Vaccination and Memes Around AZD1222 Reluctance in Germany

A British colleague wrote to me a couple days ago about a newspaper story concerning “a vaccination centre in Berlin that had 3000 people booked in one day, but only a couple of hundred turned up.” Our vaccination centre in Bielefeld was ready to handle up to 2,000 vaccinations per day in mid-December, but only started on 8th February (the second day of the big snowstorm that basically shut down all transport).

Why isn’t this capacity being used? The reason appears to be twofold. First, there is (still) limited vaccine. Second, at least in Bielefeld, small vaccination teams were going around the care homes and old people’s homes, which like everywhere else have been vulnerable to Covid-19 outbreaks; apparently, public-health administrators wanted to finish with that before starting on mobile residents. Doing two things at once is apparently difficult.

There seems to be a limit on skilled vaccination personnel and it may be that most of them were tied up doing the care-home rounds. The vaccination centre has ten lanes, which means 10 vaccinators per shift and they are not running round the clock (yet). I suspect little has been done to ameliorate the limit on personnel. Every trained nurse is capable of delivering the vaccine, and there are lots of trained nurses no longer working, or no longer working as nurses, who could have been coopted. As well as medical students and so on. But apparently only qualified doctors are vaccinating.

And then there are screw-ups. In my local newspaper the Neue Westfalische (NW), I read this morning that yesterday there was a line at the vaccination centre in Bielefeld stretching hundreds of meters outside. It consisted of people who all got their appointment at 15.00 or thereabouts, some of whom were not on the list used by the admissions personnel. Nobody knows why these multiple bookings occurred. The centre Director suspects booking software in Berlin; the regional doctors’ association doesn’t know. In particular, no one knows why people with bookings and written confirmation were not on the admissions list at the centre reception. So much for German efficiency (once again!).

The trustworthy Berlin press has a story (in German) from mid-January We don’t lack vaccine, we lack people willing to be vaccinated (my translation).

The Berlin Arena vaccination centre can handle nominally 5,000 per day. But on the one day the newspaper investigated, the doctor they spoke with only vaccinated some 20 people in her 6-hour shift, and the centre only performed about 500 vaccinations that day, out of 600 people invited. (The article suggests they were issuing 800 to 1,000 invitations per day at time of writing.) One reason for that low figure is that, in the week previous, they were only receiving 600 doses per day of vaccine. 600 invited and 500 showing suggests a no-show rate of some 20%. At the vaccination centre in Treptow, a district in SE Berlin, about 10% of people who booked aren’t turning up, says the story. I would expect some figure like that, for general reasons. But there is bureaucracy involved. The interviewed doctor vaccinated a 91-year-old man, who turned up with his 87-year-old wife, who couldn’t be vaccinated because she hadn’t received her invitation.

I am chomping at the bit. I am in Tier 3, and will move to Tier 2 in July. Vaccination of Tier 2’s is starting next week. For some reason, the Astrazeneca vaccine AZD1222 is not “recommended” for over-65’s in Germany. All medical-scientific indications, and the trial reports, suggest it is fine for all age groups, and it has been approved for all groups by the EMA. However, this article from the doctors’ newspaper Deutsches Ärzteblatt says that the federal Vaccination Commission (“Ständige Impfkommission”, StIKo) thinks there is “not enough data” on the over-65’s and “recommends” it not be used for people aged 65 and over. On the other hand, 18-64 year olds “should” be vaccinated with AZD1222 and only with something else if AZD1222 is not available.

There is something about ChAdOx1-nCov/AZD1222 in Germany. First, it is known as “AstraZeneca”, not as the “Oxford” vaccine or the “Jenner” vaccine (the Jenner Institute is not a name with public recognition). Whereas BNT162b2 is known as “BioNTech”, not as “Pfizer”. (I write mostly AZD1222 because it is easier to type.)

