COVID-19 Vaccination in Medical Practices in Germany

COVID-19 vaccines began to be administered in medical practices starting on 7 April, 2021 (1). Prior to that, vaccination had started on 28 December, 2020, but was only administered by mobile vaccination teams and in vaccination centers, due to limitations of available vaccines and the consequent prioritization of groups for vaccination (2). As of 3 October, 2021, approximately 108.1 million vaccinations had been administered in Germany (3), with about 44.2 million (40.9%) administered in medical practices (4). Further, around 21.3 million first-dose vaccinations (39.8% of all first-dose vaccinations in Germany) were administered in medical practices. Based on previously unpublished data, this article aims to present the background to COVID-19 vaccination in German medical practices, in order to enable conclusions to be drawn for future vaccination campaigns.

Methods

The Robert Koch Institute (RKI) reports the daily total number of vaccinations administered (3), whereby no differentiation is made according to the vaccination facility, but with data aggregated at the district level and differentiated according to age group and first- / second-dose vaccination. For this article, more detailed data from the German National Association of Statutory Health Insurance Physicians (KBV) on the reports from practices regarding vaccination were used (4). Data were examined, processed, and then anonymized by the KBV. Over the course of preparation, the KBV added data from the German Medical Association in accordance with the General Data Protection Regulation. Practices were identified using the permanent medical establishment number (Betriebsstättennummer), and the private practice physicians who administered vaccines were identified via their lifelong physician number. Data were then aggregated for anonymization. This was differentiated according to the municipality key at the district level, date, age group of the individuals vaccinated, first- / second-dose vaccination, and specialist group of the practice. Anonymized data were evaluated by the Central Research Institute of Ambulatory Health Care (Zi) (for all reported vaccinations as of 3 October, 2021).

Results

Specialist groups

Almost all general practitioners took part in the COVID-19 vaccination campaign and performed most of the vaccinations carried out by the private practice physicians. There was also high participation among pediatricians and gynecologists (table). Overall, 61.6% of all practices, and 64.9% of private practice doctors, administered COVID-19 vaccines. With respect to the general practitioners, these proportions included 93.1% of practices, and 94.6% of physicians.

Table. COVID-19 vaccines administered in private practices per physician specialist group, in calendar weeks 14–39 (2021), with proportion in %.

Specialist group	Number given doses	Proportion of doses given by private physicians	Number of vaccinating practices	Proportion of all practices (per specialist group)	Number vaccinating priv. physicians	Proportion of all priv. physicians (per specialist group)
Total	44 179 203	100.0	48 151	61.6	92 931	64.9
General practitioners	33 968 610	76.9	30 282	93.1	48 413	94.6
Cross-disciplinary	2 439 905	5.5	1748	62.4	13 747	65.7
Pediatricians	1 451 211	3.3	3206	81.6	5540	85.2
Obstetricians and gynecologists	1 424 672	3.2	3583	53.1	5800	56.8
Internists	1 319 995	3.0	2371	58.5	5748	65.2
Other specialist groups/unknown	1 094 642	2.5	1354	12.8	2681	16.9
ENT specialists	860 304	1.9	1449	55.9	2482	61.8
Surgeons and orthopedists	805 547	1.8	1739	35.7	3667	41.1
Urologists	268 681	0.6	650	38.5	1262	44.4
Dermatologists	242 352	0.5	750	33.3	1376	38.7
Neurologists	188 505	0.4	676	20.5	1287	26.5
Ophthalmologists	114 779	0.3	343	11.9	928	16.6

Age groups of persons vaccinated

For vaccinations covered by statutory health insurance, it is clear that the age group proportions changed according to the political criteria for prioritization. Initially, the age group primarily vaccinated were people over the age of 60, but the proportion continuously decreased in favor to those between the ages of 18 and 59. From calendar week 23 onwards, the proportion of 12- to 17-year-olds among those receiving a first-dose vaccination also increased (Figure).

Figure 1.

Weekly proportion of age groups receiving the first-dose vaccine at private medical practices.

As per the Corona Virus Vaccination Ordinance of the German Federal Ministry of Health, only the three age groups, of “under 18”, “18–59”, and “60 and over” were given for vaccination roll-out. A more detailed age distribution is therefore currently not possible. CW, calendar week

Regional differences in vaccinations administered by private practice physicians

In the 401 rural districts and urban districts in Germany, vaccines were administered in at least 34.9% of the practices and by 34.2% of the private practice physicians; the peak values were even over 80%. In a further analysis, the number of vaccine doses administered by private practice physicians in a group was compared to the total number of vaccine doses of that group. This revealed that, in rural districts (n= 295), an average of 53.5% of the doses were administered in private practices, while in urban districts (n= 106), this proportion averaged to about 39.4% (two-sample t-test for differences in mean values: p< 0.001). In particular, the general practices took on a large proportion of the vaccination process in rural districts in the federal states of Saarland, Rhineland-Palatinate, Bavaria, and Brandenburg.

Vaccines

The vaccine from Biontech / Pfizer accounted for the majority of vaccinations in medical practices (around 83.4% of the administered doses). Particularly up to calendar week 21, the AstraZeneca vaccine was also administered to a lesser but marked extent, depending on availability (about 11.9% of the total up to calendar week 39), while the Johnson & Johnson vaccine was administered in particular from calendar weeks 21–24 (about 4.5% of the total up to calendar week 39). Starting on 4 October, 2021, the Moderna vaccine can also be vaccinated in medical practices, but that falls outside of the observation period analyzed here. In comparison, the vaccination centers (plus mobile vaccination teams and workplace vaccinations) administered about 63.9% Biontech / Pfizer, 12.1% AstraZeneca, 1.4% Johnson & Johnson, and 22.7% Moderna vaccines from weeks 14–39.

Conclusion

A large part of the German COVID-19 vaccination campaign was carried out by private practice physicians, and especially by primary care practitioners—despite being included later on in the vaccination campaign. The politically prescribed vaccination prioritization was followed. It should be noted that the number of vaccines administered in the practices in the first few weeks was limited by the amount of vaccines available, and that the number of vaccine doses ordered was higher than the number of doses actually delivered. In rural districts, which are rather sparsely populated, practices had on average a higher proportion of administered doses than in urban districts, which are usually more densely populated. For nationwide vaccination, and especially in rural areas, the decentralized practice structure is of particular importance to achieve widespread vaccination.