Germany's federal and state governments came up with their "national vaccination strategy" early in November. It aims to build up infrastructure as quickly as possible to enable mass-vaccination programs. The work is a little complex and ad hoc, not least because, as the 15-page document concedes, it's not yet clear which vaccines will be available when, and in what quantities.

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But the plan's main aim is to avoid the opposite scenario: that a working vaccine cannot be distributed to the people because the logistics are lacking.

Tasks and workflows are already established. The federal government will be procuring the vaccine doses via the EU, which currently has deals with six pharmaceutical companies working on possible vaccines. The government in Berlin would then distribute doses among 60 distribution centers scattered around the country.

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That's when the states take over; they have already started setting up vaccination centers, with Berlin sharing the costs for this. Initially, vaccination will not be possible for general practitioners. That's because supply will be short at first with not enough doses for everybody, and because storing doses at normal GPs offices might not be technically or logistically possible.

The elderly and healthcare workers may come first

In Berlin, for instance, the local government is setting up six vaccination centers, including a pair in the currently deserted airports of Tempelhof and Tegel. Based on conversations with Pfizer and BioNTech, Berlin is tentatively planning on a first wave of around 900,000 doses. As each person is likely to require a pair of jabs, that would equate to some 450,000 Berliners or a little over 1 in 10 people in the capital.

"We are preparing ourselves for the earliest potential start date — December," the minister responsible for health in Berlin, Dilek Kalayci, said.

It's not yet entirely clear who will be the priority patients. A experts' commission submitted recommended guidelines to the German Health Ministry earlier in the year. It recommended prioritizing the elderly and those at particular risk from COVID-19 because of other health conditions, alongside healthcare workers and other people in professions crucial to keeping public life running. 

For now though, these remain rough guidelines, not least as some core data from pharmaceutical companies is still wanting.

"We don't yet have detailed insight into these tests," Lothar Weiler of Germany's Robert Koch Institute for infectious diseases said recently. A finalized vaccination plan will only be possible once the vaccine is available and once it's clear how it works and how effective or safe it is for various age groups; some might be deemed too potent for priority patients like the very elderly or infirm, for example.

How to reach rural residents?

Still, states are preparing as best they can. In Brandenburg, a large state surrounding Berlin with unusually low population density by German standards, they will need 12 vaccination centers rather than six. Two aim to open this year and 10 more in 2021.

Rural states like this face a particular challenge. How should older people, perhaps with limited mobility, reach centralized vaccination centers from the smaller rural villages? There has been talk of special mobile vaccination crews, but for now, these are earmarked to service care homes first.

Brandenburg's working towards the target of doing as much as possible as swiftly as possible. The state has been stocking up on vaccination materials in the meantime, buying in 3 million 1-milliliter needles, 3.5 million alcohol swabs, and refrigeration containers.

The mRNA-based vaccines from Pfizer and BioNTech and from Moderna come with very particular storage requirements. They must be kept at temperatures of negative 70 degrees Celsius (negative 94 degrees Fahrenheit). Once thawed out they have only a very limited shelf life being stored at more typical refrigerated temperatures.

Are there enough staff for the task?

The vaccination process itself will pose considerable logistical challenges. Take Berlin as an example: it's planning a first phase of vaccinations lasting 40 days, aiming for 3,400 vaccinations per center, per day. One of the simplest challenges could prove to be controlling the queues and the timetables.

The sites won't just need enough doctors for the task, but also people on the doors, drivers, helpers, and the rest.

"We will rely on asking for help from others like aid organizations, the Bundeswehr military and hospitals, to ensure that enough personnel are there," Burkhardt Ruppert from one of Germany's doctors' associations told DW.

Key questions still open

Experts warn that a degree of flexibility will be required no matter how well prepared a country might be. The chairwoman of the German ethics council, Alena Buyx, summarized some of the challenges during an international experts' discussion recently. The chances are that several different vaccines will hit the market. These might affect different age groups differently, or carry different potential side effects, and masses of new empirical data on them will still be flooding in after such a rapid development phase.

There are many factors to take into account. Christiane Woopen, who chairs the European Group on Ethics in Science and New Technologies, called for early talks on potential compensation for people who do suffer side-effects, rather than leaving the potential issue to the courts. She also called for an effort to codify vaccination strategies, seeing as there will not be enough doses for everybody for some time yet. She argued that at its most extreme, prioritizing could be interpreted as deciding "who lives and who dies."

How long this first phase will last, when prioritizing patients will be necessary, depends on how quickly pharmaceutical companies can churn out their wares, and whether vaccines emerge which can be more easily stored in traditional refrigeration units.

As soon as that is the case, and supply begins to draw level with demand, the German national vaccination strategy would then move on to phase 2, at which point doses might be sent to general practitioners' clinics as well.

For now, Germany is stocking up as best it can — according to Health Minister Jens Spahn, 300 million potential doses have been secured or pre-ordered thus far via the EU.

This article has been translated from German.