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Every weekend there is a deep slump in the vaccination statistics, because until now the following applies: Sunday is a day of rest.
“We believe that we still have room for improvement,” is the summary of Chancellor Angela Merkel (CDU).
The work in the centers could certainly be extended to a shift system and a seven-day week.
The hesitation is surprising, because the vaccination jam has been known to the Chancellery for weeks.
"At the end of March and April we will have a hard time getting everything wrong," said Merkel in February.
Only then should the general practitioners become part of the campaign - too late, some think.
Andreas Gassen, head of the National Association of Statutory Health Insurance Physicians (KBV), explains what is behind this point in time.
WELT:
Mr. Gassen, according to your calculations, a first vaccination could be completed as early as the first half of June and the extensive immunization of the adult population at the beginning of August.
Why do the practices not yet play a major role?
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Andreas Gassen:
In the deliberations of the Chancellor and large parts of the government, the public health service and the vaccination centers played a major role, the practices were mostly only mentioned in passing and included in the planning.
But just think about the flu: vaccination is day-to-day business for general practitioners.
So far, however, the vaccine has been rare and the logistics difficult, so the unfamiliar route to the vaccination centers has been taken.
WORLD:
It shouldn't start until the end of March or the beginning of April.
Gassen:
If we want significantly more speed, we need the practices, and crisis management sees it that way too.
Other countries vaccinate in the supermarket - but we actually have advantages: Our network of general practitioners and specialists is unmatched worldwide.
These do not need the complex superstructure that the centers have.
If the practices are adequately supplied with vaccines, 100 vaccinations per week and practice is not even a lot.
If the practices vaccinate five million doses per week and the centers 1.5 - then we will create a significantly earlier date than September 21.
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WORLD:
Your numbers fluctuate, however.
They say 50,000 practices out of a total of 102,000 can now vaccinate, before that it was 75,000.
How many practices are there really?
Gassen:
There are over 100,000 practices in Germany, including psychotherapists.
In our model calculation, we have conservatively assumed only 50,000 practices.
But up to 75,000 would also be conceivable.
The willingness of the colleagues is enormous.
The figures for the last flu season clearly show what is possible: in two to three months, resident doctors administered around 25 million doses - without long queues.
In some places, resolutions are difficult to understand
WORLD:
According to the latest decisions, however, only doctors who also offer "routine vaccination" should vaccinate.
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Gassen:
One wonders - especially when politicians wanted to act as vaccinators in the vaccination centers, who have studied medicine, but certainly do not routinely offer vaccinations or treat patients at all.
In some places, the last decisions are difficult to understand.
Apart from that: whether ENT or pulmonary specialists, gynecologists or orthopedic surgeons - they all vaccinate in everyday life.
WORLD:
Would the practices have had to be involved earlier?
Gassen:
You could have started earlier, but we are dependent on the amount of the vaccine, and it was very scarce at the beginning.
But we already have the situation that the quantities exceed the capacity of the centers, these two graphs are getting further and further apart.
But if there are only 500,000 vaccine doses left for the practices per week, that is not enough to vaccinate across the board in the practices.
The supplies have to flow, in the order of four to five million cans a week.
It is crucial that we can keep vaccination offers.
Cancellation of appointments would be terrible.
The loss of trust would be considerable if at the end of the day it was said that the practices are also stuck.
WORLD:
Some federal states are now starting “pilot projects” in the practices.
Do we really need that?
Gassen:
They are not made to teach doctors how to vaccinate.
But the responsibility still rests with the federal states, and one tries to inoculate the available vaccine in this way - that can be done, but it is not enough.
Until we also vaccinate nationwide in all practices that want, individual practices or specialist groups are commissioned.
WORLD:
In Israel, meanwhile, a free beer is vaccinated on the beach or in the bar.
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Gassen:
The Israelis are way ahead of us and show what is possible.
One reason is the significantly better digitization.
But the mentality also plays a role.
There it is more like: “We’ll do that now and we don’t have to discuss it for long.” The result is the breathtaking speed.
We Germans, on the other hand, tend to want to win the bureaucracy Oscar.
WORLD:
Speaking of which, practices now have to set up an extra IT solution for reporting to the Robert Koch Institute for data protection reasons.
Gassen:
The vaccinations would not be reported daily using the usual accounting data, but quarterly.
This presents us with a dilemma: When the system is fully operational, employees cannot manually send individual reports to the RKI after work.
That is why we are taking the middle ground with a new tool that transmits a reduced data set every day - in the end it is twofold, but politicians need a kind of vaccination ticker.
The positive thing about it is that you know very quickly that the risk groups are now vaccinated and it is possible to lift the restrictions.
WORLD:
Will this slow down vaccination operations?
Gassen:
At least it doesn't speed it up, and the transfer also means additional work for the practice staff.
Bureaucracy is very important for many in Germany.
WORLD:
How do appointments work in the practices?
Also with mail delivery and hotline?
Gassen:
More patient-friendly, as people know it from their practices.
That can be by phone or digital appointment scheduling, that is regulated by the practices.
Many old people were overwhelmed with the procedure in the vaccination centers or hung endlessly in waiting loops.
The practice around the corner is different: the employees know their patients and the patients know the practice.
Too much formalism does not help us, it only hinders us.
We shouldn't want to regulate everything down to the last detail.
In the centers, this led to deadlines not being kept or slots remaining empty.
Also vaccinate younger people
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WORLD:
But the sequence is also strictly regulated.
According to the latest resolutions, vaccinations should also be “strictly” prioritized outside the centers.
Gassen:
One can certainly question whether that makes sense.
Clearly yes in times of shortage.
But now the amount of cans keeps increasing.
In order to vaccinate as many people as possible as quickly as possible, the prioritization must be gradually receded.
WORLD:
Nevertheless, general practitioners will also have to make a kind of gradation.
Gassen:
Sure, but if 15 of 100 doses are left in the evening and there are still younger patients who are willing to vaccinate in the practice, then I would not hesitate and vaccinate them.
The more people who are vaccinated quickly, the better!
WORLD:
So vaccination will be the “game changer” in practices, as you promised?
Gassen:
Absolutely, I am convinced of that.
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Andreas Gassen is an orthopedic surgeon, trauma surgeon and rheumatologist. Since March 1, 2014, he has been Chairman of the Board of Directors of the National Association of Statutory Health Insurance Physicians (KBV). Gassen studied human medicine in Düsseldorf from 1982 to 1988, where he also received his doctorate. From 1989 to 1996 he worked in the Marienkrankenhaus in Düsseldorf-Kaiserswerth, later in a group practice. Gassen was President of the Professional Association for Orthopedics and Trauma Surgery (BVOU) from October 2013 to 2014.
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