguing vaccines administered from mid-November will count towards the 30. Nevertheless, it remains an ambitious goal.
The pressure is enormous: The fourth wave is the strongest to date, numerous hospitals are regionally overloaded, vaccination protection in the population is declining and the vaccination rate has been crawling towards 70 percent for months.
It does not go down well when mayors, district administrators or doctors across the country complain that they lack a large amount of vaccine doses to serve all those who want to be vaccinated.
The situation is reminiscent of the chaos at the beginning of the vaccination campaign in March, when population groups were prioritised, there were problems with appointments and general practitioners were not allowed to vaccinate.
Even now there are reports in almost every local newspaper of disappointed people who are turned away by vaccination centres or only get an appointment in January at their GP.
Delivery problems have been reported in ten federal states.
“It takes 14 days until the vaccine arrives,” sighs the SPD health expert Karl Lauterbach, himself a vaccination doctor in Cologne, in an interview with ZEIT ONLINE.
“And there is always less than what was ordered.”
In Bavaria, which was hit hard by the pandemic, the Rosenheim district cancelled all vaccination appointments until Christmas for such reasons.
After hardly anyone was interested in getting vaccinated over the summer months, according to the Federal Ministry of Health, up to 70,000 medical practices, company doctors and clinics, up to 400 health authorities, and hundreds of vaccination centres, some of which have been reopened in a hurry, are currently vaccinating again.
At the centre of vaccine logistics is the Bundeswehr, which manages the federal government’s central vaccine warehouse in Lower Saxony.
The deliveries for Germany agreed at EU level arrive there and are distributed to the federal states from there in a militarily secured manner. In the meantime, this is almost only the mRNA vaccine from Moderna, because BioNTech has to be transported at particularly low temperatures.
Doctors order the vaccine from the pharmacies, which in turn are supplied by the nine German pharmaceutical wholesalers. They get it from the central warehouse.
The vaccination centres set up by the state authorities, on the other hand, receive the doses from the state administrations, which in turn receive them from the central warehouse. The distribution key was determined by the health ministers in 2020 based on the proportion of the population.
Somewhere in that supply chain there is a problem. And in an argument about it, one points the finger at the other.
One objective reason is likely to be the extreme increase in demand since November: since vaccination breakthroughs have been increasing, hundreds of thousands are getting their booster jabs every day.
Due to the widespread 2G regulations – having to show you are either vaccinated or recovered – the number of first vaccinations is also increasing again. Orders for BioNTech vaccines quadrupled within two weeks.
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The Ministry of Health in Bavaria, which is plagued by a lack of vaccines, is optimistic despite the tense situation: “One reason for the delivery bottlenecks is the gratifyingly strong increase in the demand for vaccinations.” But that does not solve the problem.
The Federal Ministry of Health emphasises that enough vaccine doses are available or will be supplied. When looking at the detail of the numbers and tables, the overview is quickly lost, roughly it can be said: The ministry could only move certain deliveries of the Booster-compatible vaccine Moderna for 2022 forward to December, and BioNTech, which has so far been the most used vaccine in Germany, will deliver doses earlier than planned in December – but not until the week after next.
And in the following weeks there will be correspondingly less BioNTech. Johnson & Johnson is currently rarely used in Germany, AstraZeneca no longer plays a role.
The ministry does not see any fundamental problems.
The “well-coordinated cooperation” of the manufacturers, the central warehouse of the Federal Armed Forces, as well as the pharmaceutical wholesalers and pharmacies have “stood the test overall”.
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The ministry sees the causes of the shortage of vaccines as homemade by doctors and vaccination centres. “If the order is not placed in good time, it cannot be served due to the logistics.”
The federal states protect the vaccination centres and point at a higher level: “In particular, the resident doctors, but also the vaccination centres must be able to rely on the fact that the vaccine that is ordered will arrive,” demands Berlin Health Senator Dilek Kalayci.
Bavaria’s Ministry of Health also says that the vaccination centres “depend on the amounts made available by the federal government”.
One bottleneck is the ordering process, which can also confuse doctors. According to the National Association of Statutory Health Insurance Physicians, they have to order at the pharmacies two weeks in advance: Anything ordered by 12 noon on Tuesday will arrive on the Monday of the week after next. The Ministry of Health, on the other hand, says on request that delivery will take place on the Monday of the following week. The vaccine will be distributed “as needed” and “as evenly as possible to the vaccinating doctors”.
There is no limit to how much can be ordered, wrote the Association of Statutory Health Insurance Physicians to its members, but “the federal government determines the delivery quantity”.
The doctors find out what they actually get by Tuesday during the week between the ordering process and delivery. If the delivery volume is insufficient, the surgeries have to cancel patient appointments or postpone them. Vaccination centres like the one in Rosenheim, which recently received only 1,000 of the 22,000 doses of BioNTech ordered, will then practically have to close.
Because the system is also burdened by the rationing of the popular vaccine from BioNTech in addition.
Last week, almost 6.5 million doses were vaccinated nationwide, the delivery of almost six million doses was announced for this week – Moderna only makes up one-thirtieth of all doses used. In the coming weeks, however, according to previous reports, only half of BioNTech will be available.
That is why it is now rationed: Currently there is “a maximum order quantity of 30 doses / week / resident vaccinator”, according to the Ministry of Health.
Anyone who does not get BioNTech will then be vaccinated or boosted with the abundant Moderna – an equally effective and safe vaccine according to the Paul Ehrlich Institute responsible for vaccines. But Moderna is currently not recommended for under 30-year-olds and vaccination is also a matter of judgement.
This is likely to have intensified the run on the vaccination centres in the past few days, where – even in Saxony – hundreds have been queuing for hours. Because the time required for each vaccination also increases when those willing to get vaccinated learn that they will receive Moderna instead of BioNTech – the Association of Statutory Health Insurance Physicians speaks of an “increased need for advice”.
Therefore, a multitude of factors, wrong decisions and bottlenecks prevent everyone who wants to be vaccinated from getting a dose quickly.
The SPD health expert Lauterbach advocates analysing the weak points thoroughly instead of blaming each other.
“If you want to solve the problem, you first have to make a clean sweep with all those involved in the ministry, the doctors and vaccination centres in order to identify the weak points,” he says.
Additional reporting by Monika Pallenberg
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