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Corona / Covid-19 Virus - General Discussion (politics go to the Off Topic / Politics thread)

Mooney_Driver wrote:

It was always said that subject to availability, vaccines which can be handled by a normal GP practice or even pharmacies should be available through them. That is where 99% of vaccines are usually distributed, so why make an exception here?

As long as the scarce resource is the vaccine and not the physicians that put the vaccine in patients centralization of vaccine stock is the best (and only) way to ensure most efficient (and rule compliant) use of that scarce resource.

Just imagine you are at the fuel pump of your local airfield and need to get 15 gal to make the next lag safe but there is only 10 gal left at the station. Would you really say: “no problem, including the Tip-tanks I have 5 tanks in my plane so if we spread those 10gal evenly across these 5 tanks it should get me to my destination”?

The problem unfortunately is, that the German GPs do not intend to stick to the rules and people who really need it (because e.g. they have significant prior conditions) will get their vaccine later because many GPs will help their friends and family to jump the line. They even say it publicly! If you hear there official statements it always sounds like “yes, in general we will stick to the law but there are always exceptions and we do not want vaccine to be wasted…”.
If we had some kind of executive power and will to really prevent this (like to revoke the license of physicians who break the rules) these would be only very few cases. But as there is absolutely no (!) consequences for physicians even if they would sell vaccination slots on Ebay, this is just wasted vaccine.
And yes, obviously there are also many physicians in Germany that have kind of ethics that would not do that – but there are also many who will! Or does anyone believe that a Physician that issues false certificates that someone can not wear a mask for medical reasons will shy away from selling the vaccine?

MedEwok wrote:

I’m not sure if Malibuflyer wanted to say he sees vaccinations at GPs as unnecessary.

Not only unnecessary but actually harmful to the entire process – as long as the scarce ressource is vaccine and not physician capacity for vaccination.

MedEwok wrote:

In the end, the vaccination centres are “nice to have” but as Malibuflyer said, spread the scarce resource “vaccine” unnecessarily.

Don’t get this: Why is a distribution amongst about 100 vaccination centers in Germany worse than spreading it amongst ten thousands of physician practices. Figuring out how many doses each individual practice needs in the first wave alone would be a process that is largely impossible in the German system.

For our international friends: The German system of GPs and individual specialist practices is quite different from most other countries in the world. A GP practice can be everything from a 75 year old working part time to a practice with 5-6 physicians. This is organized decentrally and only the local physician unions know about the configuration of the practice. Patients do not need to register with a practice but just show up and can therefore move freely between practices – so the only thing one could know (but doesn’t because of the decentralized nature and bad data quality) is which patients were treated at which practice last quarter.

Last Edited by Malibuflyer at 08 Apr 06:55
Germany

I find it quite hilarious that the same crowd that is against age discrimination (which priority access for age groups to vaccines is whichever way you want to look at it) has no issue proposing law to make it illegal to do just that.

In July 2008 the European Commission proposed another directive on implementing the principle of equal treatment between persons irrespective of age (amongst other discrimination grounds) which would ban discrimination in the areas of social protection, education and access to goods and services. The proposal is under discussion by EU Member States in the Council of the European Union.

EU framework for equal treatment in employment and occupation
LFHN - Bellegarde - Vouvray France

LFHNflightstudent wrote:

In July 2008 the European Commission proposed another directive on implementing the principle of equal treatment between persons irrespective of age (amongst other discrimination grounds) which would ban discrimination in the areas of social protection,

The fact that this has obviously been around for more than 10 years without deciding is a good indicator that it is not so to formulate anti discrimination laws in a way they a) prevent “unwanted” discrimination but b) still make sense!

It is not only normal but absolutely essential for social and health systems to discriminate between ages: Certain medications only make sense for patients above or below a certain age threshold, social pensions (for those countries where the pension system is not an individual savings plan) are only available for people above a certain age and for safety relevant occupations there are age limits established. All of these age discriminations make sense – and so does the age discrimination for Corona vaccines: The risk of a serious progression is very strongly correlated with age. Yes, this is only a correlation and there are always individual younger people with higher risk and individual older people with lower one – but it is a good proxy.
And given the fact that we can not so an individual risk assessment for the entire population, there are few feasible alternatives as long as we do not have enough vaccine to immunize everyone who wants to…

Germany

Malibuflyer wrote:

It is not only normal but absolutely essential for social and health systems to discriminate between ages

But that is not discrimination in the legal sense.

