"We don't get pressured, but the phone doesn't stop ringing," says a woman sitting at the front desk of a family practice. Not only does she organize vaccination appointments, but she also has to do a lot of educating. "The thought that Biontech is the better vaccine is prevalent in many patients. We have to convince them that Astrazeneca is highly effective, especially in the elderly," she says. That takes a lot of time, and produces moderate success, she says. Only about ten percent of patients want the vaccine.

This also has consequences for the supply chains. Every general practitioner orders the vaccine via pharmacies, which usually happens on Mondays. On Thursdays, they then receive a commitment as to how much vaccine will be delivered. While there are fixed quotas at Biontech/Pfizer because of the shortage, many pharmacies are moving to release Astrazeneca because of low demand. In other words, physicians can order as much of it as they want.

"The important thing is that we don't throw away any vaccine," explains one primary care physician. If there are doses available but no one willing to be vaccinated, those who are currently available are taken - regardless of prioritization. "For example, there was a woman with a pre-existing condition whose husband also wanted to be vaccinated. So we did that because there was enough vaccine," he said. "Anyone who gets vaccinated with Astrazeneca has a relatively easy time of it." Another physician observes that many young people have a pre-existing condition such as asthma, which gives them priority.

There is no explicit rule that only people aged 60 and older can be immunized with Astrazeneca, it is simply a recommendation of the Standing Commission on Vaccination. Family physician Ansgar Struck advises his female patients between 20 and 55 years old against the Astrazeneca vaccine - not because it is dangerous per se, but because there is a safer alternative with the Biontech/Pfizer vaccine. "In a young man who has never had thrombosis and has no family history of it, I also give Astrazeneca." The physician does not bear responsibility if there are complications with a vaccination, he said. "But as a physician, of course, I don't feel good if something happens to my patients."

According to the Association of Statutory Health Insurance Physicians North Rhine (KVNO), the physicians' practices must comply with the current vaccination ordinance. "However, they can - depending on the individual situation and assessment - in principle also vaccinate persons from other priority groups, if all of those from higher priority groups have already been vaccinated," says KVNO spokesman Christopher Schneider.

Regarding the statement of Federal Health Minister Jens Spahn about discontinuing vaccination prioritization with Astrazeneca, the city is waiting for the state to provide rules on this. "From our point of view, a general release of Astrazeneca could further advance the vaccination pace in NRW, but the patient-specific vaccine recommendation of the vaccinator would still be important, especially when vaccinating people under 60 with Astra," says Schneider. He said they continue to rely on physicians in private practice. "Judging by the general feedback from our members, the vaccinations in the doctors' offices in the Rhineland are largely running smoothly and routinely." They are best able to speed up and handle the vaccination process based on their experience with flu shots.

From the point of view of the Bonn physicians, however, this is only half true: because flu vaccines need considerably less effort. "Nevertheless, we still have some room for improvement. Soon, the company doctors will join us, and we could put in extra shifts on the weekends," says Struck. At least for a "manageable period of time.”

(Original text: Nicolas Ottersbach - Translation: Carol Kloeppel)