Who should be vaccinated first?
The latest developments give hope in the fight against the novel coronavirus: On November 9, the pharmaceutical companies BioNTech and Pfizer presented first results from the decisive clinical study phase. The good news is that their vaccine provides more than 90 percent protection against COVID-19 disease. The companies plan to apply for approval in the U.S. next week, and supply contracts are already being signed worldwide. The EU, for example, plans to order up to 300 million vaccine doses.
But even if the first doses are available at the beginning of 2021, as hoped, they will not be enough for all citizens who are ready for vaccination. So which population groups should be vaccinated first? At the request of Federal Health Minister Jens Spahn, the Standing Commission on Vaccination (STIKO), the German Ethics Council and the National Academy of Sciences Leopoldina have now published a joint position paper on this issue. As STIKO chairman Thomas Mertens explained, this document will form the basis for more detailed recommendations that STIKO, which is based at the Robert Koch Institute, will be working on before the end of the year.
The experts at STIKO, the Ethics Council and the Leopoldina suggest that the following population groups should be vaccinated first: the elderly and people with health problems, health care workers and people who work in basic areas of general interest - i.e. in public services providing basic care, such as schools or hospitals.
At the press conference to present the results, the chairwoman of the German Ethics Council, Alena Buyx, emphasized that this prioritization - i.e. giving preference to individual population groups until enough vaccine is available for everyone - will be limited in time. But because it concerns elementary questions of health and life protection for each individual as well as justice and solidarity in society, special care must be taken. "Prioritization decisions must conform to the constitution, be publicly communicated in transparent and well-founded procedures and be legally secured," said Alena Buyx.
Fair and regulated access to vaccination
The authors of the position paper have developed four vaccination targets as a basis for prioritization. According to this, firstly, severe COVID-19 courses with hospital stays and deaths should be prevented. Secondly, persons with high occupational risk, such as medical staff, need special protection. The third vaccination target involves the protection of persons who perform functions that are particularly relevant to the community and cannot be easily replaced. These include health officials, police, firefighters and teachers, who often have direct contact with risk groups. Fourthly, the maintenance of state functions and public life must be ensured. "But you don't have to wait for the first group to be fully vaccinated before you can start with the second, that can run in parallel," says Alena Buyx. "Because some groups can be vaccinated easier and faster than others. But contingents must be kept in reserve.
The goal is to achieve the greatest benefit for the entire population, Thomas Mertens described. The experts are aware that such prioritization must be communicated to the public in a transparent and comprehensible manner - for the sole reason that vaccinations always require informed, voluntary consent. Vaccination to protect against SARS-CoV-2 infection will also be voluntary. There will be no general obligation to vaccinate, the experts made clear.
"Vaccination to protect against SARS-CoV-2 infection will be voluntary."
Establishment of vaccination centers and mobile vaccination teams
As early as mid-October 2020, Jens Spahn had commissioned the health ministers of the German states to determine locations for the 60 vaccination centers planned throughout Germany. There are several considerations behind this approach. For one thing, the SARS CoV-2 vaccines are heat-unstable and have to be transported and stored at temperatures below zero, which would pose major challenges for family doctors. Spahn also does not want to burden them with the burden of prioritization. In addition, there should be mobile vaccination teams that could vaccinate residents of old people's homes or nursing homes, for example. The vaccine would be free of charge for the population.
As with any newly approved vaccine, the SARS CoV-2 vaccine will require early detection and documentation of any side effects occurring after market launch. Structures will also be established for this purpose in the coming weeks. Taking into account data protection, certain product-specific information such as the name of the preparation and the batch number, the vaccination date, the place of residence and the age of the vaccinated person as well as any side effects will be recorded in a central database.
According to Leopoldina President Gerald Haug, the well-known corona protection measures must still be implemented and adhered to, despite all optimism. Even if the vaccines will be available, the AHA-L rules and contact restrictions will still apply, Haug emphasized.
Patience is required
Carlos A. Guzmán, head of the Department of Vaccinology and Applied Microbiology at the Helmholtz Centre for Infection Research (HZI) in Braunschweig, also believes that prioritization will be essential. But Guzmán also has another aspect to consider: "Experience with other vaccines shows that not every vaccination is equally suitable for all population groups. For example, we may have a SARS Cov-2 vaccine available that is particularly effective in adults up to the age of 59. Or another that is particularly well tolerated by people over 60. Which population groups we administer the vaccines to will therefore also depend to a large extent on the results of the clinical studies and the resulting approvals. Until these are available, we still need to have a little patience.