Two years of corona chaos around Stiko - who is to blame?

Created: 12/27/2021, 1:12 PM

From: Andreas Schmid

His decisions have an impact on Germany's vaccination campaign: Stiko boss Thomas Mertens © Kay Nietfeld / dpa

The criticism of the Stiko has recently increased.

But is the body responsible for errors in pandemic policy at all?

An analysis.

Munich - The Standing Vaccination Commission was probably much less known to people two years ago than it is now, in the middle of the second Corona winter. The main task of the Stiko is to give vaccination recommendations. The expert group thus has a decisive influence on the fight against pandemics in Germany. That doesn't always go smoothly. She was recently almost branded a bogeyman by parts of politics. The Ministry of Health complained that Stiko was taking too long to make decisions.

The Stiko in turn admits mistakes, but also defends itself.

Is it really just a toothless tiger that is neglected by politics despite the global pandemic?

Or could it provide the government with important information better and faster?

What part does Stiko have in the currently slow vaccination campaign?

What blame is politics on?

A search for clues.

Corona: Stiko sticking point personnel - only 3.5 full-time positions

The Standing Vaccination Commission has existed since 1972 and - something that was not known to many for a long time - is affiliated with the Robert Koch Institute. The RKI in turn belongs to the Federal Ministry of Health. The Stiko consists of a total of 18 experts, most of whom work on a voluntary basis. During its almost 50-year existence, the Stiko usually did not receive too much attention. The group met twice a year to develop recommendations about vaccinations in Germany, which the RKI then published. That has changed with Covid-19. The Stiko is under constant surveillance - but still works with the same resources as before Corona.

There are only 3.5 full-time positions at Stiko.

This emerges from a request from the left-wing politician Jan Korte, which

has received.

There has been no increase at Stiko since the start of the pandemic.

Korte describes this as "incredibly negligent".

The federal government - for a long time led by the Union and the SPD and now from the traffic light - is apparently "too incompetent and too stingy" to "properly equip" the Stiko office.

Party colleague Ates Gürpinar made a similar statement to our editorial team.

It is "incomprehensible" that Stiko is still working as it was before Corona.

"This is a downright refusal to work by the federal government, which we experience more often in the fight against pandemics."

Stiko calls for more staff: "Are extremely busy and understaffed"

Stiko's resources are scarce. So close that the actually media-shy vaccination commission went public with its own statement a week before Christmas. It clearly denounces the personnel list: "Like other public health facilities, the Stiko office has been extremely strained since the beginning of the pandemic and understaffed for this situation."

It urgently needs more than 18 employees.

Stiko boss Thomas Mertens was thinking, for example, of modelers who show the future path of the pandemic.

The address of Karl Lauterbach is clearly stated: "Stiko is demanding that the new Federal Health Minister strengthen the Stiko office for the areas of communication, epidemiology and modeling." The Ministry of Health let it be known that the personnel situation would be taken care of.

Lauterbach recently said on RTL: “The Stiko could decide a little faster.

But for that she needs more staff.

It has far too few employees.

I'll make sure that the Stiko is better equipped. ”It took four corona waves before the shortage of staff really became an issue.

Stiko sticking point speed: Spahn and Lauterbach criticize the way they work

Ex-Health Minister Jens Spahn (CDU) even publicly questioned Stiko in the last days of his term of office: "I simply believe that the very important instrument of the Standing Vaccination Commission is not suitable for pandemic times," he said in the federal press conference. Spahn praised the “scientific expertise and work that is available in a few other countries in the world”, but then put his criticism in concrete terms: “The only question is whether in a pandemic and health crisis there isn't a different mechanism needed for recommendations on Vaccination than the conventional one. ”When it came to boosting, for example, Germany was“ simply not fast enough ”, the member of the Bundestag said“ without reproach ”on the record.

In the Stiko itself, their own role in a dynamic pandemic situation is also not uncritically acclaimed by all members.

Why Spahn, as the responsible health minister, wasted two years making the Stiko suitable for pandemics, however, remains an open question.

"We would like to be often faster," said Stiko member Martin Terhardt on Deutschlandfunk.

However, this simply requires more staff.

Successor Lauterbach is now setting a different pace to the outside world, but also criticizes the Stiko: “We will definitely hold talks about the speed of the Stiko.

It has to go faster, ”said the SPD politician to

.

The old and the new: Jens Spahn and Karl Lauterbach talk in the Bundestag lobby.

Neither of them are completely satisfied with the Stiko.

(Archive image) © Political-Moments / Imago

Stiko sticking point working method: 16 different corona vaccination recommendations since December 2020

It is clear that the way the Stiko works has changed massively as a result of the pandemic.

In pre-corona times, the recommendation of a new vaccine was discussed for at least six months, usually more than a year.

This is done in individual working groups based on scientific studies.

This time is no longer due to Corona.

Recommendations are requested - and given - after three months.

This is also problematic because the time pressure means that tasks away from the corona are neglected.

