COVID vaccination: 'Should we draw lots?'

It is a major development in Germany's vaccination strategy: Beginning on June 7, everybody who is 16 years or older can apply to be vaccinated against the coronavirus. 

It is good news for the many Germans who are already beginning to plan their summer vacations. And good news is what ruling politicians need as they are facing a watershed national election this fall.

In the capital of Berlin, there are an estimated 2,200 general practitioner clinics and surgeries. Now the GPs can and must decide who gets preferential treatment and why. That in turn has reportedly sparked anger among some patients.

Small clinics swamped with requests

Vaccinations have quickly become part of the daily routine at GP Doris Höpner's family clinic in the Berlin district of Wedding. In the mornings, everything is as it was before for Höpner and the three colleagues she shares the practice with. In the afternoons, though, the focus is on vaccinations. The pressure is certainly on and a lot of overtime has already begun piling up.

But the tricky issue of prioritization has not gone away. Especially when it comes to deciding which patients get the BioNTech-Pfizer vaccination that is viewed by many as their preferred option. Doris Höpner even goes so far as to tell DW that she sees it as, "the luxury version vaccines."

Höpner adds: "The situation is that we have plenty of other vaccines from AstraZeneca and Johnson & Johnson. But supplies of BioNTech are limited. This means that I have to be aware of my professional responsibility and duty in dealing with the BioNTech vaccine. If there are patients on my waiting list who need to be prioritized for social or medical reasons, then, of course, they come first."

AstraZeneca? Thanks, but no thanks!

What that means on a day-to-day basis is that some patients who did not realize that they were to be administered with AstraZeneca have simply turned and departed.

The reason is that, in a relatively small number of cases, blood clots in the brain have been linked with the vaccine. And German media have been reporting on this extensively.

Nevertheless, Doris Höpner is reluctant to join in any scaremongering: "My experience is that patients are still very grateful indeed to get an appointment. Unfortunately,  media reports have tended to arouse expectations that nobody can fulfill. Even without prioritization, there are going to be waiting lists."

12 doses of BioNTech per doctor

Fact is, says Höpner, that especially when it comes to the BioNTech vaccine, demand far exceeds supply. "Next week each of our doctors will be able to administer BioNTech to 12 patients. At the same time, we can use as much AstraZeneca vaccine as we like."

"So, how should I decide who gets BioNTech and who AstraZeneca? Should we draw lots?"

And then there are acute staffing problems in the clinics, which need not only doctors but also assistants to keep the vaccination schedule on track. 

So, it is not simply a case of stepping up the vaccination rate by scrapping the priority rules. And the differences between the various vaccines remain significant: "If you want to have BioNTech, then you're probably going to have to wait between four and six weeks. But if you'll accept AstraZeneca, then you can get an appointment next week."

Speedy vaccination before the summer break?

Many patients who are pushing hard for vaccination so that they can go on holiday in the summer without too much concern.

Such considerations are a long way from the system of prioritization that was introduced at the start of the year, when the vaccination roll-out began.

The idea then was to ensure that vulnerable groups would get special protection. Initially, that meant elderly men and women over 80, or people confined to residential care homes. And health workers in general, alongside others at immediate risk of infection.

The second group included teachers and people with significant prior medical complaints such as cancer, as well as those over the age of 70.

By now members of the third priority group — for instance, the over-60s, sales assistants, supermarket employees and bus drivers — can all apply for appointments.

A third vaccination? A fourth COVID wave?

Doris Höpner is in little doubt that vaccination against COVID is going to be a central aspect of her everyday routine for many months, as most vaccines must be administered twice within a period of just a couple of months.

"We still know very little about the virus. But it seems highly likely that a third vaccination is going to be necessary," says Höppner. "And the prospect of a fourth wave of infection cannot be discounted." 

This article has been translated from German.

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