The pediatric practice in Berlin makes a clear announcement: The doctor will not administer the desired booster vaccination against Covid-19 for the two high school students, after all, there is no approval for it.

At the same time, a pediatrician in another district of the capital naturally gives a thirteen-year-old a booster.

Protection is handled differently not only among general practitioners, but also in vaccination centers.

In some federal states, the centers offer the third injection for minors between the ages of twelve and seventeen, in others not.

Christian Geinitz

Business correspondent in Berlin

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There is great confusion among politicians, doctors, children and their parents.

Both those doctors who offer the third injection and those who refuse it can justify this well.

In fact, there is no separate approval for boosting minors by the European Medicines Agency (EMA).

The manufacturers' applications have been submitted but not yet fully processed.

Federal Health Minister Karl Lauterbach (SPD) frankly admits before the federal press conference in Berlin that one does not know when the approval can be expected: "I am talking to the authorities and I hope that we can achieve that soon."

Actually, it could be boosted

Boosters for adults with the mRNA vaccines from Biontech and Moderna have been approved separately by the EMA. The Standing Vaccination Commission STIKO at the Robert Koch Institute now recommends these boosters three months after the basic vaccination; in the case of the single vaccine from Johnson & Johnson even after four weeks. For children, however, there is neither EMA approval nor a STIKO recommendation, so that many people who have been vaccinated are unsettled.

Actually, they shouldn't be, because in the opinion of the Ministry of Health these handouts are not necessary in order to administer the injections from a medical and legal point of view.

This was already the case with adults when the booster started even before the EMA and STIKO had expressed their opinion.

The doctors can now administer the third-party vaccinations for children and settle them like any other.

The liability issues, which make many doctors shy away from injections, have long been resolved, as Lauterbach clarifies: "If they are carried out because it is an approved vaccine, the federal government assumes liability."

Do the kids need the refresher?

So the vaccine itself is approved, only the extra shot is not. And although this additional permit is actually not required, it would certainly accelerate the boosting among minors and reduce fears. However, only the vaccine from Biontech is generally recommended for under 30-year-olds, and that is currently scarce. While at least 30 million doses are available for boosting with Moderna, only three million are available from Biontech-Pfizer.

The basic question, of course, is: Are the refreshments even necessary in the younger age group?

The minister has a clear opinion on this: “This is a big problem because the vaccination protection of many twelve to seventeen year olds is now slowly declining.

And we have to solve this problem. "Lauterbach himself does not want to give general booster advice," that is what the individual doctor has to decide, "as he says.

However, he recommends talking to the paediatricians so that the vaccination can be carried out safely.

Boosting children is not "off label"

Experts are much more cautious. Even without a vaccination, the risk of serious illnesses among children is very low, and it becomes even less after the double protection is administered, says Johannes Huebner, professor of paediatrics at the Munich University Clinic and former chairman of the German Society for Pediatric Infectious Diseases. Since children have only been vaccinated for a few months, there is little information about when the protection wears off. The available data suggested that the immune response was longer than in adults.

However, reliable studies are still lacking, which is why the discussion is premature. "Before we have reliable data, I do not consider the general boosting of children to be necessary," says Hübner. It should be considered, however, in the case of children at risk. These include immunocompromised risk patients who have received chemotherapy or high-dose cortisone preparations, for example.

In some media and on the Internet, the booster vaccinations are confused with the so-called "off-label use" of drugs.

However, this is only the case if a preparation for children is not approved at all.

Then the doctor operates in a gray area and is himself liable for any vaccine damage.

The boosting of twelve to seventeen year olds is within the scope of the approval and is therefore not “off label”.

The situation is different when doctors vaccinate children under the age of five for whom no Covid-19 vaccine has yet been approved.

Lauterbach says that federal liability does not apply to such "off label" types.

It must be justified very well: "I would be extremely cautious here."