"The problem is that there are not only Covid-19 in the area of ​​responsibility of Stiko, but various other vaccinations and new topics that have not been dealt with for more than a year and a half," Stiko member Sabine Wicker recently told the

.

Stiko has updated its original Corona vaccination recommendation from December 18, 2020 16 times in the last twelve months.

This happened on the basis of more than 40 Stiko consultations in plenary and numerous meetings in small working groups.

Before Corona there were new vaccine studies every few months, now they appear in the relevant science magazines on a daily or weekly basis.

Stiko sticking point boosters: The rolling course for third vaccination

Meanwhile, Stiko boss Mertens admitted that certain decisions of the commission "from today's perspective" were made too late. It would have "probably been cheaper to start boosting earlier," said the virologist on ARD. The Stiko had only recommended the booster vaccinations in November, and many doctors used it as a guide. In other countries like Israel, however, booster vaccinations had long since started. The third syringe was given in Israel in August. In Germany at that time it was campaign time for the Bundestag election.

With the booster vaccinations, there were always discrepancies between the position of the Stiko and the announcements of the Ministry of Health. Stiko spoke of a six-month gap between the second and third vaccination until mid-December, while Spahn and other health ministers at state level such as Klaus Holetschek (CSU) - in this case chairman of the health ministers' conference - suddenly considered five months to be sufficient in mid-November. This coincided with the assessments of the European Medicines Agency (EMA), but: Stiko and the Ministry of Health once again gave different opinions.

Some people who wanted to be vaccinated were therefore turned away to general practitioners' practices and vaccination centers because the six-month deadline had not yet been reached.

A chaos for which Stiko is also partly responsible.

Overall, there were three different assessments of the booster within a month.

• November 18, 2021

  : Stiko recommendation for boosting for all population groups.

  A third dose was previously recommended for immunocompromised and over-70s.

  Recommended interval to the last vaccination: six months.

• November 29, 2021

  : Updated booster recommendation.

  The first calls to shorten the vaccination interval to five months are loud.

  The Stiko writes: "A shortening of the vaccination interval to five months can be considered in individual cases if there are medical reasons or if there are sufficient vaccination capacities."

• December 22nd, 2021

  : Stiko recommendation to boost after just three months.

Stiko sticking point child vaccination: Germany is taking more time

Compared to other countries, Germany takes more time with vaccination recommendations.

Lower Saxony's Prime Minister Stephan Weil (SPD) recently denounced that the Federal Republic had started vaccinating later again and again in an international comparison, also due to later Stiko recommendations: "That must not happen to us again in this situation." That is the case with the USA Vaccination of pregnant women started in July 2021, while Stiko did not recommend this until September.

When child vaccinations were already being carried out in Austria at the beginning of December, a recommendation first had to be drawn up in Germany.

If a vaccine is approved by the EMA, the Stiko makes a recommendation.

The EMA had announced well in advance of the Stiko that child vaccinations could be possible from December 13th.

Stiko wanted to wait for data from the USA before making a recommendation.

However, this scientifically understandable position faded into the background because Mertens said publicly that he would not (yet) have his own child of primary school age vaccinated.

For this statement there was criticism from, among others, Markus Söder.

In view of the low vaccination rate, Söder rated the attitude of the Stiko boss as "strange".

Stiko sticking point of the Ministry of Health: Again and again unclear communication

On December 9th, Stiko finally issued a restricted vaccination recommendation for five to eleven year olds. The recommendation only applies to children with previous illnesses and contact with high-risk patients. According to Mertens, the data required for a comprehensive assessment was lacking. "The data basis for a general recommendation is not given at the moment from the point of view of the Stiko." Actually, a clear communication from the vaccination commission. However, the Federal Ministry of Health writes on its website for a brochure on vaccination information: "The Standing Vaccination Commission (Stiko) at the Robert Koch Institute recommends vaccination with an mRNA vaccine for all children and adolescents between 5 and 11 years of age and from 12 years of age." The wording is not entirely correct, however. Because the Stiko recommendation does not refer to

children.

The ministry

told

that the corresponding text was written before the Stiko recommendation.

“The anteaser text on the homepage may be a little inaccurate, we'll take another look at that.” But it is also true that “all children from the age of 5 can be vaccinated”.

Stiko boss Mertens was irritated to our editorial team about the corresponding text passage.

“I cannot tell you why the BMG chose this formulation.

It may be a

. ”However, it is questionable whether this simplified representation improves communication between Stiko and the Ministry of Health.

There had also been a public crash between the RKI and the ministry before Christmas, although everyone involved tried to relax the situation afterwards.

Stiko boss Mertens rejects criticism: "These are all things that do not affect us at all"

Mertens did not want the ARD to accept that the Stiko's way of working would result in disadvantages for the politicians' vaccination campaign. It is not the job of Stiko to organize “the implementation of the vaccination” or to decide “how the vaccines are procured, how the vaccines are distributed. These are all things that do not affect the Stiko at all ”. The RKI argues similarly. "The implementation of vaccination recommendations for around 83 million residents in Germany is a matter for the federal states, not for Stiko. A voluntary committee currently consisting of 18 members has neither the mandate nor the capacity for this. "

Stiko member Wicker agrees with this point of view.

