District Administrator Leo Schrell in the Swabian district of Dillingen, like many colleagues in other districts, is currently receiving an increasing number of critical inquiries from his citizens: Why do citizens in neighboring districts get vaccination appointments more quickly? Why is the vaccination rate in Dillingen increasingly falling behind the rate in the Free State? 28.6 percent was the rate of people with a first vaccination in the district, according to the last published reported status on Thursday. 32.9 percent were it on Sunday in all of Bavaria, 32.1 on the comparable Thursday.

District Administrator Schrell must then answer that he would very much like to vaccinate more, the capacity in the local vaccination center would be available. However, the lower vaccination rate in the district is due to the fact that there are fewer family doctors in rural Dillingen - and thus fewer vaccines arrive there overall.

"No district administrator and also no mayor of an independent city can simply accept that, because he will then be stoned by his citizens," it is said from the circle of local politicians. To quote anonymously, of course. Too many see themselves exposed to nasty comments from their citizens. The pressure is growing, and for good reason: Those who are fully vaccinated will enjoy more freedom in the future, also in view of the upcoming beer garden and vacation season.

In the district of Hof, for example, the vaccination rate of 46.1 as of Friday is well above the average in the Free State, where they benefited from special allocations for border regions. Aichach-Friedberg, on the other hand, falls behind, as does Dillingen. There one refers as reason to special allocations for other districts as in yard or to the fact that the physicians in the district inoculate less than in other regions. The Dillingen district office can substantiate this with figures: The vaccination center receives vaccine for about 2500 vaccinations per week, so the physicians in private practice would have to do about 3000 vaccinations per week to stay on average. "But this contradicts reality," says Schrell. The physicians in private practice are working at their limits, but they cannot manage more than 1500 vaccinations per week: among other things, because there are fewer than in other regions.

The practices are entitled to a fixed number of vaccine doses each week

But before the district councils, responsible for the vaccination centers, and the representatives of the panel doctors, responsible for the distribution of doctors' seats, start arguing too much about who is responsible for the dilemma, Bavaria's Health Minister Klaus Holetschek (CSU) intervenes. He called on the federal government to allow "more flexibility in orders for Corona vaccine by doctors' offices." Despite a lower physician density, rural areas must be supplied with vaccine in the same way "as regions with a high physician density," Holetschek announced in a press release.

Background: Bavaria's practices are entitled to a predefined number of vaccine doses per doctor's office each week. If there are many physician practices in a region, such as in the state capital of Munich, which is blessed with many large group practices, then at least theoretically many vaccine doses are also available there. And where there are fewer physician seats - for example, because retiring physicians in rural areas have not found successors to take over their practices - the opposite may be true. In Dillingen, for example, three family doctor positions are currently unoccupied, partly due to two deaths. In addition, federal regulations prevent new doctors' practices from being licensed in some regions of Bavaria. Even if they would be urgently needed there.

Christian Bernreiter (CSU), District Administrator in the Deggendorf district and President of the Bavarian District Council, has therefore been calling for some time for the distribution key for the vaccine to be supplied to doctors to be changed, i.e. to be linked to the number of inhabitants and not to the number of doctor's practices. Holetschek's proposal now also goes in this direction.

The demand for vaccine is still much greater than the supply throughout Bavaria - and so at the most recent meeting of the Bavarian Vaccination Alliance, all participants supported Holetschek's initiative: the Association of Statutory Health Insurance Physicians in Bavaria (KVB), the Bavarian State Pharmacists' Association, and the Association of Counties and Cities. But there are still concerns. For example, there is the question of whether doctors in regions with few practices would even be able to administer the extra vaccine - see Dillingen. After all, they would also have to be available for regular care.

KVB boss Wolfgang Krombholz considers the current discussion, including blame, to be off the mark anyway: "The figures currently available don't really say anything about whether more or less vaccination is taking place in one district compared to others." According to Krombholz, quite a few patients had themselves vaccinated in medical practices in the neighboring county. "So we're dealing with statistics that are limping," he says.

The Ministry of Health doubts anyway that there are "significant distortions with regard to the vaccination rate in the individual counties and independent cities". What's more relevant, he says, is that "the vaccination rate is currently 32.9 percent statewide for first-time vaccinations and 8.6 percent for second-time vaccinations." That, Krombholz said, is thanks to both the doctors and the vaccination centers. "The doctors and the vaccination centers are doing an outstanding job," Bernreiter also emphasizes.

Hans-Peter Hubmann, who as head of the Pharmacists' Association is now to lobby in Berlin for a change in the specifications for vaccine deliveries to Bavaria's doctors, expects much higher volumes of incoming doses from the beginning of June anyway. "We will then have to talk a little less about vaccine shortages," he says. Quite a few who are now hoping for their first vaccination will still have to be patient. First come the many people for whom the second vaccination is now due

Photo by Mehmet Turgut Kirkgoz