Balance of care-vaccination obligation: threats with few consequences

It is still unclear whether the obligation to vaccinate nursing and health staff will be extended. The calls for their abolition are getting louder. How has vaccination been enforced so far and what has it achieved?

Five past twelve, Mondays in Durmersheim. With whistles and posters, they stand in a circle in front of the outpatient nursing service Pinkinelli and make noise. Because “five past twelve” also describes a permanent condition in nursing.

In mid-March, the institution-related vaccination requirement was added. Since then, people working in healthcare must be vaccinated or recovered. They must submit corresponding proof to the management of their institution or company. If they don’t, the health department has to be called in. This can impose fines and also react with entry and activity bans.

Compulsory vaccinations led to frustration

What did this compulsory vaccination ultimately bring about? Here in Durmersheim, above all, frustration: “I no longer feel like getting excited and talking about these small issues,” Peter Koch calls out at the demo. He is the managing director of the Gaggenauer Altenhilfe and chairman of the Mittelbaden care alliance. Instead of dwelling on “small issues” such as the institution-related vaccination requirement, “a fundamental care reform” must finally be tackled.

After all, what ultimately became of compulsory vaccination? “The threatening notices have all gone out,” says Nursing Service Manager Ralf Pinkinelli. “After that, nothing came.” The whistles shrill.

Regional differences in implementation

There were early signs that there could be problems with implementation: In February, Bavaria’s Prime Minister Markus Söder announced “the most generous transitional regulations”, because otherwise the burden in care could worsen significantly. And many district administrators, whose health departments have to enforce facility-related compulsory vaccination, met with reluctance and rejection.

There were even lawsuits against it. But the Federal Constitutional Court declared compulsory vaccination to be compatible with fundamental rights. In North Rhine-Westphalia, Lower Saxony and Rhineland-Palatinate, the first entry and activity bans have since been confirmed by courts in summary proceedings. In Bavaria and Saxony, on the other hand, activity bans were not even imposed, according to the ministries.

Johannes Nießen, Chairman of the Federal Association of Physicians in the Public Health Service, confirms this regionally different implementation. “A city like Hamburg, with 1.8 million inhabitants, issued 261 entry bans by mid-September alone. Other cities with a population of over a million have not managed and done so,” says Nießen.

procedures are still ongoing

Also in Baden-Württemberg – with Ralf Pinkinelli and Peter Koch – the procedures have not progressed very far. “There was no fine, it was just the threat,” says Pinkinelli. For the employees it was “always a horror”. “It was really a burden, just plain and simple.”

And the procedures are still ongoing – Pinkinelli’s last letter to the health department went unanswered. “If you don’t get an answer to a letter, you think about what’s going to happen,” he says. “There remains this uncertainty in the room. We had to live with that.”

High vaccination rate in the nursing sector

The compulsory vaccination in Pinkinelli’s nursing service has not achieved its actual purpose – only vaccinated people in nursing. Eight of 41 employees were not vaccinated and would not have changed their minds. A single employee who feared for his job would have considered getting vaccinated. “I could just tell him, please don’t do it out of compulsion, but do it out of your own conviction. Our support is there,” says Pinkinelli.

The situation is similar in the Gaggenau care for the elderly. Of around 350 colleagues, ten to fifteen were not vaccinated, says Peter Koch. He has “one or two employees who found it extremely difficult and then, after months, could no longer withstand the pressure”. Some of them also had psychological problems.

According to a report by the Robert Koch Institute (RKI), in April 2022, 93.3 percent of employees in care facilities were vaccinated twice in Germany. By August 2022, the rate rose to 93.8 percent. In absolute numbers, that’s 99,334 more double-vaccinated people.

“Every vaccination that is not done is one too few”

In vulnerable areas such as retirement homes and hospitals, a few percentage points could make a difference, says Nießen from the Federal Association of Doctors in Public Health Services. “Every vaccination that is not given to the staff is one too few.”

For the health authorities, the facility-related vaccination requirement meant a “considerable effort”. Nevertheless, the bottom line was that the result was positive. However, since the virus has now changed, he advocates not extending it.

The legal basis for compulsory vaccination expires at the end of the year. Federal Minister of Health Karl Lauterbach (SPD) recently left open whether it will expire or be extended. Last week, the health ministers of Saxony, Bavaria, Baden-Württemberg and Thuringia called for an end to the institution-related vaccination requirement.

Many have lost confidence in politics

Pinkinelli from Durmersheim also agrees with this demand: It must finally come to an end. “And now, not just in December.”

One thing in particular has been lost among nursing staff as a result of compulsory vaccination: trust in politics. “We in care, we now distrust politics, we just can’t really judge who is honest with us,” says Pinkinelli at the end of the small demo. And so they roll up their posters again. See you next Monday, five past twelve.