“Ultimately, it is a medical-epidemiological question as to when and whether someone should be vaccinated.

These questions should primarily be answered medically and epidemiologically. ”Politicians should then implement them.

What is the task of the Stiko and what is not is regulated by the Infection Protection Act.

The commission gives recommendations for the implementation of protective vaccinations and for the implementation of other measures for the specific prophylaxis of communicable diseases and develops criteria for differentiating between a usual vaccination reaction and any damage to health that goes beyond the usual extent of a vaccination reaction.

Section 20 Infection Protection Act

Stiko sticking point Astrazeneca: back and forth with age recommendations

With its decisions, however, the Stiko influenced the vaccination campaign at least in part.

She revised earlier decisions several times, for example at Astrazeneca or Moderna, where the age recommendations were adjusted several times.

This is done on the basis of carefully worked out scientific findings.

If there is new data, the recommendations also need to be adjusted.

This is understandable from a scientific point of view, but may cause uncertainty in parts of the population - just like the possible impression that vaccination recommendations are made more politically than scientifically.

• January 29, 2021

  : Astrazeneca receives EMA approval.

  On the same day, the Stiko recommends not to use the vaccine in people over the age of 65 for the time being.

  There is not enough data yet.

• March 11, 2021

  : The Stiko changes the age recommendation for the first time.

  Astrazeneca can be vaccinated for all population groups.

• March 15, 2021

  : Germany stops vaccination with Astrazeneca.

  The background is cerebral vein thrombosis in young women.

• March 19, 2021

  : According to EMA, the benefits of the Astrazeneca vaccination outweigh the risks.

  Several countries leave the vaccine out, Germany continues to vaccinate all people over the age of 18.

• March 30, 2021

  : The Stiko changes the age recommendation again.

  Astrazeneca should only be vaccinated in people over the age of 60.

  The federal government stops vaccinating the younger generation.

• July 1, 2021

  : Updated recommendation from Stiko.

  Whoever received the first dose of Astrazeneca should receive the second vaccination with Biontech or Moderna - regardless of age.

Stiko sticking point corona communication: task of the vaccination commission?

The back and forth about Astrazeneca caused uncertainty among the population.

Correct communication is also important on this point.

Left-wing politician Gürpinar sees the fundamentally independent way of working of the Stiko as "a valuable asset", but communication, which is now threatening to become a handicap for the German vaccination campaign, is in need of improvement.

Stiko and politics are more and more at odds.

The lines of communication should actually be short, after all, both institutions are connected to one another via the Robert Koch Institute.

"The Ministry of Health is represented as a permanent guest in all Stiko meetings," explains a spokeswoman for the RKI on request.

Nonetheless, the cooperation seems to be at least partially disrupted.

"The waiting, hesitant formulations unsettle people who cannot understand the course of scientific studies from their own experience," says Left Party Vice-President Gürpinar.

"We need science communication that allows even less informed people to make an informed decision for the benefit of their health." That means: "The findings have to be translated into everyday language."

But: is Stiko responsible for this communication at all?

Or is it not rather up to politics to “translate the Stiko findings into colloquial language”?

The Standing Vaccination Commission is actually only responsible for the assessments.

Political decisions derived from this do not fall within their area of ​​responsibility.

"The tasks of politics (making decisions) and Stiko (developing recommendations as a basis for decision-making) are different," says the RKI.

Corona: Can speed and thoroughness be reconciled?

"If politicians come to the conclusion that a vaccination is sufficiently safe to be used strategically in the pandemic, even without the relevant evidence, that is a decision that politicians can make on behalf of society as a whole," said Stiko- Member of the

Fred Zepp

. "But they cannot expect Stiko to legitimize such decisions as part of their previous statutory work mandate as long as insufficient data is available."

It is also a fact: The federal government made several decisive mistakes in the corona pandemic that have nothing to do with the Stiko: Reacting too late to the low vaccination rate, breaking the word regarding mandatory vaccination, repeatedly too few vaccination doses ordered. In December vaccination appointments had to be canceled across Germany because there was simply no vaccine available. The Upper Bavarian district of Rosenheim, one of the pandemic hotspots in Germany, received just 1,000 * of the 22,000 Biontech vaccine doses ordered. And that in the middle of the fourth wave, in which Germany is discussing compulsory vaccination.

Overall, the pandemic policy is faced with the question: Can speed and thoroughness be reconciled?

In the midst of the crisis, politics demands quick decisions, for Stiko scientific correctness has top priority.

Both components do not seem to be entirely mutually exclusive.

In order for them to harmonize with one another, however, successful communication between the two parties is also required.

Both sides should be interested in this goal, as everyone is concerned - as is always emphasized - with the health of the population.