How did Germany turbocharge its vaccine rollout - and what can it do better?

Anyone who lives in Germany will know how frustrating the vaccine rollout has been thanks to supply issues, bureaucracy difficulties and the inflexible vaccination prioritisation list. But things shifted up a gear after Easter.

Overall, Germany has now administered more than 35 million vaccine doses against coronavirus. Around 27.3 million were first doses and about 7.8 million were for second jabs.

Up to May 10th, a total of 33.3 percent of the population had received at least one shot, and 9.6 percent of the population had been fully inoculated.

We faced difficulties at the beginning. But the vaccination campaign is now in full swing in Germany. Have reached higher daily per capita rates than in the US or UK. Big thanks to the many people who helped us manage this important turn around. pic.twitter.com/ESPNLOLkOu

— Miguel Berger (@GermanAmbUK) May 12, 2021

More vaccine supplies 

Perhaps the main reason Germany’s inoculation campaign got off to a frustratingly slow start was because of the EU-wide supply issues for coronavirus vaccines.

Here in Germany we watched as countries like Israel, the US and the UK - among others - jabbed their populations at super speed, while our own rollout and that of other EU countries fell short.

Now many of these countries are opening up widely again with low Covid rates, while Germany is still lagging behind.

The chart above by Our World in Data shows the breakdown of vaccinations by those that have been partly or fully vaccinated.

The lack of vaccines was blamed on the purchasing strategy of the EU - the Commission is said to have signed its contracts too late and paid the pharma firms too little money.

Meanwhile, the main providers in the first part of the year – BioNTech/Pfizer, Moderna and AstraZeneca – all failed to deliver the agreed amount of doses for the first quarter of the year, further impacting EU countries.

It led to some of the 430 vaccine centres across Germany being underused or even lying empty. Some even had to close when they had run out of vaccine doses. 

This changed in the second quarter. From April onwards, Germany received significantly more deliveries of vaccine doses. 

By March 22nd 2021, over 14.3 million vaccine doses from BioNtech, AstraZeneca and Moderna had been delivered to the federal states.

In the week after Easter alone, almost 3.3 million doses of vaccines were delivered throughout the country. 

And in the last week of April, 5.4 million doses were delivered, 3.2 million of which were expected to be administered in doctors’ practices.

The federal government says Germany is expected to receive a total of 300 million doses if all possible vaccine candidates are approved. The vaccine Johnson & Johnson, which only requires one dose, has also now been approved and is involved in the rollout. 

READ ALSO: Germany makes J&J vaccine available to all adults: What you need to know

Family doctors giving out jabs

This is arguably the biggest gamechanger. Allowing GPs to vaccinate their patients led to a significant boost to Germany’s vaccine drive.

It’s evident in the numbers - in the first week that GPs joined the vaccination effort (from April 6th) Germany hit its first major achievement - the country vaccinated 656,000 people in a day. Up until that point, no more than 367,000 vaccine doses had been administered in Germany on any given day.

People queueing up for a jab in the Chorweiler district of Cologne. The western city has started giving out vaccinations in socially disadvantaged areas. Photo: picture alliance/dpa | Oliver Berg

These numbers have remained consistently high, at least on weekdays. And on Wednesday April 28th, the country smashed a European record by delivering 1.116 million jabs into the arms of residents.

A week later a similar amount of shots were given.

READ ALSO: Germany reaches milestone of 30 percent of population vaccinated against Covid

According to the Health Ministry, a total of 31.4 million vaccine doses against Covid-19 were administered in Germany up to and including May 4th. Of these, 25.4 million doses were given in vaccination centers and 5.9 million in medical practices. 

The head of the National Association of Statutory Health Insurance Physicians, Andreas Gassen, praised GPs for their role. He said: "This is actually probably the decisive milestone in the fight against the pandemic."

So what is it about doctors that helps the campaign? Well, there are now around 65,000 of them taking part so there's lots more medical professionals giving out jabs.

But it's also about the close relationship they have with their patients, which can help encourage those with vaccine hesitancy.

Doctors can also call patients up at short notice if they have leftover doses at the end of the day.

This localised way of delivering jabs into arms is a huge positive. If you only need to go down to the road to your local GP who you've known for yours for the vaccine rather than trailing across a town to a centre full of strangers, it can make the experience much less daunting.

The chart above shows the daily number of Covid-19 vaccination doses administered per 100 people. This is shown as the rolling seven-day average.  Germany has climbed to a higher position in this chart in recent weeks.

And the reason it took so long for them to join the campaign? The government said they didn't have enough supplies in the first quarter to provide for both the vaccination centres and GP practices. So the introduction of doctors goes hand in hand with the availability of vaccines.