ESKC (Uppsala/Sundbro), Sweden

Malibuflyer wrote:

Don’t get this: Why is a distribution amongst about 100 vaccination centers in Germany worse than spreading it amongst ten thousands of physician practices

Because it needs to establish a whole new infrastructure. The distribution of vaccines to thousands of practices was no problem before Covid. There is no need for the state to have any say in the matter at all. The German doctors could do all this all by themselves, without political interference. If the state had only bought the vaccines and then let the pharmacies and practices deal with the rest, as with all other vaccines, the campaign could have started faster and the most vulnerable patients would have been reached just as fast.

Admittedly, that’s just speculation on my part.

Low-hours pilot
EDVM Hildesheim, Germany

MedEwok wrote:

The distribution of vaccines to thousands of practices was no problem before Covid.

Only no problem when the challenge you solve for is the actual distribution of a vaccine that is available in adequate amounts. The challenge we currently have in Germany is a completely different (while technically also a distribution challenge) if not the opposite one.

Let’s reconsider my aviation example with not or hardly enough fuel for your next leg available at the pump.

What would you do? Would you try to spread the scarce fuel across all the tanks in your aircraft or would you concentrate it in the main tank (as long as W&B allows).
Or would you even say: There is a proven solution for not enough fuel for the leg: Let’s install an additional ferry tank! Yes, this is absolutely a proven solution for a challenge that sounds very similar but is the almost complete opposite!

MedEwok wrote:

and the most vulnerable patients would have been reached just as fast.

Even if we had the dream that physicians are only and always doing the right things (and there are cases already documented where they instead used the vaccine for family and friends) that would not be true. Distributing a scarce resource amongst thousands of practices is not trivial. There is no way that one could correctly estimate how many of the “most vulnerable” are visiting each practice. So in the end each one gets a certain quota and that is bad luck for the physicians next to an elderly care home and good luck for the hipster practice in Berlin. (or for their patients). Even perfect physicians could only create a local optimum in distribution and never a global optimum.

And even if all of this would not be true, there is a much easier fact: The problem that is said to be solved by decentral physicians vaccinating simply does not exist. Despite some tiny glitches in the first days there has never been a shortage of staff.

MedEwok wrote:

The German doctors could do all this all by themselves, without political interference.

Absolutely – but they should not! As long as there is a shortage of vaccine it is (!) a political question of who should get it – and not up for the doctor to decide if they like patient a more or patient b (or their neighbor who is not a patient at all).

Germany

Malibuflyer wrote:

It is not only normal but absolutely essential for social and health systems to discriminate between ages:

Is it? so when I say, confine the old (above 80) liberate the young are you willing to follow that logic. Or am I discriminating then. this ‘’ pandemic’’ would have been a non – event if we would have taken that stance from the beginning. It’s pure statistics.

LFHN - Bellegarde - Vouvray France

A family member in Germany, mid-50s, says he has not even had a date for his vaccination, and that Bavaria is looking at going it alone and buying the Russian vaccine. This may be a problem for some because, reportedly, the EU vaccine passport scheme will issue it only for EMA-approved vaccines. One Turkish pilot I know got the Pfizer one for this reason, even though his country is offering the Russian one. The Pfizer one is available “for money” in that part of the world.

The family GP system here seems similar to Germany’s, but some/many GP practices here are not doing vaccinations, for reasons best known to themselves…

We don’t have many 1-person practices, especially since Dr Shipman That said, the system carries a lot of blame for what he was able to do.

It is not only normal but absolutely essential for social and health systems to discriminate between ages

It gets tricky if you have to take action which for medical reasons happens to be aligned with something which is a political or political-correctness no-go area. And CV19 has loads of factors like that, which have had to be ignored, when addressing them directly might have resulted in a more effective response.

Administrator
Shoreham EGKA, United Kingdom

This may be a problem for some because, reportedly, the EU vaccine passport scheme will issue it only for EMA-approved vaccines.

Bayern’s contract for Sputnik is contingent on EMA approval, so no difference between this order and the other advance orders placed before the EMA review process even started.

T28
Switzerland

Peter wrote:

It gets tricky if you have to take action which for medical reasons happens to be aligned with something which is a political or political-correctness no-go area

I think you are absolutely right in pointing this out and this is definitely the case in many European countries (including Germany), to give an example 28% of the German population still smokes (smoking laws are more liberal in Germany than in the UK as an example) with 14% of all illness related deaths in Germany being caused by smoking. (121k deaths annually vs 78K COVID deaths in 15 months) as well as 7% of all hospitalisations (which is way more than COVID btw). Cancer is one of the main causes of death, with 52 per cent of male smokers and 41 per cent of female smokers dying from complications stemming from the disease.

No complaints about these irresponsible people clogging up our hospitals btw. (btw global second hand smoke deaths are still at 600K annually)

LFHN - Bellegarde - Vouvray France
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