Heroes to Zero: How German Perfectionism Ruined Your Covid Vaccination Campaign | Germany


In December, two weeks before the European Medicines Agency authorized the first Covid-19 vaccine for use throughout the European Union, Berlin unveiled a plan to boost its German precision-engineered immunization campaign. The jabs would be administered en masse at specially designed vaccination centers where patients could be transported through waiting lanes like cars through a car wash.

A Lego screen demonstrating the efficiency of the complex system impressed journalists at a press release, but set off alarms in the head of Janosch Dahmen, a former doctor-turned-Green Party MP. “It all seemed very logical in theory,” says Dahmen, who worked on the front lines of the pandemic until November. “But looking at it as a doctor, I thought: this is not how vaccines work in practice.

“She wants her grandmother to get a call from the GP who has been treating her for 20 years and tell her not to worry about the side effects she has heard about on the radio. People are not cars. “

Three months later, the alarm bells are ringing loud enough for all of Germany to hear.

Last spring, at the start of the pandemic, the country seemed like a role model for how to deal with the viral threat. It was managing to contain the outbreaks thanks to a high testing rate and an advanced contact tracing system. As of mid-April, its fatality rate from Covid-19 infections was less than 3%, compared to 14% in the UK and 13% in France, despite a lockdown that was softer than others. parts of the continent. Compliance levels were high, as were the government’s approval ratings.

However, on Friday, the head of Germany’s disease control agency warned that the country was heading for a third wave of the pandemic that would likely be the worst yet, while the government seemed lost in search of answers, giving a 180 degree turn in 48 hours strictly. Plan to lock Easter without offering alternative restrictions in place.

Frustration grows with a patchwork of complex rules, increasingly difficult to follow, issued after increasingly acrimonious videoconferences between Angela Merkel and the heads of Germany’s 16 federal states.

Worst of all, the immunization hyperdrive remains stuck in first gear: 90 days since the first puncture was administered, only 10% of the population in Germany have received their first dose, compared to 42% in the UK and 26% in the US Even France, once considered the most lagging vaccine in Europe, has given a first dose to a larger proportion of its population than Germany.

From the outside, Germany’s relatively successful handling of the first wave of the pandemic was often tied to the wise decision-making of its chancellor, a trained quantum chemist who could calmly explain complex scientific calculations where other leaders resorted to martial metaphors. .

“Macron’s response to the pandemic was’Nous sommes in guerre‘”Said Andreas Rödder, a historian at the University of Mainz.Merkel’s was: ‘Remember to wash your mask at 60 degrees.’

Seen from inside Germany, both the country’s early victories and the current malaise were most easily explained by structural factors, cultural priorities and some degree of fortune: good in 2020, less in 2021.

When Germany imposed its first lockdown on March 22 last year, it was fortunate that, unlike Italy, the virus had not yet quietly spread across the country and into nursing homes. In the highly decentralized country, Covid-19 also faced a political system that was surprisingly well placed to deal with the initial challenges.

People wait to receive a Covid vaccine at a center temporarily installed at a fairground in Cologne. Photograph: Thilo Schmülgen / Reuters

Since health is one of the policy areas delegated to the federal states of the country, Germany had more than 400 local health authorities who already had experience in implementing contact tracing schemes. And a competitive network of regional private and university laboratories gave the country an advantage in testing.

“German federalism in its current form may have historically been designed as a straitjacket for a notoriously aggressive state,” said Siegfried Weichlein, historian of federalism at the University of Freiburg. “But it is a popular straitjacket. At best, as we saw at the beginning of the pandemic, it is a dynamic system that can lead to competition to the top and a higher average acceptance of political decisions. “

By some measures, Germany still stands out: its relative number of pandemic deaths remains considerably lower than comparable western European states such as France or the United Kingdom. But the fear of losing face in the immunization race has come to dominate the national conversation.

A joint procurement program that relied too heavily on the wrong candidate vaccines has created supply shortages across the EU. However, Europe’s largest economy has been slow to administer even the doses it has on its hands, injecting vaccines into people’s arms at a slower rate than 13 other EU states.

Germany’s stockpile of unused vaccines had risen to 3.5 million doses early last week, in part, but not only, because the Health Ministry insists on keeping between 20% and 50% of doses. for the second injection, according to the manufacturer.

In some cases, the immunization campaign has seen the positives of federalism turned into negatives. The western city of Wuppertal announced on Wednesday that it was left with 2,000 doses of unused vaccine, because it had finished inoculating all residents over the age of 80, but authorities in North Rhine-Westphalia had prevented it from moving on to the next group of age. , that he wanted the entire state to move in sync.

Far from seeing a race to the top, the immunization program had created a scenario in which “the laggards are setting the pace,” as the head of the city’s crisis task force put it.

“Whether it’s a bleeding patient or a pandemic: speed trumps perfection,” Dahmen told the Observer. “In Germany, we tried to reinvent the wheel with the launch of vaccines, to perfect a system before putting it into practice. That kind of thoroughness is now backfiring. “

The reason behind running the program solely through the vaccine centers, Dahmen said, was in part that mRNA vaccines like BioNTech / Pfizer and Moderna were thought to require high-tech storage facilities, but also out of fear of a Excessive decentralization: family doctors, concerned authorities, might have been tempted to deviate from the order of priority and administer precious blows to private patients or friends.

Without using GPs, each German state has had to build its own system to find the right people in the right age groups for a jab appointment, some inviting patients by letter, while others rely on being contacted at through overloaded hotlines and screeching online portals. In Lower Saxony, authorities used post office records to search for candidates for the first round of coups, guessing people’s ages based on their first names.

These evils may be produced locally, but public anger is now also reaching the doors of the chancellery in Berlin. Cautious pragmatism has served Merkel for most of her 15 years in power. But among 90% of the unvaccinated public, many now call for bolder leadership.

Hopes that the practices of Germany’s doctors could soon join the vaccination effort were dashed earlier this month when the vaccines authority recommended temporarily suspending use of the AstraZeneca jab over reports of blood clot disorders in a small number of recipients.

Contrary to some speculation in Britain, Merkel’s decision to follow the regulator’s advice had little to do with attempts to politicize the vaccine developed at the University of Oxford. Rather, it was the opposite: an affirmation of the belief that a culture of bureaucratic management without shortcuts can still defeat the virus. Failure to halt the launch of the vaccine despite the caution of the medical regulator would have been political action, but a risk that many Germans would have forgiven their chancellor.

“Instead of making a mistake, it seems, we prefer to stand still,” said former physician Dahmen. “If you want effective crisis management, fear of making mistakes is a toxic attitude.”

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