Thomas Mertens is not easy to upset. The chairman of the Standing Vaccination Commission (Stiko) is one of the defining faces of the pandemic, along with Lothar Wieler and Christian Drosten. All three were exposed to hostility for their assessments, but Mertens became a Watschenmann for parts of the public, perhaps because even in times of greatest uncertainty he exuded this friendly calmness that can make hectic people nervous.
Now Mertens has become annoyed, namely about the “unreflected criticism” of the family doctors, who accused him and the Stiko blanket of poor communication. In detail, it is about the recommendation announced last week by Stiko to use an mRNA vaccine for the second vaccination after a first vaccination with the vaccine from Astra Zeneca, i.e. vaccine from Biontech or Moderna. According to Stiko, the immune protection is “clearly superior” if two different preparations are given with a vector and an mRNA vaccine than if Astra-Zeneca vaccine were given both times.
Many patients are unsettled by the new recommendation, say the family doctors
The family doctors reacted indignantly to the “surprising” recommendation. Patients are “insecure and ask which vaccine they will receive with the second vaccination and want to bring their appointment forward accordingly,” complained Ulrich Weigeldt, chairman of the German Association of General Practitioners. The additional effort is enormous, in the next few weeks alone there would be three million second vaccinations with the Astra Zeneca vaccine in practices, said Andreas Gassen, head of the National Association of Statutory Health Insurance Physicians. Lack of vaccine, overworked employees – the culprit for the expected chaos in the practices was quickly identified: the Stiko. There was a lack of “clear communication and early involvement of those who ultimately implement the recommendations,” said Weigeldt.
Thomas Mertens knows that “God gave him a thick skin”, but in this case the Stiko boss sees his commission treated unfairly. “Apparently very few people know how a recommendation is made,” says Mertens. Surprisingly, nothing is owed here, but rather the careful weighing of scientific findings and the gradual evaluation and discussion. To make this clear, Mertens wrote an open letter that was published in German Medical Journal should be published and the SZ is already available.
Accordingly, the Stiko first define which scientific findings should be available for the respective recommendation. After extensive, systematic literature research and mathematical modeling, the result is evaluated and discussed, the same happens with the first draft of the text until the revised text is voted on among the 18 Stiko members. Then the draft of a new recommendation goes into the opinion process, in which the federal states, the Ministry of Health and specialist societies are involved. The draft is public no later than one hour after this prescribed procedure has been initiated; possible changes can be agreed.
“I can understand the problems that have arisen and the additional workload in the practices, but what better communication could have avoided this is open,” says Mertens. After all, as with other important changes, Stiko itself informed in advance. Mertens is convinced that such advance information can only be given in public, because it would never remain “secret”, but instead be widely discussed immediately. Mertens is convinced that doctors would not believe that if they had been informed in advance about a new vaccination sequence they could still have vaccinated according to the outdated recommendation and that their patients would have accepted this.
The frustration of the general practitioner is understandable; Nerves are bare everywhere during the pandemic. For general practitioners and specialists, who were only included in the vaccination campaign with a delay and who have made a significant contribution to increasing the vaccination rate, vaccination means considerable additional effort. The spade in the upper arm is the smallest part of it. Drawing up the syringe from the tiny vials takes a lot of time and patience. Informing the patient as well, plus follow-up observation. The documentation is extensive, the IT announced by the Ministry of Health for the digital vaccination certificate did not work at all at first – it still does not work for those who have recovered who only receive one vaccination. The 20 euros that doctors are allowed to charge for the vaccination process in their practice barely cover the effort – and seem unfair in view of the better pay for doctors in the vaccination centers and the 18 euros that pharmacists only received for a vaccination certificate until recently.
For doctors, it is also uncertain every week how much vaccine they will receive in the next week. The planning of who gets which vaccine and when, pushes practice employees to their limits; There are also patient requests for appointments before the holidays. With the Stiko recommendation for cross-vaccination with Astra Zeneca and Biontech or Moderna, the effort increases again – which the Stiko can do little for, however.