Also let's not forget that giving out Covid-19 vaccines in practices is worthwhile for doctors from a business perspective. According to Wirtschafts Woche, a practice that carries out 20 vaccinations a day could potentially generate around €400 additional income.

Lifting the priority list on some vaccines 

Another big moment in Germany's vaccine campaign came when some states - initially Berlin, Bavaria, Saxony and Mecklenburg-Western Pomerania, announced in April they were to lift the priority order for the AstraZeneca vaccine, meaning it could be offered to everyone over the age of 18 regardless if they were a 'risk' group or not.

Due to risks connected to blood clotting conditions, Germany had advised that AstraZeneca should only be given to the over 60s. But those under 60 who wanted it could get it after a detailed consultation with a doctor.

Last week all federal states opened up AstraZeneca to all, and on Monday the same happened with the Johnson and Johnson vaccine.

It means that anyone over 18 who wants one of these vaccines can ask their own GP for an appointment, they can call or email other doctors' offices or they can keep an eye out for open clinics where doctors give out the jab. These are often advertised online or passed around on social media.

For example, some doctors have been publishing online when they plan to give out the vaccine, and people queue up for it, like in the below tweet from Berlin.

The great AstraZeneca free-for-all has begun: about 200 people in this queue stretching all the way to a family doctor offering jabs without appointment or pre-registration today. pic.twitter.com/sR0rDWJqj6

— Philip Oltermann (@philipoltermann) May 8, 2021

Increasing flexibility has led to more people outside of high priority groups receive a vaccination.

The states who made this move first did it to avoid wasting doses. Throughout the vaccination campaign in Germany, reports have emerged of AstraZeneca doses being left unused.

Last month Bavaria’s health minister Klaus Holetschek said: “Every dose of vaccine must be administered as quickly as possible."

How can Germany keep the momentum up?

The country is relying on a steady supply of vaccines over the coming months. If that box is ticked, it makes everything else easier.

Starting in June, in-house company doctors nationwide will be given the green light to go ahead and vaccinate staff. That will see entire workforces inoculated against Covid-19.

Some regions are already running pilot projects with companies.

Employees of the chemical and pharmaceutical company Merck KGaA in front of the Covid vaccination centre earlier in May. Hesse has started a pilot project with five pharmaceutical companies to vaccinate employees. Photo: picture alliance/dpa/dpa/POOL | Arne Dedert

Authorities, including Cologne and Berlin, are also going into socially-deprived areas to help deliver the vaccine to people in communities with mobile clinics.

Bavarian premier Markus Söder said recently that the southern state will look to give the vaccine out at supermarkets and other locally accessible places. Other states will likely follow.

READ ALSO: Bavaria plans vaccines 'in supermarkets, schools and pharmacies'

Countries that have already achieved a high level of vaccination coverage for the population, such as the USA or Israel, have opted for different ways of getting injections to people. They are often delivered in the form of drive-ins with mobile teams.

What can Germany do better?

Despite a clear acceleration of vaccine delivery in Germany, we've heard anecdotally that there are still people who belong to 'risk' priority groups who have not been vaccinated yet.

Readers of The Local have also reported that they've struggled to find information or get an appointment even though they qualify for a shot.

This could be down to bureaucratic failures in states when trying to secure appointments. It's also not particularly helpful that each state in Germany has a different way of doing things, and processes change at short notice.

For instance, Berlin recently stopped sending out letters to eligible people and published online that people who qualify should book appointments themselves. But does everyone know that? 

Some local authorities have also been slammed for not making a bigger effort to carry out vaccinations at the weekend and on holidays. At Easter some states announced they were closing their vaccination centres on the public holidays.

Another factor is the behaviour of people. It appears you are more likely to get a vaccine if you push for it, ask your GP repeatedly or have the time and resources to contact lots of different doctors.

You might know a person with a contact for a vaccinating doctor, or you might be lucky enough to receive an appointment from your own doctor.

However, if you are waiting for a vaccine appointment to come, it might take a lot longer.

This points to a long-standing problem with Germany's organisation of the vaccine rollout: it isn't very logical, and a lot of it depends on luck. 

As the country looks to lift the priority list and open up vaccines to everyone over 18 some time in June, the infrastructure to offer appointments in many more places will have to be there so that people can access jabs more easily.

And as the German government has already relaxed Covid restrictions for vaccinated people, lots of residents want their jabs as soon as possible so they can get more freedoms and back to some kind of normality.

READ ALSO: 'Mood is getting more aggressive: Thousands of people in Germany caught skipping line for Covid vaccine