When Jens Spahn (CDU) visited the vaccination center in Berlin's Messe on Easter Monday, the health minister seemed a little more confident than he did a few days ago. So far, vaccinations against Sars-CoV-2 have been slow - even though Germany has more doctors than most other countries. The goal announced by Chancellor Angela Merkel (CDU) of offering all citizens a vaccination by September 21 would not be achievable at this rate. But now the physicians in private practice are supposed to help - hence Spahn's new confidence.

How many vaccine doses will the general practitioners get?
Because all vaccine manufacturers can still produce fewer doses than have been ordered worldwide, and because in Germany the vaccination centers and clinics are still being supplied, the first batch to the practices will be modest: one million doses in the first week. With 35,000 primary care practices participating in the campaign nationwide in the first stage, and the model practices that have already been participating for days, each practice would receive approximately 20 doses.

Initially, the vaccine from Biontech will be used, followed by deliveries of the vaccine from Astrazeneca and Johnson & Johnson. Health Minister Spahn had said that the Moderna preparation would initially be vaccinated in the vaccination centers. Soon, however, larger quantities are to go to the practices that vaccinate 20 million patients against influenza every year. From the end of April, three million doses per week are to be distributed to the practices.

Will all German citizens receive a vaccination offer by "the end of summer"?
There is apparently skepticism among the population. On behalf of the Deutsche Presse-Agentur, the pollsters of "YouGov" started a survey: only 23 percent of the respondents said that the goal of offering a Corona vaccination to every person willing to be vaccinated by September 21 will be met.

By Easter, according to the Robert Koch Institute (RKI), almost 10.1 million men and women had been provided with a first vaccination dose, or 12.1 percent of the population. Minister Spahn announced Monday, "By the beginning of May, 20 percent of Germans will be able to be vaccinated." There would be more vaccine than in the first months of the year, the infrastructure in centers and practices stands, the vaccination rate will continue to increase in the second quarter.

The Association of Statutory Health Insurance Physicians (KV), which is responsible for physicians in private practice, says that five million vaccinations per week are possible in the practices - if the necessary preparations are supplied. Then also established specialists and private practices are to participate. According to information from the Tagesspiegel, medical officials in Berlin and Brandenburg, as well as the heads of vaccination centers, assume that Merkel will be right with her announcement, despite all the mishaps - such as the dispute over side effects of the Astrazeneca vaccine.

What is the situation in Berlin - and how can vaccination be accelerated?
It is not yet clear how many practices in Berlin will start offering Corona vaccinations and when. Most recently, there was talk of up to 4,500 general practitioners and specialists. Berlin is well supplied with GPs; at last count, there were 2592 GPs in private practice in the city, almost 50 more than in 2016. Based on local social data, the KV calculates a coverage rate: how well a place is equipped with practices is then given as a percentage - from 100, coverage is considered adequate, from 105, good. In 2020, Berlin had a coverage rate of 105.2 percent with primary care physicians.

In addition, experts are pushing for vaccination in companies soon. Many large companies have a permanent company doctor, whom the workforce sometimes even knows from previous assignments. As soon as "sufficient quantities of vaccine are available," Berlin's Senate announced its intention to provide company doctors with the vaccine in addition to doctors' offices.

Which patients should doctors in private practice vaccinate first?
In doctors' practices, too, prioritization, i.e. the patient order of the Standing Commission on Vaccination at the RKI, is the basis: as long as vaccines are in short supply, the order should be maintained. Initially, these would be those plus-80-year-olds who have not yet been able to keep an appointment at the vaccination center. Then, roughly simplified, practices would have to offer vaccinations according to age and previous illness. However, doctors often know their patients and are better able to take into account the chronically ill than was possible via the vaccination invitations of the federal states. According to the amended federal vaccination regulation of March 8, it is possible to deviate from the order anyway "if this is necessary for the efficient organization of vaccinations or the timely use of existing vaccines, in particular to avoid the discarding of vaccines." This applies equally to vaccination centers and primary care physicians, but it is likely to be done more expeditiously in practices: If vaccine (from opened vials) is still left in the evening, those who just want it - including younger people - will be supplied.

What is the impact of the debate about the Astrazeneca vaccine?
According to employees of the vaccination centers, there is still "Astrazeneca skepticism". The Berlin KV informs on request: "The current situation around Astrazeneca led to a decrease in acceptance of the vaccine in the practices. In connection with the prioritization requirement, medical practices have to call a very large number of patients until a sufficient number declare their willingness to be vaccinated. Often, it is only in individual doctor-patient discussions that reservations about the vaccine can be reduced."

Some of the model vaccination practices that have been active since March have stopped offering the British-Swedish vaccine. The RKI now recommends the Astrazeneca drug only for plus-60-year-olds. Younger people can take the vaccine voluntarily after receiving medical education. Who is liable if the Astrazeneca shot then has negative consequences?

The Ministry of Health writes: "If the Länder recommend Astrazeneca vaccination on the basis of the Stiko decision (i.e., vaccination recommended from 60 years of age, as well as under 60 years of age at the doctor's discretion and with individual risk analysis after careful information), then the Länder are liable if the known side effects occur." If damage occurs, "depending on the case," the pharmaceutical manufacturer may also be liable.

"The doctor can and should get a written release from liability from patients under 60 who want Astrazeneca," said Rüdiger Heicappell, a vaccinologist in Berlin and Brandenburg. "For vaccinations recommended by the federal government, the states, which ultimately supervise vaccinators, are liable. The exception is if the individual physician is grossly negligent."

Photo by Mat Napo