After months of preparation, the first people in Germany will be immunized against the corona virus this Sunday. People who are particularly at risk are to be the first to receive the preparation from Biontech and Pfizer: Mobile teams carry out the vaccinations in old people’s and nursing homes. In a second step, the over 80s should then have a turn. When the vaccine can be administered in the vaccination centers depends on the location of the respective federal state. Health Minister Jens Spahn believes that a vaccination in the area is possible in mid-2021. The vaccine from Biontech and Pfizer was approved by the European Medicines Agency (EMA) and the EU Commission shortly before Christmas. The most important questions and answers.

What kind of vaccine was approved?

BNT162b2 is a so-called mRNA vaccine that is developed and manufactured by the Biontech / Pfizer company. In the body, mRNA normally represents a biological messenger between the genetic material DNA and the protein factories that convert genetic blueprints into biomolecules. According to the instructions of the injected vaccine mRNA, a protein is produced, a piece of the virus that serves as a warning shot for the immune system. In the event of an infection, it then recognizes the pathogen more quickly and can eliminate it before the vaccinated person becomes ill. The mRNA is not incorporated into the human genome, but rather breaks down very quickly. This vaccine is given in two doses about three weeks apart.

How well is this protected against infection?

It is still unclear. According to the current data, it is certain that this vaccine protects against disease very well. The effectiveness is given with 95 percent – across broad age groups and in different ethnic groups. There are also indications that the vaccine ensures a milder course in the rare case of illness. So far, however, there is a lack of data on the question of whether people who have been vaccinated can spread the virus even if they do not fall ill. Many experts doubt that “sterile immunity” can be established with mRNA vaccines, but initial data indicate that the vaccinated at least excrete fewer viruses than the unvaccinated.

Who can get vaccinated first?

According to the federal vaccination ordinance, older people over 80 years of age and nursing home residents should first be vaccinated, as well as medical staff, for example in emergency rooms or corona wards and in care for the elderly.

How much vaccine does Germany get?

Initially there should be around 400,000 cans of BNT162b2. According to the Federal Ministry of Health, three to four million doses could be available in January. In the first quarter, the ministry expects 11 to 13 million vaccine doses.

Do vaccinated people still have to wear a mask?

Both the now approved vaccine from Biontech / Pfizer and the one from Moderna, which is expected to follow soon, are unlikely to create completely sterile immunity, which means that people who have been vaccinated can still pass the pathogen on, albeit probably in smaller quantities. It is known from animal experiments that vaccinated monkeys do not get sick if they are infected with Sars-CoV-2, but that they still have live viruses in their noses that they can spread. For this reason, vaccinated persons cannot be released from the obligation to wear a mask and should not do without it for their own protection. They should also keep to the rules of distance and hygiene and ventilate regularly. The first two vaccines are extremely effective, but no one is guaranteed to be protected. It is still unclear to what extent future vaccines will ensure sterile immunity.

Are there any known side effects?

The clinical studies have shown that the mRNA vaccines stimulate the immune system to such an extent that some people feel marked vaccination reactions. In many cases they are described as short but fierce. It starts with a swollen arm, cold symptoms can set in, but also chills and fever. Up to five percent of the subjects from approval studies had temporary severe symptoms, which is why some experts recommend not making any important appointments on the days after the two vaccinations. The body sometimes reacts violently to flu vaccinations and other immunizations. 30 percent of the test participants who were not vaccinated with the corona vaccine but with a placebo in the clinical studies also complained about such vaccine reactions. In the vaccination group, some people reported swollen lymph nodes and a very small number reported paralyzed facial nerves, although in the latter case a connection with the vaccination is unclear. By the weekend, the Biontech-Pfizer vaccine had been injected more than 270,000 times in the US. Severe allergic reactions occurred in six cases. People who have had an allergic reaction to a vaccination should definitely tell their doctor. If many people are vaccinated, the likelihood of severe side effects increases in individual cases. The tolerability of the vaccines will therefore continue to be monitored even after they have been approved. Experts emphasize that the real risk of infection must be compared to the theoretical risks of vaccination. Roughly one in one hundred infected people dies from the virus; about two out of a hundred need intensive care.

Could complications still arise a few years after vaccination?

Real long-term experiences cannot be made just four months after the first administration of the vaccine to a larger group of test persons. The participants’ health should be monitored for two years. In the past, the rare documented vaccine damage usually occurred quite soon after vaccination and not decades later. The fact that there is no long-term experience with mRNA vaccines, as is often claimed, is not correct, however: Vaccines of this type have been tested against other infectious diseases on humans for more than five years and have so far been shown to be very tolerable in these studies.

How are side effects and long-term effects monitored?

“Side effects with vaccines are rare, but can never be completely ruled out,” says the Federal Ministry of Health. Therefore, when introducing new Covid-19 vaccines, “active monitoring of the effectiveness and safety of the vaccines is absolutely essential.” At the Paul-Ehrlich-Institut, vaccination complications can be submitted directly via the website Nebenektiven.bund.de. Anyone can use the form if he or she suspects a connection to the vaccination. Doctors, pharmacists and companies are obliged to report. Federal Health Minister Jens Spahn announced that side effects will soon also be able to be transmitted via a dedicated app.

Is there a central documentation of the vaccinated?

According to the Federal Ministry of Health, non-personal data is used to monitor the vaccination rate in the population. A system was specially developed by the Robert Koch Institute for this purpose and is to be used in vaccination centers as well as by mobile teams.

Who gets which vaccine?

After the Biontech Pfizer vaccine, the next vaccine approval by the EMA is expected in January, and further vaccines could be available in a few months. The Standing Vaccination Commission at the Robert Koch Institute is to develop recommendations as to which vaccines are particularly suitable for which groups of people.

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Should people who have already had Sars-CoV-2 infection be vaccinated?

People who have previously been infected have very different amounts of antibodies in their blood that can protect them from a new infection. It is also unclear how long this protection will last. Therefore, many experts are of the opinion that sick people should also be vaccinated. “The previous vaccines produce a very strong antibody response that may last longer than the one caused by an infection,” says Eleanor Riley, professor of immunology and infectious diseases at the University of Edinburgh. It is also logistically impossible to test everyone for antibodies before vaccination. “It’s a lot easier, faster, cheaper, and less risky when everyone is vaccinated.” The President of the Robert Koch Institute Lothar Wieler also refused an antibody test before the vaccination in mid-December in order to put already infected people on the back burner. According to previous knowledge, less than ten percent of the population – including the number of unreported cases – have been infected with the corona virus.

Will there be compulsory vaccination?

No. So far, the federal government has clearly ruled out a general vaccination requirement.

Updated version of the text dated December 21, 2020.

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