Heroes to zeros: how German perfectionism wrecked
its Covid vaccine drive
The same thoroughness that made Angela Merkel’s
government a pandemic role model is now holding it back
Philip
Oltermann in Berlin
@philipoltermann
Sat 27 Mar
2021 14.19 GMT
In
December, two weeks before the European Medicines Agency authorised the first
vaccine against Covid-19 for use across the European Union, Berlin unveiled a
plan to rocket-fuel its immunisation drive with German precision engineering.
Jabs would be mass-administered in purpose-built vaccination centres where
patients could be shuttled through queuing lanes like cars through a car wash.
A Lego
display demonstrating the complex system’s efficiency impressed journalists at
a press launch, but set off alarm bells in the head of Janosch Dahmen, a former
doctor turned Green party MP. “It all looked very logical in theory,” says
Dahmen, who worked on the pandemic frontline until November. “But looking at it
as a doctor, I thought: that’s not how vaccinations work in practice.
“You want
your grandmother to get a call from the family doctor who has been treating her
for 20 years and tells her not to worry about those side-effects she has heard
of on the radio. People are not cars.”
Three
months on, the alarm bells are ringing loud enough for the whole of Germany to
hear.
Last
spring, at the start of the pandemic, the country looked like a role model for
how to deal with the viral threat. It was managing to contain outbreaks thanks
to a high rate of testing and an advanced contact-tracing system. In mid-April,
its case fatality rate for Covid-19 infections was less than 3%, compared with
14% in the UK and 13% in France, in spite of a lockdown that was softer than
elsewhere on the continent. Levels of compliance were high, as were the
government’s approval ratings.
Yet on
Friday the head of Germany’s disease control agency warned that the country was
heading for a third wave of the pandemic that was likely to be its worst one
yet, while the government looked lost for answers, U-turning within 48 hours on
a strict Easter lockdown plan without offering alternative restrictions in its
place.
Frustration
runs high with a complex, ever harder to follow patchwork of rules, issued
following increasingly acrimonious video conferences between Angela Merkel and
the heads of Germany’s 16 federal states.
Worst of
all, the immunisation hyperdrive remains stuck in first gear: 90 days since the
first jab was administered, only 10% of Germany’s population have received
their first dose, compared with 42% in the UK and 26% in the US. Even France,
once seen as Europe’s vaccine laggard, has given a higher share of its
population a first dose than Germany.
From the
outside, Germany’s relatively successful management of the pandemic’s first
wave was often linked to the wise decision-making of its chancellor, a trained
quantum chemist who could calmly explain complex scientific calculations where
other leaders reached for martial metaphors.
“Macron’s
response to the pandemic was ‘Nous sommes en guerre,’” said Andreas Rödder, a
historian at the university of Mainz. “Merkel’s was: ‘Remember to wash your
mask at 60 degrees.’”
Seen from
inside Germany, both the country’s early victories and current malaise were
more easily explained by structural factors, cultural priorities and a degree
of fortune – good in 2020, less so in 2021.
When
Germany imposed its first lockdown on 22 March last year, it was lucky that, unlike
in Italy, the virus had not yet silently spread around the country and into
care homes for the elderly. In the highly decentralised country, Covid-19 also
came up against a political system that was surprisingly well-placed to cope
with the initial challenges.
With health
one of the policy areas devolved to the country’s federal states, Germany had
more than 400 local health authorities that were already experienced in running
contact-tracing schemes. And a competitive network of regional university and
private laboratories gave the country a head start on testing.
“German
federalism in its current form may historically have been designed as a
straitjacket for a notoriously aggressive state,” said Siegfried Weichlein, a
historian of federalism at the university of Freiburg. “But it is a popular
straitjacket. At its best, as we saw at the start of the pandemic, it is a
dynamic system that can lead to a competition to the top and a higher average
acceptance of political decisions.”
By some
measures, Germany still excels: its relative pandemic death toll remains
considerably lower than in comparable western European states such as France or
the UK. But the fear of losing face in the immunisation race has come to
dominate the national conversation.
A joint
procurement programme that placed too much faith in the wrong vaccine
candidates has created supply shortfalls across the EU. Yet Europe’s largest
economy has been slow to administer even the doses it has got its hands on,
injecting vaccines into people’s arms at a slower rate than 13 other EU states.
Germany’s
stockpile of unused vaccines had grown to 3.5 million doses by the start of
last week – partially, but not just, because the health ministry insists on
holding between 20% and 50% of doses for the second jab, depending on the
manufacturer.
In some
cases, the immunisation drive has seen the positives of federalism converted
into negatives. The western city of Wuppertal announced on Wednesday that it
was left with 2,000 unused doses of vaccine, because it had finished
inoculating all residents aged over 80, but had been stopped from moving on to
the next age group by the authorities in North Rhine-Westphalia, which wanted
the entire state to move in sync.
Far from
seeing a race to the top, the immunisation programme had created a scenario
were “the laggards are setting the pace”, as the head of the city’s crisis
taskforce put it.
“Whether
you are dealing with a bleeding patient or with a pandemic: speed trumps
perfection,” Dahmen told the Observer. “In Germany, we tried to reinvent the
wheel with the vaccine rollout, to perfect a system before we put it into
practice. That kind of thoroughness is now becoming self-defeating.”
The
rationale behind running the programme solely through vaccine centres, Dahmen
said, was partly that mRNA vaccines like BioNTech/Pfizer and Moderna were
thought to require high-tech storage facilities, but also out of a fear of too
much decentralisation: family doctors, authorities worried, might have been
tempted to stray from the priority order and administer precious jabs to
private patients or friends instead.
Without
using GPs, each German state has had to build its own system for finding the
right people in the right age groups for a jab appointment, with some inviting
patients by letter, while others rely on being contacted via overburdened
hotlines and creaky online portals. In Lower Saxony, authorities used post
office records to seek out candidates for the first round of jabs, guessing
people’s ages on the basis of their first names.
These woes
may be locally made, but public anger is now also arriving at the doorstep of
the chancellory in Berlin. Cautious pragmatism has served Merkel well
throughout most of her 15 years in power. But among a 90% unvaccinated public,
many are now calling for bolder leadership.
Hopes that
Germany’s doctors’ practices could soon join in the vaccination effort were
dashed earlier this month when the vaccine authority recommended a temporary
halt on using the AstraZeneca jab over reports of blood-clot disorders in a
small number of recipients.
Contrary to
some speculation in Britain, Merkel’s decision to heed the regulator’s advice
had little to do with attempts to politicise the vaccine developed in Oxford
University. Rather, it was the opposite: an affirmation of the belief that a
cut-no-corners bureaucratic management culture can still win out against the
virus. Not pausing the rollout of the vaccine in spite of the medical
regulator’s caution would have constituted political action – but a risk that many
Germans would have forgiven their chancellor for taking.
“Instead of
making a mistake, it seems, we preferred to stand still,” said ex-doctor
Dahmen. “If you want an effective crisis management, fear of committing errors
is a toxic attitude.”
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