Who will get the coronavirus vaccine and when?

More than enough vaccines

People have been receiving the coronavirus vaccine in Germany since the end of 2020. The first vaccine was promptly approved once both efficacy and tolerability were demonstrated. Yet many people are still wondering if there will be enough vaccine doses to go around. The answer is yes [1-3].

Before we can return to pre-pandemic life, we need to achieve “herd immunity.” Enough people must be immune to the virus to stop it from spreading. Researchers estimate we will achieve herd immunity to coronavirus when 70% of the population is immune [4, 5].

In Germany, the BioNTech/Pfizer vaccine was approved in December 2020. The Moderna vaccine came next, and 140 million vaccine doses were contractually secured for Germany. Even though each person requires two doses, this will be enough to achieve herd immunity. More than enough vaccines are on the way, especially since additional vaccines are coming from AstraZeneca and other manufacturers. [6, 7].

The current bottleneck resulting in vaccine shortage is due to production and delivery. Eventually we will have enough vaccines. The real question is “when?”

Who will get the vaccine and when?

Since there won’t be enough vaccine doses to vaccinate everyone at the same time, the German government has created three groups for vaccination: highest priority, high priority, and increased priority [5, 8-10]. 

The primary aim is to protect people at increased risk for severe COVID-19 as well as medical personnel with high exposure first. Another goal is to maintain essential state functions and public life as much as possible. “Essential workers” is a phrase often heard in this context [5, 8-11].

People with highest priority [10]:

• Those aged over 80

• Those receiving treatment or care in inpatient facilities for people who are elderly or otherwise in need of care, and people who work in these settings

• Nursing staff in outpatient care services

• Healthcare workers with a high risk of exposure, such as those working in intensive care, emergency rooms, emergency services, palliative care centers, and SARS-CoV-2 vaccination centers

• Healthcare workers who treat or care for high-risk patients

More details about priority levels can be found here.

All data is based on mathematical calculations. According to these, advanced age is the greatest risk factor for a severe or even fatal course. This explains why some 800,000 nursing home residents in Germany will be among the first to be vaccinated. However, this is associated with a great deal of effort due to the limited mobility of older people [5, 12].

For some vaccines, including the BioNTech and Moderna vaccines, one dose is not enough. A follow-up or booster dose is also needed. According to the Standing Committee on Vaccination (STIKO) at the Robert Koch Institute, the second dose of vaccine should, where possible, be given within 21 days of the first dose in the case of the BioNTech vaccine or 28 days in the case of the Moderna vaccine. The administration of a second vaccine dose to people who have already received their first dose takes precedence over the administration of the first dose to people who have not yet been vaccinated [5, 8, 10].

The vaccination campaign in German nursing homes should be completed this January. Over time, the list of priority groups may change slightly. By late summer, however, even people who do not belong to a priority group should get the opportunity to be vaccinated. However, it is difficult to make an accurate prediction without knowing when exactly further vaccines will be approved [5, 12].

According to the current recommendations, people with a history of confirmed COVID-19 should still receive at least one dose of vaccine. In nursing homes in particular, people who have recovered from the infection should be offered the vaccine immediately. For people who have had the infection and do not belong to a risk group, however, the question of how urgently the booster vaccination needs to be given is still being discussed [5].

Will I be contacted and how do I get an appointment?

The responsibility for organizing and running the vaccination campaign is divided as follows: The federal government is responsible for procuring and paying for the vaccines, while individual states are responsible for contacting people, scheduling appointments, and distributing and administering vaccines locally [10]. 

Nursing homes are actively targeted by “mobile vaccination teams.” In hospitals and inpatient care facilities, staff physicians can perform the vaccination in some cases. The rest of the population, on the other hand, can get vaccinated at newly established vaccination centers [10]. 

Vaccination centers offer a number of advantages. Mass vaccination can take place more quickly, vaccine storage under the correct conditions is guaranteed, and prioritized vaccine allocation to specific groups of people is easier to implement. Later in the vaccination campaign, it may also be possible to get vaccinated against coronavirus by your family doctor [5].

The federal states will actively contact everyone whose turn it is to be vaccinated. Once you have been contacted, you can arrange an appointment at a vaccination center, either online or by calling a telephone hotline at 116117. Appointments are important to avoid long queues at the vaccination centers [10].

At the vaccination center, a doctor will give you information about the vaccination. The vaccination itself can also be performed by trained medical support personnel. You will need to bring your ID card or another form of photo ID to the vaccination center [10].

Which vaccine will I receive?

Several COVID-19 vaccines are currently in various phases of the approval process, which means that the situation is changing all the time. This is confusing for many people, especially when they hear about “the coronavirus vaccine.” Fortunately, time is on our side, because the more time goes by, the more vaccines are likely to be proven tolerable and effective and approved as a result.

Five vaccines in particular could play a role in Germany. These are the vaccines produced by BioNTech/Pfizer, Moderna, CureVac, AstraZeneca, and Johnson & Johnson. What they all have in common is that Germany has already contractually secured millions of doses of vaccine. However, they will only be used once they have been approved [5, 9, 13, 14].

So, although available doses may be scarce in the beginning, several different vaccines may already be on the market. Which vaccine you receive in this case will depend on the recommendations of the Standing Committee on Vaccination (STIKO) at the Robert Koch Institute and the licensing specifications [10]. 

For example, a vaccine may be very effective in young people but less effective in older age groups. In this case, the vaccine would presumably only be licensed for and used with a certain age group.

This being said, it cannot be emphasized enough that all vaccines licensed in Europe and released by the Paul Ehrlich Institute in Germany have been extensively tested beforehand in three study phases and meet high standards and quality requirements. Furthermore, vaccination is completely voluntary [5, 7, 10].

Beyond Germany: Vaccine allocation around the world

Given that the grass is always greener on the other side and our innate tendency to compare things also extends to vaccines, it’s worth taking a look at what’s happening in other countries. 

First, the criteria used to prioritize vaccine allocation in Germany are largely in line with the ethical considerations of the World Health Organization (WHO). According to these, the most vulnerable people and the professionals looking after them should be vaccinated first [9, 10, 15]. 

In addition, according to the WHO, no distinctions should be made between people with the same conditions and the best possible use of scarce resources should be taken into account. All of these factors are also taken into consideration in Germany [9, 10, 15].

In the USA, vaccination is also free of charge for citizens. However, vaccination may be mandatory for healthcare personnel or essential workers. Each US state sets its own priority groups. However, the guidelines issued by the Center for Disease Control and Prevention (CDC) are similar to the German recommendations [16, 17].

When it comes to the speed of vaccine rollout, most countries are relatively close to each other in an international comparison. All are still a long way from herd immunity. However, Israel in particular is far ahead of other countries in this regard [18]. 

By the middle of January, 2.2 million people in Israel had already received their first vaccination. Israel’s vaccination success has been attributed to various factors. Among other things, it is a comparatively small country with a highly digital healthcare system and it launched a major campaign to combat vaccine misinformation [19].

Vaccines remain our best hope of managing the coronavirus pandemic. From the hundreds of vaccine candidates initially identified, more are being approved all the time. There is no question that great challenges lie ahead. And some countries are moving more quickly than others. But at least now, the finish line is gradually coming into view.