Vaccine shortage

Florian Tiefenböck studied human medicine at the LMU Munich. In March 2014, he joined as a student and has supported the editorial team with medical articles ever since. After receiving his medical license and practical work in internal medicine at the University Hospital Augsburg, he has been a permanent member of the team since December 2019 and, among other things, ensures the medical quality of the tools.

More posts by Florian Tiefenböck All content is checked by medical journalists.

Every now and then there are delivery bottlenecks for medicines. This can also affect vaccines. The Standing Vaccination Commission recommends different approaches in such cases. The main aim of this is to vaccinate those who need it most urgently. Read here what a vaccine shortage can cause and who doctors then give priority to vaccinating.

Vaccine Shortages: Why Are Vaccinations Important?

In addition to hygiene measures, vaccines are the most important means in the fight against infectious diseases. Smallpox, for example, has been eradicated through global vaccination campaigns. Polio and measles have also been successfully contained through vaccinations.

Vaccinations basically have two goals:

• The protection of the vaccinated (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.

Community protection means that those who are not vaccinated are also less at risk. Vaccinations are particularly important for infants and young children, certain occupational groups, as well as for the chronically ill and the elderly. They are often more susceptible and usually more difficult to develop certain infections.

However, so that these goals can be achieved, it is important that people receive the vaccinations in a timely manner (e.g. the correct age). The Standing Vaccination Commission (STIKO) of the Robert Koch Institute (RKI) has therefore drawn up vaccination recommendations. They tell you what, when and how often a person should be vaccinated.

Vaccine Shortages: Causes

Sometimes there are not enough vaccines left to implement the STIKO recommendations. The vaccine shortage can be due to several reasons:

Increased demand: Especially in times of crisis like the Sars-CoV-2 pandemic in 2020, more people than usual are interested in vaccinations. Even if countries change their vaccination recommendations, this can lead to increased demand and thus to a vaccine shortage.

Increased consumption: In some crises not only the demand but also the need and thus the consumption of vaccines increases. One example is the European refugee movement in 2015: Many victims from countries without clear vaccination regulations were vaccinated, which resulted in a shortage of vaccines.

Delivery bottlenecks: The production and delivery of a vaccine is repeatedly 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 delivery problems.

Vaccine withdrawn from the market: Every now and then a manufacturer decides to withdraw its vaccine from the market. The reason for this is, for example, increased quality requirements, for example on the production facility.

Too high costs: Rising drug prices mean that certain vaccines are becoming scarce, especially in poorer countries.

Too little profit: Vaccines sometimes make little money for pharmaceutical companies - measured in terms of development and manufacturing costs. Then too few companies produce too few vaccinations. If the demand is still high, there will be a shortage of vaccines.

Competent authority

In Germany, the Paul Ehrlich Institute notifies you when a vaccine is scarce. The pharmaceutical companies report the supply bottleneck themselves. They inform the authorities if the supply chain of a vaccine is interrupted for at least two weeks.

How many vaccinations are still available at the time of reporting is not recorded centrally. Often there are still stocks in pharmacy wholesalers, in clinics, in medical practices or in local pharmacies. This often makes it difficult to assess the actual extent of a vaccine shortage.

Vaccine Shortages: What To Do?

If a vaccine is scarce, doctors have to make good use of the remaining vaccines that are still available. The STIKO offers assistance. In the event of a vaccine shortage, the experts generally recommend:

Use alternative vaccines: If the approved vaccine is not available, doctors use similar vaccines. For example, these are not applied by default for the affected age group, but they are also effective.

Single 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 endure several vaccinations, but is still protected. If individual vaccines are only available for part of the actual combination vaccination, doctors inject them anyway. The rest will be made up later.

Low-valent instead of high-valent vaccines: Some vaccinations work against different types of a single pathogen. A well-known example: the pneumococcal vaccination for children. There is a vaccine that works against 13 pneumococcal variants (PCV13) and one that covers ten variants (PCV10). If PCV13 is then not available, doctors choose PCV10.

Postpone booster vaccinations: Booster vaccinations renew a possibly weakened immune protection. If there is a shortage of vaccines, these repetitions take place later. But don't worry: many of them still have adequate protective effects - even after the refreshment appointment.

