German Health Minister Karl Lauterbach is working hard to restructure the entire German public health bureaucracy, according to the lessons our rulers have derived from the Covid pandemic. The purpose of his reforms are hard to work out, and ominously, nobody at the Health Ministry will explain them. A little-known agency called the Federal Centre for Health Education will be merged into a larger “Federal Institute for Public Health,” which will assume responsibility for “networking health authorities and health communications.” While the Robert Koch Institut (our CDC) will maintain its alleged “scientific independence,” it will lose much of its staff to another new concoction, namely the “Federal Institute for Prevention and Education in Medicine” (BIPAM). Henceforth the RKI will deal only with transmissible pathogens; BIPAM will be responsible for non-communicable diseases and will also take over the public communications responsibilities of the “independent” RKI. So we have 1) a campaign to separate administrative responsibility for infectious and non-infectious diseases, so that we can continue to address respiratory pathogens as a general threat to the entire population and in isolation from the preconditions which make them dangerous to specific vulnerable groups in the first place; and 2) an effort to steer public health much more in the direction of “health communication,” because last time the virus panic propaganda was not nearly uniform or comprehensive enough.
An additional, highly suspicious reform targets our Standing Committee on Vaccination (STIKO). This is a purportedly independent advisory board that provides vaccine schedule recommendations for the Federal Republic. Before the pandemic, most people had hardly heard of STIKO, but the Covid vaccines brought them into the headlines and into conflict with the political establishment, as the vaccine mania of our follow-the-science politicians frequently outpaced the vaccine mania of their scientific advisers. Nowhere was this conflict more pronounced than in the bizarre and completely unjustified campaign to vaccinate German children that took shape in the summer of 2021. STIKO and its head, Thomas Mertens, did not believe the evidence justified the Health Ministry’s planned child vaccination campaign, but in August 2021 they folded to immense political pressure and gave the green light to jab teenagers anyway.
Lauterbach wants to impose term limits on STIKO members, which will effectively force 12 of the 17 commissioners out of office by February. Mertens, who stood most publicly against the child vaccination campaign, is among the casualties.
I was not sure what to make of the new STIKO term limits until I encountered a very bizarre article in Zeit this morning, bearing the headline “Political manoeuvre or totally normal procedure?” and promising to reveal “what’s behind the radical reorganisation.” I read it twice, and came away from the experience powerfully convinced that there is a lot more to this story than anybody will let on. You must understand that Die Zeit is the broadsheet of the establishment and their right-thinking supporters. Its editors cultivate a curious all-things-considered style; by pantomiming openness while restricting the terms of discussion entirely to orthodox premises, Zeit allows readers to feel well-informed and confident that are politicians are doing just the right thing, however insane this thing happens to be.
The article quotes a Health Ministry spokesperson, who pleads that the term limits are merely a reform intended to bring STIKO into line with international standards. Consistent with their both-sides tactic, they also provide some perspective from within STIKO, reporting that members felt their termination was too sudden and did not sufficiently acknowledge the depths of their pandemic service. There is all too much emphasis on the butthurt of specific Commission members here; it is a way of implying that this whole thing is a pseudo-controversy over hurt academic feelings. They also interview Martin Terhardt, one of the affected STIKO members, who pleads the move is too sudden and will deprive the Commission of much experience. To counter this sentiment, they bring in an anonymous source to say that actually this is nothing to worry about because STIKO has a substantial full-time staff that carries out much of the evaluation for the voting members and all of these employees will stay on. It is always an important signal, when reporters extend anonymity to sources who say totally banal things like this. Almost as important is a headlined promise to provide an explanation, which the article never quite delivers. At the end of this piece one is still very puzzled about “what’s behind the radical reorganisation.”
Buried in the middle of the piece are curious remarks about the timeline. All members should have been up for reappointment in March 2023, but in June 2022 Lauterbach asked them to stay on for another year, “because of the pandemic.” Then it was radio silence until the start of this month, when newly term-limited STIKO members began getting calls from the Health Ministry telling them their time was up.