The NW this morning has as its major headline “Doubts About Astrazeneca Upset Vaccination Plan” (“Zweifel an Astrazeneca bringt Impfplan durcheinander”). As indicated in the Berlin story above, there are rules about who can get vaccinated and who can’t, and politicians, including our state Minister-President Armin Laschet, are starting to say “if someone doesn’t want it, then bring in the next in line.” About time. I’d be in there like a shot for my shot.

It turns out I know three people who “won’t get vaccinated” with AZD1222. The first meme is that “it is not as effective“. It is apparently sticking in people’s minds that “effectiveness” is “95%” for BNT162b2 and “70%” for AZD1222 (and, I presume, “94%” for mRNA-1273, which is approved but I don’t think yet available here). It must be the first time in history in which numbers from Phase 3 clinical trials are making it into the public consciousness.

However, ask people what “effective” means and you get all kinds of answers. The numbers above refer largely to symptomatic reinfection (although the trials had different primary endpoints and are thus not directly comparable). Both vaccines are apparently exceptionally good at keeping you out of hospital, which is one of the two big things that count. The other big thing that counts is whether your infectivity is dampened, and by how much, if you are vaccinated and infected. No one knows yet, but the outlook seems to be positive.

The second meme is that apparently people are reporting strong reactions to AZD1222 vaccination. The most popular German newspaper is the tabloid Bild, and on 2021-02-21 there was a story about a nurse who was vaccinated with AZD1222. It laid her low for a day and a half. But – a key point for me – she said she already knows that from flu vaccinations. We know there are many such people with sensitive reactions to vaccinations. There are some amongst my acquaintances. And of course Bild can find them. The nominal point of the story is, first, as the nurse emphasises, it shows her that the vaccine is doing its thing on some level; second, it is way preferable to getting sick with Covid-19. The article says (in italic script) “Like [the nurse] there are many people currently being vaccinated with Astrazeneca. A good half suffer from headache and fatigue, about 40% myalgia, and 10% nausea and fever, like [the nurse].” (My translation.) The article tells us that the Paul-Ehrlich-Institute, responsible for vaccine safety, says “all are effective” and superstar virologist Christian Drosten says “all are extremely good“. But many Bild readers are going to note the nurse got an AZD shot and was off work for two days.

Although there are reports as in this story of a strong reaction to AZD1222 vaccination, it seems there are few or no such reports in the public domain for BNT162b2. But surely there are such reactions – there always are. Astrazeneca and Oxford actually reported that there were very few such reactions in older people. It is ironic that the StIKo is recommending against it for the over-65’s.

There is another  meme which hooks into something EC President Ursula von der Leyen said during the Astrazeneca/Article 16 debacle. Attempting to defend the bureaucratic and, at the time, clearly less effective EU approach to vaccine approval, she said on 2021-02-10  in a speech to the European Parliament that “[t]here are no compromises to be made when we are injecting a biologically active substance into a healthy person.”

That may be literally correct but it was politically tin-eared. The issue for most people was why it took the EMA a month longer than the US FDA or UK MHRA to evaluate the vaccines, on the very same data. The answer is not “because we are not making compromises“.

It also feeds into the following. Apparently there was/is a meme doing the rounds in Germany  that these “new” mRNA vaccines affect your genome. Of course it doesn’t. I can find news stories from Nov 2020 – Jan 2001 which explain that it doesn’t. Examples are from the pharmacy newsletter Pharmazeutische Zeitung from 2020-11-20 and this from the radio+TV channel Südwestrundfunk on 2021-02-14

There is possibly a linguistic enabler here. The word “genome” in English is taken over from science and has no emotional resonance. Say to the person on the street “mRNA might affect your genome” and there is a good chance the response will be “what is all that supposed to mean?” German for genome is “Erbgut”, a word with two fundamental Ur-German components. “Erbe” is inheritance and “Gut” is property/estate/manor. Your “Erbgut” is what you have that you pass on to your family, either your genes or your property. It has obvious emotional resonance. You don’t want people, or anything else such as mRNA, whatever that is, messing with your Erbgut. Words do matter.


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