"No One Is Going to Be Sent to Jail" German Health Minister on Vaccine Mandate

New German Health Minister Karl Lauterbach speaks in an interview about the "two things" that can get us out of the coronavirus pandemic and why he believes a vaccine mandate is an essential tool in dealing with the crisis.
A DER SPIEGEL Interview Conducted by Markus Feldenkirchen, Milena Hassenkamp und Martin Knobbe
German Health Minister Karl Lauterbach

German Health Minister Karl Lauterbach

Foto:

Andreas Chudowski / DER SPIEGEL

DER SPIEGEL: Mr. Lauterbach, were you stunned when you learned last weekend that you were going to become Germany’s next federal health minister?

Lauterbach: I was just happy. It’s a big job, but it is also a gift.

DER SPIEGEL: The rumor is that you didn’t even expect to get the nomination. How did you still manage to show up with a fresh haircut for your swearing in?

Lauterbach: I hope my haircut doesn’t give the impression that I went to an amateur hairdresser in my apartment building in a rush. No worries: I was in professional hands. It was time again anyway.

DER SPIEGEL 50/2021

The article you are reading originally appeared in German in issue 50/2021 (December 11th, 2021) of DER SPIEGEL.

SPIEGEL International

DER SPIEGEL: Even within your own party, many were skeptical of your appointment, with people saying: He may be well-versed in his field, but he’s not a manager. There was doubt about your ability to run an organization as large as the Health Ministry.

Lauterbach: Those who say such things obviously don’t know my resume. I most certainly have management experience. Even when I was still quite young, I set up a new Institute for Health Economics and Clinical Epidemiology at the University of Cologne. It had about 50 employees, including many doctors. I have conducted studies involving hundreds of doctors across Europe.

DER SPIEGEL: The Health Ministry has 750 employees: What qualifies you to lead such a large agency?

Lauterbach: I know the Health Ministry very well. I worked there at the end of the 1990s as an adviser to then-Health Minister Andrea Fischer. Later, I also advised (Health Minister) Ulla Schmidt for many years. I was also a member of the Expert Council to the Health Ministry and helped negotiate numerous laws. Some of the people I taught at university are now working in the Health Ministry. So, I know the ministry better than at least some people before they became ministers.

DER SPIEGEL: You have a reputation for wanting to do things yourself. Will you now have to become better at delegation?

Lauterbach: No minister can work without delegating. That especially applies to this ministry, with all the laws and regulations that have to be written. You need good lawyers for that. I like to delegate.

DER SPIEGEL: For a long time, you were a one-man operation, setting up your own appointments with your mobile phone rather than relying on staff.

Lauterbach: Those days are over, of course, no question about it. But I have always had a staff of good employees.

DER SPIEGEL: How many talk shows do you plan to appear on in the future?

Lauterbach: I’ll be on the talk shows less often because I have a different job to do now. Nevertheless, I will continue to do public outreach. In a health crisis, where the population needs to be informed, it is crucial that the minister translates science and policy into everyday language. So, I will use different formats, including talk shows.

DER SPIEGEL: You are considered by many to be a kind of absent minded professor, who is a bit chaotic at times.

Lauterbach: So which is it? Am I absent minded or the one who organizes everything himself? The prejudices don’t match up.

DER SPIEGEL: Is there resentment toward professors in Germany?

Lauterbach: Yes, that could be. And you have to live with it. I think a cabinet needs to be filled with people who are well-suited to the tasks of their time. For the Health Ministry, in particular, I think it is crucial at the moment that it be led with scientific expertise. We need greater coordination between science and politics.

DER SPIEGEL: So far, you’ve been in the advantageous position of being able to issue warnings from the sidelines. Now, though, you have to deliver. Do you fear that you won’t be able to live up to your own standards?

Lauterbach: I have plenty of fears, but not of that.

DER SPIEGEL: Which ones, then?

Lauterbach: That’s not the point here. I want science to be the basis of political decisions to a greater degree than it has been so far. To that end, I will work closely with a network of scientists to ensure that they play an even greater role in policy-making.

DER SPIEGEL: How do you intend to pursue a science-based course together with the market-oriented Free Democratic Party (FDP), which has occasionally shown a penchant for ignoring the science?

Lauterbach: My impression so far from talking to (FDP leader) Christian Lindner or (Justice Minister) Marco Buschmann (also of the FDP) is that the FDP wants to end the pandemic. I want that too, so we have the same goal.

DER SPIEGEL: So, why was this government's first draft of the package of laws aimed at controlling the spread of the coronavirus so badly off the mark?