Why the sudden change of attitude? Could it have something to do with the vaccines that STIKO are currently considering? Our all-things-considered both-sides-heard Zeit reporter does not want to talk about this very much, but Terhardt brings up the subject and so he can’t totally ignore it:
By summer … STIKO hopes to make a recommendation for the new vaccine and the prophylactic antibody against respiratory syncytial virus (RSV), which has caused emergencies in German paediatric clinics over the past two years …
Various new recommendations are pending in the coming year, and the current STIKO have already started work on them. In addition to the evaluation of the RSV antibody Nirsevimab and the RSV vaccination for pregnant women, the focus is also on vaccinations against meningococci and influenza. Terhardt fears that the sudden reorganisation will lead to delays in STIKO’s work.
After some further poking about, I realised that the Zeit article is an oblique rebuttal of an earlier, critical report on Lauterbach’s reforms in Welt. The upshot of that piece is that Lauterbach might be forcing out two-thirds of STIKO as revenge for pushing back on his deranged vaccine mania in 2022:
CDU politician [Tino] Sorge sees the move as a consequence of the Commission’s criticism of Lauterbach’s “unauthorised vaccination recommendations.” STIKO indeed drew attention with statements that contradicted the views and directives of the new minister. In July 2022, for example, Chairman Mertens rejected Lauterbach’s advice that young people should be vaccinated a fourth time. He knew of no data that justified this. At the time, Mertens said: “I think it’s bad to make medical recommendations after the style ‘more helps more’.” Lauterbach later urged the commission to make further vaccination recommendations, but the commission resisted.
Is this Lauterbach’s motive for restructuring STIKO? “The Minister made the decision. That’s all I know,” says STIKO member Fred Zepp … “Replacing two thirds of the committee is a considerable loss of experience,” Zepp says …
His Commission colleague Christian Bogdan also criticised Lauterbach’s decision … “Why the Ministry has opted for a disruptive change is incomprehensible and does not serve the central mission of STIKO.”
His former [STIKO] colleague Gerd Antes puts it more clearly: “This massive intervention gives the impression that the aim here is to curtail STIKO’s independence by transforming it into an instrument for confirming and applauding the announcements of the Minister of Health instead of providing independent scientific advice” … Antes … sees the decision in connection with the planned restructuring of the RKI and the dissolution of the Federal Centre for Health Education: “I suspect that Lauterbach wants to have a scientific back-up choir behind him. Critical voices only get in the way.” Epidemiologist and ex-WHO member Klaus Stöhr is also worried: “STIKO will take a long time to become fully operational again.”
In a separate piece, Welt interviews another STIKO member, Sabine Wicker, who like her colleagues believes the enormous turnover has the potential to incapacitate the Commission in the near term. She also mentions the upcoming RSV vaccine recommendations as most likely to be affected by Lauterbach’s term limits. A subcommittee is working on this recommendation; permanent STIKO staff form part of this subcommittee, but all such groups have to be headed by voting STIKO members. The term limits therefore amount to removing the subcommittee leadership ahead of a crucial decision. According to Wicker, “That’s going to make things a bit hard.” The staff continuity underlined by the anonymous informant in Zeit is therefore at best a half-truth.
Exactly how the new STIKO members will be selected is not something anybody is eager to explain. In the past, STIKO staff apparently drew up lists of candidates with help from professional organisations, and the Health Ministry made appointments from these lists, theoretically in consultation with the health authorities of the federal states. Even assuming Lauterbach follows these old procedures, his term-limit manoeuvre will grant him substantial power over STIKO’s membership, and the chance to pack the Commission with inexperienced and pliable scientists months ahead of their RSV vaccine decision. We can presume there will be no more hesitancy when it comes to child vaccination in Germany.
As bad as the lockdowns and mass vaccination were, the most ominous thing about the pandemic response it what it portends for the future. Covid has taught the Lauterbachs of the world that even the pretence of independent public health organisations and advisory bodies is too dangerous to be trifled with. These have to be brought into line, either via substantial reorganisation (in the case of STIKO) or via reduction in staff and responsibilities (in the case of RKI). Substantial expansions to the “health communication” bureaucracy will keep everybody on-message even more than they were during the Corona era. The road must also be cleared for pharmaceuticals to profit maximally from the heightened post-pandemic interest in vaccines, particularly the new RSV vaccines, which are only a thing in the first place because the immunity deficits wrought by hygiene measures put a bunch of children in the hospital after we re-opened.