The Standing Vaccination Commission is under pressure: Several politicians have asked them to make a recommendation to vaccinate children and adolescents. Is the board working too slowly – or is it simply independent?
The federal and state health ministers are expanding the Corona vaccination offer for children and adolescents between 12 and 17 years of age, although the Standing Vaccination Commission (Stiko) has not yet issued a general vaccination recommendation for the group. A contradiction? There are also questions and answers.
Who is the Standing Vaccination Commission?
The Stiko has 18 members from various disciplines who work on a voluntary basis in the independent committee. They are appointed by the Federal Ministry of Health in consultation with the highest state health authorities for three years each. The committee headed by the Ulm virologist Thomas Mertens is supported by experts from the Robert Koch Institute (RKI). What is to be achieved with the vaccination recommendations is laid down in the Infection Protection Act.
What relevance does the work of Stiko have in medicine?
If the Stiko recommends a vaccination, it carries more weight for doctors than the term “recommendation” suggests laypersons: It is not just a well-intentioned piece of advice, but is more of an authoritative guideline. Some doctors adhere strictly to it. Normally, the Stiko judgment is important for questions of liability and the assumption of costs by the statutory health insurance companies – with the corona vaccination campaign, however, this is regulated by the federal government. Vaccination is formally possible without a Stiko recommendation, but it contradicts the “practice that has always been established,” said the German Society for General Medicine and Family Medicine weeks ago.
How does the board work?
According to its own information, Stiko is continuously evaluating studies and data and weighing up the following: What are the benefits and what are the risks of a vaccination for the individual and for the community? The recommendations are not set in stone, but are adjusted depending on the level of knowledge: The eighth update is now available for the Covid-19 vaccination. The Stiko provides detailed, long-term scientific reasons for this. In an interview with the DPA news agency, Mertens said: “We are working under the greatest pressure anyway. The politicians’ calls over the past few weeks that we should reconsider our recommendation were as unnecessary as a goiter.”
Why do the assessments of Stiko and EU institutions on child vaccinations differ?
The European Medicines Agency (EMA) and the EU Commission gave the green light for the approval of vaccines from Biontech / Pfizer and Moderna from the age of twelve, while Stiko has so far only recommended their use to a limited extent. This need not come as a surprise: The Stiko refers to different tasks. More generally, EMA is about reviewing data on effectiveness, safety and quality. At Stiko, the focus is on regulating the use of vaccines for the best benefit of the individual and the population in this country. In other countries, for example with a higher proportion of children, the considerations may be different.
What has Stiko recommends so far when vaccinating children against Corona?
The recommendation supports vaccinating a group that, according to Mertens, includes around 350,000 children and adolescents between the ages of 12 and 17. It is about children and adolescents with certain pre-existing conditions such as obesity or chronic lung diseases – and those with relatives or contact persons who are at high risk of corona. According to Federal Health Minister Jens Spahn (CDU), more than 900,000 people between 12 and 17 have been vaccinated at least once, around 20 percent of this age group.
How does Stiko rate the decision to expand the range of vaccinations?
The decision was “not a catastrophe”, but it wasn’t ideal either, said Mertens. He refers to a passage in the vaccination recommendation that covers the decision: According to this, the use of the vaccine is “possible after medical advice and if the individual wishes and if the risk is acceptable”. The virologist also speaks of “unfortunate hectic pace” and complains of political activism, which he explains with the start of school, the overabundance of vaccines and the vaccination centers that are no longer being used to capacity. Stiko only needs around ten days to update its recommendation, said Mertens.
Does that mean there will be a general recommendation next week?
According to the Stiko boss, this is by no means clear: “The outcome is open, we are in the process of weighing up.” His Stiko colleague Christian Bogdan spoke of the currently unfulfilled requirements for this. Meanwhile, Stiko member Ulrich Heininger said on “Deutschlandfunk”: “Either it stays as it is, or – and that is my personal hope – we come to a somewhat broader recommendation.”
What does the decision depend on?
The Stiko is now primarily about the safety of the vaccination: According to Mertens, there is a lack of data on the possible consequences of myocardial inflammation, although the acute course is usually not severe. This heart muscle inflammation occurred in about one case per 18,000 vaccinated in the United States. However, this information comes from a system in which those affected report the complaints themselves, an unreported number is to be assumed.
In some cases, those affected had to go to the intensive care unit, but the exact extent is unknown, said Mertens: “So far, no one has had this number, not even Karl Lauterbach.” The SPD health expert had attested the Stiko in “Deutschlandfunk” an “outsider position” and said that the main studies resulted in “that the infection with the Delta variant would be much more dangerous than the vaccination, that the vaccination has meanwhile been well investigated” .
Why did vaccination recommendations for adults go so much faster?
Because adults, in contrast to children, get more sick with Covid-19 and the benefit of the vaccination for the individual is clear, argues Mertens. He reiterated that, according to the modeling, it is important to significantly increase the vaccination rate among 18 to 59 year olds in order to combat the pandemic. “That’s where the problem lies, not with the children.” It is crucial to make it clear to people of this age group that the further course of the pandemic in Germany depends on their willingness to be vaccinated – with consequences for the lives of individuals, the community and ultimately also the economic recovery.
What do politics and medical associations say?
Spahn defended the planned additional vaccination opportunities. “It’s expressly not about applying pressure, we don’t do that either.” If parents and children said that they wanted to wait for more data, that was okay and not a problem. He opposed constructing a contradiction – the decision of the federal and state governments was “entirely in line with the Stiko”.
The spokesman for the professional association of paediatricians, Jakob Maske, has been backing the Stiko for a long time. Since Corona infections in children and adolescents were relatively mild, there was no need to rush – you could wait for the week until the reassessment, he told the Phoenix broadcaster. The German Association of General Practitioners criticized that the procedure could lead to uncertainty.