Lauterbach: It wasn't badly off the mark. But politics is like everything else in life. It’s all about persuasion with good arguments. With time, the draft got better and better. It is a good basis for getting through the next few weeks well.

DER SPIEGEL: You're presenting things in a much better light than they actually were. The FDP wanted to categorically rule out the possibility of a nationwide lockdown …

Lauterbach: … and in the end, good arguments won out. If the situation demands it, parliament can continue to shut public life down even further. I’m not saying that’s what I want. But if we get to that point, that's what I will propose to parliament. I am certain that lawmakers will behave as the situation demands.

DER SPIEGEL: Starting in mid-March, a facility-based vaccination requirement is to go into effect. But that’s too late for the fourth wave.

Lauterbach: There will be checks on the vaccination requirement from the middle of March. In other words: Vaccinations will be administered before that. But you’re right, the sooner people get vaccinated, the sooner that requirement is fulfilled. I want to urge as many people as possible to get vaccinated as quickly as possible. This means, we have to get those people in question to take it upon themselves to make early appointments.

DER SPIEGEL: Could that also apply to staff at daycare centers?

Lauterbach: Yes. I am an adamant supporter of mandatory vaccinations for child-care workers. From what we know so far, the new Omicron variant is affecting children much more strongly than the previous variants. Children are getting infected more often, and they are also suffering more severe symptoms.

DER SPIEGEL: Does that also mean that vaccinations for children will become more important?

Lauterbach: Yes. At the very least, there is a lot to be said for vaccinating children. For children, the disease is the danger, not the vaccination. Side effects are extremely rare. The data from the United States on 5 million vaccinated 5-to-11-year-olds is very compelling. Although close attention was paid to possible complications, such as myocarditis, not a single case occurred. STIKO is in the process of finalizing its recommendation. (Eds: the Standing Committee on Vaccination, or STIKO, is an independent expert commission that provides scientific analysis of the risks and benefits of vaccination.)

DER SPIEGEL: So, you will continue to make your decisions according to recommendations from STIKO, regardless of how long it takes them to make them?

Lauterbach: We will definitely have talks about STIKO’s speed. It has to be faster. What also has to be clear, though, is that even if there is a scientist in the ministry now, STIKO will continue to act entirely without any influence or pressure from the ministry. I am a politician and a minister and it is not my job to make recommendations. STIKO has to be entirely free in its decision-making process.

DER SPIEGEL: Are you satisfied with STIKO’s work?

Lauterbach: It definitely needs more staff. And I am going to make sure it gets it.

DER SPIEGEL: A general vaccination requirement for the entire population will be decided on by this spring. By that point, though, infection numbers will be lower again. Will there still be a majority for compulsory vaccination despite that?

Lauterbach: It will hardly be possible to prevent the Omicron  variant from spreading in our country. The analyses of experts like Sandra Ciesek  and others all point in the same direction: With the double vaccination, we have very limited protection against infections, possibly none at all after several months. Then, the unvaccinated and those without booster shots would be at full risk in terms of infection. Protection against serious illness would probably remain. That is why we absolutely need mandatory vaccination. Mandatory vaccination is one of the two things that can drive us out of the crisis. The second is a successful booster campaign. With the Omicron variant, especially, booster vaccinations could be particularly important.

DER SPIEGEL: What will you do better than your predecessor when it comes to the booster campaign?

Lauterbach: Jens Spahn has done a good job. This is demonstrated by the success of booster vaccinations. But I will address the public directly in my new role as health minister, and I will make my appearances together with doctors and scientists.

DER SPIEGEL: What exactly do you mean when you say you will be addressing the public directly?

Lauterbach: We need a direct approach. Newspaper ads aren’t enough.

DER SPIEGEL: Are you imagining a kind of State of the Union address following the evening news?

Lauterbach: There will be different formats.

DER SPIEGEL: How do you intend to reach people who aren’t open to medical arguments?

Lauterbach: I first have to win over the many who think: I’ve already been vaccinated twice, all is well. To them, I have to say: All is not well, you have to get a booster shot. Getting a booster shot isn’t a luxury – you’re not fully vaccinated until you have had three jabs.

DER SPIEGEL: According to the vaccination certificate in the government’s Corona-Warn-App, you are protected for a year after obtaining two vaccination shots.

Lauterbach: That is no longer medically tenable.

DER SPIEGEL: And how do you plan to reach the others now?

Lauterbach: Those who are not reached by the medical arguments are the target of compulsory vaccination.

DER SPIEGEL: What will happen if people shirk that duty? Are you thinking about heavy fines or even jail sentences?

