Vaccine shortage: Why are vaccinations important?
Alongside hygiene measures, vaccines are the most important means of fighting infectious diseases. Worldwide vaccination campaigns have eradicated smallpox, for example. Polio and measles have also been successfully controlled by vaccination.
Vaccinations basically have two goals:
- The protection of the vaccinated person (individual protection)
- The protection of fellow human beings through herd immunity (community protection): A vaccinated person is protected from the disease, at least for a certain period of time, and thus cannot infect others.
Through community protection, those who are not vaccinated are therefore also less at risk. Vaccinations are particularly important for infants and young children, certain occupational groups, and the chronically ill and elderly. They are often more susceptible and usually fall ill more severely from certain infections.
Vaccine shortage: causes
Sometimes there are not enough vaccines left to implement the STIKO recommendations. Vaccine shortages can have various causes:
Increased demand: especially in times of crisis, such as the Sars-CoV-2 pandemic in 2020, more people than usual are interested in vaccinations. Also, when countries change their vaccination recommendations, this can lead to increased demand and thus a vaccine shortage.
Increased consumption: in some crises, not only does demand increase, but so does the need and therefore the consumption of vaccines. One example is the European refugee movement in 2015: many affected people from countries without clear vaccination regulations were vaccinated, resulting in a vaccine shortage.
Supply shortages: Time and again, the production and delivery of a vaccine is disrupted. For example, industrial accidents, regional problems such as acts of war, or a global crisis such as the Corona pandemic cause vaccine shortages due to supply difficulties.
Costs are too high: Rising drug prices are making certain vaccines scarce, especially in poorer countries.
Too little profit: Vaccines sometimes bring in only a little money for pharmaceutical companies – measured against the development and manufacturing costs. Then too few companies produce too few vaccines. If demand is nevertheless high, a vaccine shortage results.
Competent authority
In Germany, the Paul Ehrlich Institute notifies when a vaccine is in short supply. The pharmaceutical companies themselves report the supply shortage. They inform the authorities when the supply chain of a vaccine is interrupted for at least two weeks.
However, how many vaccines are still available at the time of notification is not recorded centrally. Often, there are still stocks in pharmacy wholesalers, clinics, doctors’ offices or local pharmacies. This often makes it difficult to assess the actual extent of a vaccine shortage.
Vaccine shortage: what to do?
If a vaccine is in short supply, physicians must make sensible use of the remaining vaccines that are still available. The STIKO offers assistance. The experts generally recommend the following in the event of a vaccine shortage:
Individual vaccines instead of combination vaccines: If combination vaccines are in short supply, doctors use individual vaccinations against the respective diseases instead. The patient then has to undergo several vaccinations, but is still protected. If individual vaccines are only available for part of the actual combination vaccination, doctors inject them anyway. The remaining vaccines are then given later.
Low-valent instead of high-valent vaccines: Some vaccines are effective against different types of a single pathogen. A well-known example is the pneumococcal vaccine for children. Here, there is one vaccine that is effective against 13 pneumococcal variants (PCV13) and one that covers ten variants (PCV10). If PCV13 is not available then, physicians choose PCV10.
Postpone booster vaccinations: Booster vaccines renew immune protection that may have been weakened. If there is a vaccine shortage, these booster shots take place later. But don’t worry: For many, there is still adequate protection – even beyond the booster date.
Vaccine shortage: who gets vaccinations?
In general, vaccinations are important for everyone. But in the event of vaccine shortages, physicians must decide to whom they will administer the remaining stocks. Here, too, the STIKO provides a decision-making guide. According to this, vaccinations should be given in descending order:
- Certainly unvaccinated persons (choosing a vaccine that covers as many pathogens as possible)
- Household members of persons at risk (cocoon strategy)
- Booster vaccinations of preschool children
- Booster vaccinations of adolescents
- Booster vaccinations of adults
Vaccine shortage: specific recommendations
The STIKO experts do not only provide general advice. They also regularly update their specific tips in case of vaccine shortages of certain vaccines.
Vaccine shortage: shingles vaccination
The vaccine shortage in this case involves an inactivated vaccine against shingles (herpes zoster) and associated nerve pain. Physicians recommend vaccination to all people over the age of 60, and to at-risk groups such as the chronically ill as early as 50. The shingles vaccine consists of two vaccine shots given two to six months apart.
Vaccine shortage: HPV vaccination
There is an inactivated vaccine against human papillomaviruses (HPV) that is effective against nine HPV types. The STIKO recommends HPV vaccination for all girls and boys between the ages of nine and fourteen. It consists of two vaccine doses five months apart. If the interval is shorter or the children are older than 14 years, then the experts even advise three shots.
If this vaccine is missing, doctors give the remaining vaccination primarily to unvaccinated children. The STIKO recommends that children be vaccinated as early as possible and only once at first to ensure a better immune response. Further vaccinations are then given as soon as the vaccine is available again. It is also conceivable to use an alternative vaccine that is effective against two HPV types.
Vaccine shortage: MMRV vaccination
At the first vaccination appointment against measles, mumps, rubella and varicella, doctors split the vaccination – at least when it comes to basic immunization in children. At one body site they administer the MMR vaccination, at another the chickenpox vaccination. For the second vaccination, however, physicians use a combination vaccine against all four pathogens (MMRV).
Vaccine shortage: pneumococcal vaccination
Children typically receive three vaccinations between the ages of two and 14 months. Doctors use a vaccine against 13 pneumococcal types (PCV13). Adults receive a standard one-time pneumococcal vaccination against 23 subtypes (PPSV23) starting at age 60. Special rules apply to at-risk groups.
However, vaccination against the pathogens that cause pneumonia, middle ear infections or meningitis has often been in short supply, especially in times of crisis. Then the STIKO recommends:
- Pneumococcal conjugate vaccine PCV13: It should be used exclusively for basic immunization in infants up to the age of two. If the vaccine is not available, the 10-valent conjugate vaccine (PCV10) should be administered instead.
- Pneumococcal polysaccharide vaccine (PPSV23): It should be given primarily to people with immunodeficiency, seniors 70 years of age and older, and people with chronic respiratory disease.
Vaccine shortage: tetanus/diphtheria/pertussis/polio vaccine.
These booster vaccines in particular have been in short supply in recent years. However, there are a number of different combination and individual vaccines that doctors can give instead. In doing so, they also make sure to use as few pricks as possible. The STIKO also advises using combination vaccines that are as broadly effective as possible.
Once the vaccine shortage has been resolved, the STIKO’s usual vaccination recommendations apply. You can read about these in our vaccination calendar.