Every vaccination counts: If there are still residues in a doctor's office, these are also administered. This also applies if it is foreseeable that the next dose of a vaccination series cannot be given due to the shortage of vaccines. With many vaccinations, the vaccinated build up a defense after the first immunization. The other doses are mainly given to strengthen the immune protection for a long time and thus also protect those who are not sufficiently affected by the first vaccination.

Vaccine Shortages: Who Will Get Vaccinations?

In general, vaccinations are important for everyone. But in the event of a vaccine shortage, doctors have to decide who to give the remaining stocks to. Here, too, the STIKO provides a decision-making aid. Accordingly, vaccinations should be given in descending order:

1. Certainly unvaccinated people (choosing a vaccine that covers as many pathogens as possible)
2. Household members of people at risk (cocoon strategy)
3. Booster vaccinations for preschoolers
4. Booster vaccinations for adolescents
5. Adult booster vaccinations

Vaccine Shortages: Specific Recommendations

The STIKO experts not only give general advice. They also regularly update their specific tips for vaccine shortages for certain vaccines.

Vaccine shortage: shingles vaccination

The lack of vaccine availability concerns a dead vaccine against shingles (herpes zoster) and associated nerve pain. Doctors recommend the vaccination to all people aged 60 and over, risk groups such as the chronically ill from 50. The shingles vaccination consists of two doses of vaccine at an interval of two to six months.

If the shingles vaccine is scarce, the STIKO recommends using the vaccine preparations that are still available in order to complete the vaccination series. The first vaccination is therefore only given if it is certain that the second immunization can also take place despite the shortage of vaccines.

Vaccine shortage: HPV vaccination

There is a dead vaccine against human papillomavirus (HPV) that works against nine types of HPV. The STIKO recommends the HPV vaccination for all girls and boys between the ages of nine and fourteen years. It consists of two doses of vaccine five months apart. If the distance is shorter or if the children are older than 14 years, the experts even recommend three syringes.

If this vaccine is missing, doctors give the rest of the vaccination primarily to unvaccinated children. The STIKO recommends vaccinating the children as early as possible and initially only once because of a better immune response. Further vaccinations will be given as soon as the vaccine is available again. It is also conceivable to use an alternative vaccine that works against two types of HPV.

Vaccine shortage: MMRV vaccination

At the first vaccination appointment against measles, mumps, rubella and varicella, doctors split up the vaccination - at least when it comes to basic immunization for children. They give the MMR vaccine to one part of the body and the chickenpox vaccine to another. For the second vaccination, however, doctors use a combination vaccine against all four pathogens (MMRV).

In the event of a vaccine shortage, there is an advantage: two MMRV vaccinations are available in Germany. If one can no longer be delivered, doctors switch to the other. If the bottleneck affects both quadruple vaccines, doctors inject separately as with the first vaccination - once a vaccine against measles, mumps, rubella and at the same time a vaccine against chickenpox in a different part of the body.

Vaccine shortage: pneumococcal vaccination

Children typically receive three vaccinations between the ages of two and 14 months. Doctors use a vaccine against 13 types of pneumococci (PCV13). As standard, adults aged 60 and over receive a single pneumococcal vaccination against 23 subtypes (PPSV23). Special rules apply to risk groups.

The vaccination against the pathogens of lung, middle ear or meningitis was often in short supply, especially in times of crisis. Then the STIKO recommends:

• Pneumococcal Conjugate Vaccine PCV13: It is intended to be used only for primary vaccination in infants up to two years of age. If the vaccine is not available, the 10-valent conjugate vaccine (PCV10) should be used instead.
• Pneumococcal polysaccharide vaccine (PPSV23): It should be given primarily to people with immunodeficiency, seniors aged 70 and over and people with chronic respiratory diseases.

Vaccine shortage: tetanus / diphtheria / pertussis / polio vaccination

The basic immunization against the diseases already takes place in infancy - together with the vaccinations against Haemophilus influenzae B and hepatitis B. Doctors inject a six-fold vaccine four times. There are additional vaccines against tetanus, diphtheria and pertussis, as booster vaccinations are necessary here. Polio is also repeated in adolescence - usually together with the vaccination against the other three pathogens.

These booster vaccines in particular have become scarce again and again in recent years. However, there are a number of different combination and single vaccines that doctors can give instead. They also pay attention to as few spikes as possible. The STIKO also recommends combining vaccines that are as broadly effective as possible.

Once the shortage of vaccines has been resolved, the STIKO's usual vaccination recommendations apply. You can read about this in our vaccination calendar.

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