Thirty years ago there were some who envisioned a new united Germany combining the best of east and west: A vibrant market economy with an expanded commitment to economic justice, a confident democratic federal government balanced by a greater variety of states, and a commitment to individual liberty reinforced by the recent experience of dictatorship. A bridge between the solid democracy in America and the rising democracy in Russia.
Instead, Covid has revealed the modern Federal Republic as the combined worst of both systems: A timid central government in thrall to private business interests, unable to take decisive action to protect public health because of a lack of confidence that their authority would be seen as sufficiently legitimate. A resurgent right wing inspired by American and Russian ethnonationalists to express their individual liberty by rejecting even elementary public health measures. And now, a public vaccination campaign dominated by the financial and status needs of private physicians, and prioritising those people with high levels of what the East Germans called Vitamin B — “B” for “Beziehungen“, connections, the way scarce resources were distributed under socialism.
When the vaccination program started it was concentrated in large vaccination centres (Impfzentren). These were highly efficient, providing rapid throughput and simple logistics, and the official priorities of the Permanent Vaccination Commission (Ständige Impfkomission, or STIKO) — covering people over 60 years old, those with serious medical conditions putting them at elevated risk of Covid complications (including pregnant women and their companions), police, teachers, and government officials — could be securely monitored.
There were two major problems with this system: First, the physicians in private practice, for whom vaccinations were traditionally a great money spinner, felt that they were losing money and influence; Second, there was no unobtrusive path to providing priority immunisation to people who were important, influential, or just rich, threatening to lead to the sort of blatant corruption that just embarrasses everyone. This led the government* to bring the GPs into the vaccination program, paying them upwards of €50 per vaccine. The GPs, unsurprisingly, rushed to vaccinate their friends and favourite patients — particularly those patients with private insurance, who they are generally keen to hold on to, as the private insurance covers all manner of treatments that the public insurance won’t pay for, and the payment levels are generally significantly higher.
How should one respond to this? The Ethics commission is very concerned… that people who haven’t been clever enough to work the system might be jealous of the superior people who have. Here is a comment from a recent podcast interview with commission chair Alena Buyx:
AB: We shouldn’t confuse the people who have gone the extra mile and somehow managed to get it organised, or had a stroke of luck, with those who have cheated.
Spiegel: … It could be that someone who isn’t so resourceful… for various reasons, it could be social background, it could be language, it could be some lack of access to information –and I can understand that they might feel he or she feels like you’re taking something away from them.
AB: These are things that one couldn’t have imagined earlier. We have vaccine envy and also vaccine guilty conscience. But all I can say is: Good People, every vaccination is a good vaccination… Those who have been lucky, or who have profited from this “flexibility” — if they haven’t cheated anyone — they should enjoy their good fortune.
From there to full social Darwinism is just a small step, and that step was taken by one Christoph S. in the comments section of the national newspaper Die Welt:
In my social circle — definitely well off — is just about everyone vaccinated, and always the whole family, including the university-age children. None of them in the vaccination centre, always in the GP practice or through doctors they know personally. In other words, since the GPs have been doing vaccinations the prioritisation has fallen away de facto, at least for the “higher” levels of the population. This is not pretty, but as long as they’re managing to vaccinate up to a million people a day in Germany, I find it acceptable. One shouldn’t make a fuss about the people who try to cut ahead at the vaccination centres; Germany has much bigger problems than someone getting vaccinated a few days early. And, by the way, this is how it’s always been, that those who make the most noise prevail, and presumably that’s why Homo sapiens has managed to survive.***
* Just to be clear, this is not the official justification. This is a purely speculative exercise on my part. It’s hard to think of any other justification, though. It’s not as though the GPs were otherwise unoccupied, with huge amounts of spare capacity for taking on vaccination duty.
** AB: Man sollte die einen, die sich einfach reinhängen, und das irgendwie organisiert kriegen, oder ein bissl Glück haben, nicht verwechseln mit denen die einfach betrügen.
Spiegel: … Es könnte auch jemand geben der nicht so pfiffig ist… aus den verschiedensten Faktoren, das könnten die sozialen Hintergründe sein, das könnte die Sprache sein, das kann so ein bisschen Informationsferne, sich da dran zu fühlen als würde man ihm oder ihr etwas wegnehmen, da kann ich wiederum schon nachvollziehen. Was macht man denn mit diesem schlechtem Gefühl?
AB: Da gibt es Dinge von denen wir nie sich hätte träumen lassen dass wir davon reden. Jetzt gibt es Impfneid und genauso gibt es Impf-schlechtes Gewissen. Aber da kann ich allen nur sagen, ihr lieben Leute, jede Impfung ist eine gute Impfung… Diejenigen die Glück gehabt haben, oder die sozusagen von dieser Flexibilität profitiert haben — wenn sie nicht betrogen haben — die sollen sich freuen…
*** In meinem Bekanntenkreis – durchweg wohl situiert – ist praktisch jeder, und zwar stets die ganze Familie mit Kindern im Studienalter, bereits geimpft. Davon keiner im Impfzentrum, sondern alle über ihre Hausarztpraxen oder befreundete Ärzte. Mit anderen Worten, seit auch die Hausärzte Impfungen durchführen, ist die Priorisierung de facto gefallen, zumindest bei den ‘oberen’ Bevölkerungsschichten. Solange auf diese Weise täglich bis zu 1 Million Menschen in Deutschland geimpft werden, halte ich das zwar für unschön, aber hinnehmbar. Man sollte daher auch bei denjenigen, die sich im Impfzentrum vorzudrängeln versuchen, den Ball flach halten; Deutschland hat ganz andere Probleme als das Vorziehen einer Impfung um ein paar Tage. Im Übrigen war es schon immer so, dass sich die durchsetzen, die am lautesten schreien, und vermutlich hat genau aus diesem Grund der homo sapiens bis heute überlebt.
Common Infirmities 