Lauterbach: No. No one is going to be sent to jail. But the imposition of fines will be inevitable.

DER SPIEGEL: What kind of fines are we talking about?

Lauterbach: Psychologists and economists must be consulted about when punitive measures start to have an effect.

DER SPIEGEL: What happens if someone doesn’t pay?

Lauterbach: Then the fines must be increased considerably. But I am sure that just by announcing a general vaccination requirement that we will already reach a lot of people.

DER SPIEGEL: What has to change in the hospitals in the longer term so that we are better prepared for such crises? Do they need to be funded differently?

Lauterbach: The SPD already ensured during the last government that nursing care was removed from flat-rate payments per case. If a hospital hires addition nursing staff, it does not come at the expense of the hospital’s bottom line – it is paid for by the statutory health care system. However, the implementation hasn’t been optimal so far, and we will change that.

DER SPIEGEL: That still won’t be enough.

Lauterbach: No, we have to create economic incentives for nursing staff to make the profession more attractive. I could imagine pay for these important professions becoming completely tax free for Sunday and holiday work.

DER SPIEGEL: Bavaria has proposed doubling the salaries of intensive care nurses.

Lauterbach: This would create a large wage gap between nursing staff in the intensive care unit and in other areas. That would be hard to explain. The proposal sounds better than it is.

DER SPIEGEL: Many parents are wondering about Christmas: Should my children really go to school until December 23 and then sit in front of the Christmas tree together with their grandparents on Christmas Eve?

Lauterbach: It is important that children always wear masks at school and are tested. I personally recommend daily testing, definitely in the five days before you leave to see grandma and grandpa.

DER SPIEGEL: A year ago, you and others recommended that schools should close a week before Christmas.

Lauterbach: That is correct, but that is not what the Conference of (State) Education Ministers decided.

DER SPIEGEL: Why don’t you say that daily testing at schools needs to be mandatory?

Lauterbach: I am not the education minister.

DER SPIEGEL: But you are the health minister, who is responsible for combating the pandemic.

Lauterbach: That is why I advise taking the mask requirement in class very seriously. And if possible, testing should be done daily in schools. That would make it possible for classes to continue – even in winter and even with rising incidences.

DER SPIEGEL: Do you worry that you won’t be able to push through your important issues because of the different divisions of responsibilities between the ministries and between the federal government and the states?

Lauterbach: No. I am now working to convince - from a scientific point of view - the cabinet, the conference of state and federal health ministers, and the governors of what will help us most. If it doesn't always work on this or that issue, I'll just have to live with it.

DER SPIEGEL: You were a member of the supervisory board of the private Röhn-Klinik hospital. Is that a liability as a minister, something that you wish you hadn't done in retrospect?

Lauterbach: That was eight years ago. I was also on the supervisory board of municipal hospitals, and I helped reform the largest municipal hospital in Europe, Berlin’s Charité University Hospital. Is it a disadvantage for a minister to have practical experience in the hospital sector?

DER SPIEGEL: The criticism isn’t directed against outstanding reform proposals, but against the money you received for it, and the dependency that creates.

Lauterbach: As I said, I have gone without that money for eight years. I am prepared to discuss what I may have done wrong on the board back then. But I think it’s inappropriate to criticize me for membership alone.

DER SPIEGEL: A long time ago, you developed the idea of a "citizen’s insurance," which would force the privately insured into the statutory insurance system. Now, you will not be able to implement that idea as a health minister because your coalition partner, the FDP, is against it. Is that a bitter pill for you to have to swallow?

Lauterbach: At the moment, we have other problems. We are in midst of the greatest medical emergency since World War II. I see my core task as that of ending the pandemic in Germany and keeping mortality as low as possible in the waves that lie ahead.

DER SPIEGEL: But don’t you need to be looking ahead right now? The statutory insurance companies are ailing and are additionally burdened by the pandemic. Nursing staffs are burned out. Reforms will be needed urgently.

Lauterbach: A large part of the additional expenditures that are now being provided - to hospitals, for example - are being paid out of tax revenues. These funds remain available. Long-term health insurance reform is a project that is pending, but we wouldn’t be able to do it right now anyway, even if the FDP was asking for it.

DER SPIEGEL: So that means that Germany will continue to have a private health insurance regime during your tenure?

Lauterbach: We will not touch private health insurance during this legislative period. That is written into the coalition agreement.

DER SPIEGEL: Will you still have the chance to see your children at all with your new job?

Lauterbach: Of course. I'm meeting up with my daughter right after this interview.

DER SPIEGEL: Mr. Lauterbach, we thank you for this interview.

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