Critics are calling it a two-tier health system one for the politically well connected, another for the hoi polloi. As Germany launched its mass-vaccination program against the H1N1 flu virus on Monday, the government found itself fending off accusations of favoritism because it was offering one vaccine believed to have fewer side effects to civil servants, politicians and soldiers, and another, potentially riskier vaccine to everyone else. The government had hoped that Germans would rush to health clinics to receive vaccinations against the rapidly spreading disease, but now rising anger over the different drugs may cause many people to shy away.
Amid growing fears of a possible global flu pandemic, the German government prepared for its mass-vaccination campaign earlier this year by ordering 50 million doses of the Pandemrix vaccine, enough for a double dose for 25 million people, about a third of the population. The vaccine, manufactured by GlaxoSmithKline, contains an immunity-enhancing chemical compound, known as an adjuvant, whose side effects are not yet entirely known. Then, after a report was leaked to the German media last week, the Interior Ministry confirmed that it had ordered a different vaccine, Celvapan, for government officials and the military. Celvapan, which is made by U.S. pharmaceutical giant Baxter, does not contain an adjuvant and is believed to have fewer side effects than Pandemrix.
Anger at the news was widespread in Germany. "If mass vaccination is considered to be necessary, then everyone should be treated the same way," says Birgitt Bender, health spokeswoman for the Green Party. Ulrike Mascher, head of the VdK social-welfare association, says giving government officials a vaccine that's different from that given to the rest of the population sent the "wrong signal" and gives many people "the impression that they are second-class patients." A story on the front page of the mass-circulation Bild newspaper accused the government of giving "second-class medicine" to regular Germans.
Doctors and medical experts are divided over the safety of Pandemrix. While some say it's the best vaccine available, others have serious misgivings about it. "The Pandemrix vaccine can't be recommended for pregnant women or young children because it has an increased risk of side effects. Pandemrix has an adjuvant which hasn't been tested sufficiently up until now," Alexander Kekulé, a virologist at the University of Halle, tells TIME. "Celvapan is a whole-virus vaccine, which has fewer side effects than Pandemrix, but it leads more often to fever or local swelling when compared with the normal seasonal-flu vaccine," he adds. Although Kekulé calls the government's handling of the vaccination program a "scandal," he says government officials and soldiers are not necessarily getting a better deal with Celvapan. "Neither Celvapan nor Pandemrix are ideal," he says.
The Interior Ministry hit back at suggestions of preferential treatment, saying it had ordered about 200,000 doses of the Celvapan vaccine from Baxter before the differences between the two vaccines were documented, and the government was bound by the terms of its contract. The government also points out that both Pandemrix and Celvapan have been approved by the European Union and that other countries, such as Britain and Sweden, are using the Pandemrix vaccine. In an attempt to put a lid on the simmering controversy, Chancellor Angela Merkel's spokesman, Ulrich Wilhelm, said the German leader would consult with her doctor in the next few days, and if she decided to receive a jab, it would be Pandemrix.
At least 26,000 people have been infected with swine flu in Germany, resulting in three deaths. Although the majority of patients have experienced only mild flulike symptoms, a steady increase in the number of cases of H1N1 in recent months has raised alarm across the nation. In its latest report, the Robert Koch Institute, the federal agency for infectious diseases, said new cases in Germany have jumped to about 1,600 each week, double the 700 to 800 weekly cases reported in early autumn. With the onset of winter, when seasonal-flu infections typically peak, many experts are concerned that H1N1 infections will spike dramatically. Klaus Osterrieder, a virologist at the Free University of Berlin, now fears that with the worries over the possible risks associated with Pandemrix, many people will avoid getting a vaccine altogether. According to a survey conducted on Oct. 23 by the Emnid Institute, only 13% of Germans said they wanted to receive a swine-flu vaccine this winter.
"The public debate is bad because it raises questions about the whole vaccination program," Osterrieder says. If the government doesn't find some way to remedy the current public relations disaster and clear up the confusion over the different swine-flu vaccines, it could be faced with an even greater emergency, especially if the country's hospital wards start overflowing with flu patients in the coming months.