Icon: enlarge
Corona vaccine ampoules in a senior pen: five or six doses?
Photo: Laci Perenyi / imago images
Since the vaccination started at the end of December in the European Union (EU), a good 1.3 million people in Germany have received the corona vaccination.
The implementation has also been criticized since the start of the vaccinations.
At first it was said that the number of vaccine doses purchased was insufficient, and on January 8, 2021, the EU Commission then reordered 300 million doses.
Now there are new difficulties.
Vaccine manufacturers Biontech and Pfizer have announced delivery delays.
Conversion measures that are intended to allow more extensive production in the long term therefore mean that the active ingredient cannot be produced in the previous quantities in the short term.
"It was to be expected that there would be delivery bottlenecks in the meantime, especially as long as one is primarily dependent on one active ingredient," said vaccine researcher Leif Erik Sander from the Berlin Charité to SPIEGEL.
Before the start of the vaccination, experts had pointed out that there could be difficulties in expanding production capacities.
The effects of the production changes at Pfizer, however, are manageable.
From January 25th, Biontech / Pfizer will deliver fewer bottles with the rare vaccine.
Nevertheless, the federal states are getting no fewer doses than originally planned because a bottle now officially contains six instead of five doses.
Average with room for improvement
In the federal states, the delivery delays are still causing uncertainty.
In some regions, such as North Rhine-Westphalia, vaccination efforts were initially interrupted.
At the same time, hundreds of thousands of vaccine doses are lying around unused, and vaccinations are far from being given to the same extent every day of the week.
Sundays in particular have an unpleasant pattern: The vaccination statistics of the Robert Koch Institute (RKI) show that the number of vaccinations on the weekday drops regularly.
However, one can only speculate as to why this is the case.
It seems obvious to researcher Sander that it is more difficult to mobilize staff for the vaccinations on Sundays.
Sander believes that stronger monetary incentives could help here.
But it is also conceivable that the willingness to vaccinate is lower on Sundays because people do not perceive them as potential vaccination days.
So far, 34 percent of vaccinations have been given to nursing home residents and almost half to medical staff.
The vaccination in the vaccination centers, outside of clinics and homes, is just getting started.
According to a SPIEGEL survey in the federal states, many institutions also want to open on Sundays.
However, there is currently a completely different problem.
Get faster and better
Most of the federal states report that the vaccination doses are the limiting factor.
"The opening times of the vaccination centers depend on the amount of vaccine delivered," says North Rhine-Westphalia, for example.
Other federal states, such as Berlin, are waiting for more vaccination doses to even open all vaccination centers.
In an EU comparison, Germany is not doing so badly.
The number of inoculated doses per inhabitant is roughly the European Union average.
Almost 1.4 million people in Germany have received the first dose of vaccine so far, which corresponds to around 1.7 percent of the population.
Around 115,000 people received the second vaccination.
Still, there is room for improvement.
"We have to get faster and better," said Sander, referring to the still high death toll.
"I think that's out of the question." Any strategies that would allow more people to be vaccinated in less time would have to be examined.
In addition to more efficient logistics, this also applies in particular to the availability of vaccination doses.
Around half of the deliveries are in the dump
So far, for each vaccine dose administered, a further vaccination should be withheld for the second vaccination planned a few weeks later.
The second vaccination is necessary to achieve almost complete protection against Covid-19, as has been demonstrated in the approval studies by Biontech / Pfizer and Moderna.
How many vaccination doses are currently in storage rooms for this reason cannot be precisely calculated from the daily published vaccination data from the Robert Koch Institute, but it can at least be estimated.
The problem: Biontech, in its information on vaccine deliveries, is already assuming that six doses will be obtained from each ampoule of vaccine delivered.
Since when and to what extent this has been implemented by the federal states, however, is uncertain.
The European Medicines Agency (Ema) approved the procedure on January 8th.
Assuming that by January 8th five doses were obtained from each bottle and from January 9th six, Biontech / Pfizer and Moderna have delivered more than three million vaccination doses to Germany by January 21st, according to SPIEGEL calculations .
About 47 percent of them were vaccinated, the rest is in the depots according to the bill and will be saved for the second vaccination and further primary vaccinations on the following days.
When holding back the doses for the second vaccination, the federal states proceed differently.
Mecklenburg-Western Pomerania, Schleswig-Holstein and Rhineland-Palatinate put back fewer cans than the other federal states.
If the weekly Biontech deliveries suddenly fail completely, according to SPIEGEL calculations, they would not have enough doses to vaccinate all people who have been vaccinated a second time.
Become more flexible
"The delivery bottlenecks at Biontech / Pfizer are unfavorable, so it is all the more important that we deal more flexibly with the vaccine range," said Sander.
He refers to ongoing modeling studies by colleagues who are running through various vaccination scenarios.
more on the subject
Covid-19 vaccinations in Germany: Most of the cans are stored in the depot by Holger Dambeck
Dispute between Berlin and Brussels: Who knew about the delivery bottleneck and when? By Markus Becker and Cornelia Schmergal
It shows that with the currently selected strategy, higher case numbers and greater mortality can always be expected than with more flexible approaches.
"Depending on the expected vaccination deliveries, you could decide how many doses have to be withheld," says Sander.
"Instead of holding back another dose for each inoculated dose, an emergency reserve of 10 or 20 percent for the second vaccination would be conceivable."
The importance of the second vaccination
Sander also points out that there is room for maneuver in the time window for the second vaccination, in the event that bottlenecks should arise.
The Standing Vaccination Commission (Stiko) of the RKI recommends that the vaccination doses be administered at least 21 or 28 days apart and no later than 42 days after the first vaccine dose.
Even if it gets later, it won't be a drama, says Sander.
Between the years it was discussed, for example, whether the interval between the vaccine doses should be extended in view of the scarce vaccine quantities.
Then, so the idea, more people could initially receive the first vaccination and would at least have some kind of protection against Covid-19.
The Stiko has so far advised against this.
It is uncertain whether a postponement of the second vaccination dose "prevents more serious illnesses and deaths than a prompt second vaccination for high-risk groups, which then leads to almost complete protection from disease." The problem: It is still unclear how great the protective effect after first vaccination is.
"In the current situation, however, I think it is crucial to discuss a change to a more flexible strategy," explained Sander.
As soon as it is clear how good the vaccination protection is after the first dose, specialists should again advise whether the interval between the first and second vaccination can be extended.
Icon: The mirror
Collaboration: Nina Weber
