Who should get the booster and when?

style="float: right; margin-bottom: 10px; font-weight: 600;"Thu 18th Nov, 2021

Now that German Health Minister Jens Spahn (CDU) has spoken out in favor of allowing everyone over the age of 18 to receive a booster vaccination against the coronavirus - even if it has not been six months since the last vaccination - a debate has broken out about the future vaccination campaign. Doctors are pushing for the prioritization of certain groups, much like they did at the start of the Corona vaccination campaign last winter.

"The interval of six months for complete immunization in persons aged 18 years and older, as provided for in the approval, is to be understood as a temporal guideline, which of course cannot be adhered to on a daily basis," reads a letter from Spahn and the chairman of the National Association of Statutory Health Insurance Physicians, Andreas Gassen, to all contract physicians in Germany, which was made available to the Daily Mirror newspaper on Tuesday.

"You can therefore vaccinate every patient over the age of 18, even if they do not belong to the risk groups according to the current STIKO recommendation such as the elderly, residents of care facilities and medical and nursing staff, promptly and even before the six months at their own discretion," Spahn and Gassen said.

The chairman of the Standing Commission on Vaccination (Stiko), Thomas Mertens, has held out the prospect of an early extension of the recommendation for Corona booster vaccinations. The Stiko will discuss on Wednesday "about the next, so to speak, the updated recommendation, and that will not take long, and then the recommendation that you are now complaining about will also come," Mertens said on Tuesday in response to a corresponding question in the ZDF program "Markus Lanz". So far, the panel recommends a booster vaccination, among others, people from 70 years. When asked, Mertens made it clear that the recommendation could be lowered "to 18".

The Stiko also already advises people with immune deficiencies, residents of care facilities and staff in medical facilities, and nursing staff to take the booster. Last week, the committee announced in a statement a "timely" update of its recommendations, also with regard to booster vaccinations. Even then, it was said that for immunological and infection epidemiological reasons, it would make sense to go beyond the current recommendation and offer all others a booster vaccination in the medium term. As far as possible, this should be done in descending order of age.

Mertens emphasized in the ZDF broadcast that at the moment only about eleven percent of those over 60 had received a booster vaccination. Referring to acquaintances and friends his age, Mertens said, "They got their vaccination appointment with their family doctor for the beginning, middle of December. That's the problem, you see, and not the problem now to still say everybody should run to the GP." The problem right now, he said, is capacity - "primary care physicians are severely challenged right now."

The German Family Physicians Association rejects booster vaccinations for all interested parties at this time and warns against a distribution battle. First, vulnerable groups such as people over 70 and the chronically ill would have to receive the so-called booster vaccination, association head Ulrich Weigeldt told the newspaper Rheinische Post.

"Discussions about vaccinating the entire population a third time virtually at the same time do not help in the vaccination campaign." Younger and healthier people are usually well protected even six months after the second vaccination. Since the protection, especially against severe courses, also exists beyond that, they could also get the booster vaccination a little later without any problems, if necessary.

"The hectic pace caused by desolate crisis communication, which has also been continued by the caretaker federal government, only leads to unnecessary stress in GP practices and at least does not contribute to accelerating the vaccination campaign," Weigeldt said.

In the desire for a rapid booster, it must be taken into account "that this would possibly be at the expense of vulnerable patients," Weigeldt told the newspapers of the Funke Media Group. With the third vaccination, it is also important to keep a close eye on those at risk. In addition, far too many people had not even received the first vaccination.

Eugen Brysch, chairman of the German Foundation for Patient Protection, is also in favor of a priority check for booster vaccinations similar to the one at the beginning of the vaccination campaign. It is now "the task of the Conference of Minister Presidents to ensure an orderly booster procedure," Brysch told the newspapers of the Funke Media Group. "Prioritization according to age, illness, as well as occupational group, must be considered again."

The German Medical Association is pressing the federal and state governments for a clear roadmap for millions of first, second, and third vaccinations this fall and winter. A prerequisite for accelerating the vaccination campaign is "that the federal and state governments now create suitable framework conditions for an equally safe, unbureaucratic and low-barrier vaccination campaign," reads a letter from physicians' president Klaus Reinhardt to the 16 heads of the states, the chancellor's office, and the federal health minister, from which the newspapers of the Funke media group report.

Ahead of the Conference of Minister Presidents on Thursday, Reinhardt is calling for additional vaccination services "by reactivating existing vaccination centers, by creating pop-up vaccination centers, e.g. in residential areas and public facilities, by vaccination centers at selected hospital locations, and by vaccination mobiles, especially for rural areas," to relieve the burden on practices that are heavily used during the flu season. Municipalities should also establish centralized appointment points for booster vaccinations and invite vulnerable groups, in particular, to receive booster vaccinations by letter.

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