Innoculation costs

Plans announced by the German government last month to vaccinate 25 million people against swine flu this autumn are increasingly coming under attack. Officials have ordered 50 million units of vaccine, since each person must be innoculated twice.

Berlin estimates the immunization program will cost 600 million euros ($850 million), although health insurance companies argue that one billion euros is more realistic.

Where to send the bill?

One big unanswered question remains; who will pay for the immunization program? Berlin has said the health insurance companies must bear the costs, while they, in turn, have threatened to raise their premiums or impose a surcharge on patients. The Federal Association of Local Authorities (DSTGB) insists its members should not have to pay for the vaccinations. Consumer and employer associations have also warned against attempting to pass on immunization costs.

"It's poison for employment, especially during this economic crisis," said the German Chamber of Commerce and Industry (DIHK) in a statement.

Is the effort worthwhile?

The benefits of such a massive program have not been adequately substantiated, according to Professor Gerd Glaeske, who researches pharmaceutical applications at the Center for Social Politics at the University of Bremen. “Vaccinations are not a panacea,” Glaeske said.

Some critics even suggest that much of the hysteria over a possible swine flu epidemic has been artificially created. They point to the very limited number of swine flu infections in Germany, none of which have been fatal.

“This is huge business for the pharmaceutical industry,” said Social Democrat deputy, Wolfgang Wodarg. "The swine flu outbreak is no different from a normal flu outbreak", he told the Neue Presse newspaper in Hanover. “Quite the opposite, if you compare the number of swine flu cases with other flu outbreaks. It's ridiculous,” he added.

The government plan, so far

The German Health Ministry late last month announced a draft plan outlining who will be immunized first. Those suffering from asthma, bronchitis, diabetes, certain immune deficiencies including HIV infections, or heart, liver and kidney ailments top the list, as well as pregnant women and the obese. Healthcare workers and public employees are also high on the list.

Meanwhile, it has been determined that a so-called PCR test, which could confirm if someone has swine flu, is too unreliable to be used except in extreme cases. The test failed to detect the presence of swine flu in half of all cases.

Chaos feared

Berlin plans to immunize millions of citizens in a very short time to beat the start of the flu season. The DSTGB fears being overwhelmed with the task. It says the government's draft vaccination plan has not been carefully thought through and warns of confusion due to a poor allocation of responsibilities. It has called for local health authorities, doctors and clinics to be urgently informed of the government's specific plans.

A spokeswoman for the German Health Ministry said vaccination agreements will be finalized with Germany's 16 federal states over the next few weeks.

Germany's largest health insurer, AOK, has already suggested setting up four “Vaccination Sundays” in order to carry out the massive task of immunizing 680,000 people in the northern state of Schleswig-Holstein within a very short space of time.

Vaccine still untested

Meanwhile, pharmaceutical companies, including Sanofi Pasteur, Novartis and CSL are producing the vaccine at top speed. But, although vaccinations are set to begin in the fall, final clinical tests could take more than a year.

Prodution of the swine flu vaccine will not be able to meet worldwide demand. To make the most efficient use of the doses available, the World Health Organisation (WHO) said in a press conference in Geneva on Thursday, that countries in the northern hemisphere should be the first to get the vaccine in September or October, when the flu season starts there. The WHO added that doctors and nurses in the southern hemisphere should also be among the first people to receive swine flu shots.

wl/AP/dpa/AFP/Reuters

Editor: Susan Houlton