The newest decision of Germany’s top vaccine agency will almost definitely delay the end of the COVID-19 pandemic in Germany by months.

This evening, Germany’s prestigious STIKO, an expert body for vaccination policy decided to recommend the COVID-19 vaccine from AstraZeneca only for people over 60 years of age. The decision follows a temporary suspension of the vaccine just two weeks ago, after reports of a rare clotting disorder that has affected a disproportionately large number of people a few days after having been vaccinated with the AstraZeneca shot.

Vaccinations with AstraZeneca resumed only to be suspended again today for those under 60 years of age. The STIKO is now citing statistics on a total of 31 cases with venous sinus thrombosis, a life threatening blood clot in large veins of the brain within days after getting the shot. All of those affected were under the age of 60 years and predominantly female. These statistics may be somewhat biased by the fact, that up until a few weeks ago, the AstraZeneca vaccine in Germany was not recommended for people over the age of 65, because of “insufficient data” in this age group. In 19 cases, the patients also exhibited low platelet counts, which is a rare constellation of symptoms only happening in severe infection, cancer or a rare disease called “HIT2” (heparin-induced thrombocytopenia type 2). Indeed, a German research group specializing on HIT2 identified the same autoantibodies responsible for this rare disease in several blood samples from the vaccinated patients showing the syndrome. They have coined the name “VIPIT” (vaccine-induced prothrombotic immune thrombocytopenia) for this new form of disease occurring after the vaccinations. So far, 9 patients died. In Germany, approximately 2.7 million people received the first dose of the AstraZeneca vaccine to date. It is unclear, if people under 60 who have already recieved the first shot should now get the second shot in 12 weeks, as planned. Currently, a second vaccination instead with the shot from Pfizer/BioNTech is being discussed.

Even though there are good arguments to be cautious with vaccinations now, based on current data, mortality rates of COVID-19 are considerably higher than the risk of death by this new rare clotting disorder. Continuing vaccinations with AstraZeneca by weighing these two risks against each other is ultimately a political decision. In the case of virus related mortality, direct responsibility of decision makers is more widespread, it is less easy to point the finger. With vaccinations, however, decision making bodies could ultimately be held responsible by public opinion (if not legally) for any deaths resulting from AstraZeneca vaccinations, especially with all of the public attention around this vaccine, and Germany’s decision makers are apparently not comfortable with the prospect.

The decision of the STIKO is not yet final until Thursday, currently it is still subject to “feedback” from German federal states and other expert bodies. These discussions between medical professionals are part of the normal decision making process, however now they are being carried out in the limelight of public attention. At any rate, Chancellor Merkel and Minister for Health Jens Spahn declared in a press conference, that the federal government will follow recommendations from the STIKO and that the changes in the recommendations regarding different age-groups will come into effect already tomorrow, Wednesday March 31. There is discussion about further allowing vaccinations with AstraZeneca for those under 60 after informed consent and at the person’s own risk. Whatever the final outcome regarding AstraZeneca vaccinations of the younger population, I am fairly certain that the already shattered trust in this vaccine will no longer recover. Since Germany and the EU have based at least half of the vaccination effort on the AstraZeneca shot, these developments will most probably prolong the pandemic in Germany and maybe Europe by several months.