COVID: Is Germany prepared for another pandemic?

The world seems to have largely got over COVID-19 — and is now making preparations for how to cope with any future pandemic. A global agreement on pandemics is designed to improve communication between countries. Members of the World Health Organization (WHO) are currently negotiating the draft accord.

Many scientists are convinced that there will be another pandemic. Flu, a new coronavirus or a pox virus are among the potential candidates.

"Bird flu would be uncomfortable," said Emanuel Wyler, a molecular biologist from Berlin's Max Delbrück Center. "Pox would be a small nightmare. "

But measles or multi-resistant bacteria are also possible — the list is long.

Our increasingly connected world and climate change mean that infectious diseases can spread increasingly quickly and easily. Intensive livestock farming and the encroachment of people into wildlife habitats make zoonoses more likely. That is when a disease jumps from animals to people.

Germany is also considering whether it has learned the right lessons from COVID-19. Is the country prepared to face another pandemic?

Hospitals will play a critical role

Images of packed intensive care wards and overworked staff have seared themselves into our brains. In any future pandemic it'll be crucial how well Germany's hospitals are armed to cope with a sudden influx of patients.

"Health care provision in times of crisis will only work well if hospitals run well in normal times," said Christian Karagiannidis, a critical care doctor at Cologne-Merheim Hospital in western Germany. "That doesn't currently exist in the form we need."

There is no contingent of spare beds for unforeseen eventualities. There are almost 1,700 hospitals in Germany, but only a quarter treated COVID-19 patients during the pandemic. 

Germany's health ministry is now working on transforming the hospital sector so that the load is distributed more evenly. Karagiannidis is part of the government commission involved in the hospital reform. He thinks it is crucial to expand the number of clinics that have at least ten intensive care beds with intubation facilities, plus special features, like a heart catheter and a helipad. But that would mean smaller hospitals would have to close.

Germany needs more health care workers

Another problem is aging health care workers. In the western German state of North Rhine-Westphalia (NRW), one in three are over the age of 55, according to the NRW Pflegekammer. The organization, which represents health care workers in Germany's biggest state, says only 15% are younger than 30. The health insurance company DAK says it is impossible to replace those retiring.

The fact that hospitals learned to work together rather than as rivals gives cause for hope, says Karagiannidis. And the lesson has been learned that it's a good idea to have a stock of masks and medication.

While stockpiling might be working at the hospital level, there is an implementation problem at the national level. At the start of the coronavirus pandemic in 2020, the German government decided to set up a national reserve of protective clothing and medical products. The idea was to stockpile centrally and supplement the stock with medication and medical products made in Germany in an attempt to avert supply chain problems.

Four years later, however, the project has not made much progress. Masks that are past their best by date are being destroyed.

"That could backfire on us again next time," says Philipp Wiesener, who is responsible for national crisis management and public health protection for the German Red Cross.

On the plus side: during the coronavirus pandemic, we learned how to set up vaccination centers and vaccinate large numbers within a short space of time, says Wiesener. That's something that could be drawn on next time.

A starting point: The vaccines

The rapid development of effective vaccines averted a worse health care crisis. The mRNA technology had been the focus of research as a way to help cure cancer.

"It was indeed fortunate that the development of mRNA technology had progressed so far," said Emanuel Wyler. 

During the pandemic, mRNA vaccines proved to be a flexible tool. However, they only work if it is clear exactly which pathogen structures they should target. The vaccines would be useful if the next pandemic were again to involve a new coronavirus, molecular biologist Wyler says, warning that they may be less useful in the fight against some other viruses such as smallpox, for which the world's population is not sufficiently vaccinated against.

But the question is also whether Germans will get vaccinated at all next time.

German society is more skeptical

Shortly before the WHO declared the end of COVID-19 as a public health emergency in May 2023, more than 20% of the population in Germany had not gotten vaccinated. And quite a lot of people say they lack confidence in government measures. In a survey conducted by psychologist Cornelia Betsch from the University of Erfurt in late 2022 and early 2023, a third of those questioned said they would not take protective measures in the next pandemic. And almost a third even said they would like to see the government punished for the way it handled the pandemic.

The COVID-19 outbreak exposed numerous shortcomings. It was hard for health care officials to reach less educated people and those with lower incomes. Digitalization in the health care system and schools was again shown to be way behind in Germany. Many children and young people are still suffering from the effects of COVID school shutdowns. Scientists have criticized the lack of systematic data collection to evaluate the measures.

Doctors in intensive care units, however, are clear on what needs to be done. 

"We need to run through what would happen if the next pandemic were to break out now," says Karagiannidis. 

How do we react? What will happen to children? What will happen to schools?

"We need to develop a scenario so we can see where the weak spots are," he says.

That has still not happened.

This article was originally written in German. 

Editor's note: The previous version of this article has been modified to remove a factual inaccuracy. 

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