Science, Politics, and Pandemic: Dr. Karl Lauterbach, Germany’s Leading Health Policy Expert, on Why There Has Never Been a More Crucial Time for Scientists to be Engaged in Politics
The current COVID-19 pandemic has affected nearly every country since it was first reported in China last December. Globally, the number of cases has surpassed 18 million, with a cumulative death toll of 700,000 as of August 4, 2020. Germany’s approach to handling this public health crisis has been hailed as one of the most successful. Thus far, it has largely managed to limit the spread of SARS-CoV-2. By June 1, 2020 it had recorded 181,815 cases and 8,511 deaths. Germany’s mortality rate is among the lowest in Europe and the world, estimated at 11.1 deaths per 100,000 population (current as of Aug 12, 2020). Starting in May, it has begun a gradual and closely monitored re-opening after nearly three months of strict lockdown.
To discuss Germany’s exemplary response to COVID-19, the Voices in Leadership series invited Dr. Karl Lauterbach, professor of Health Economics and Clinical Epidemiology at the University of Cologne in Germany, to be interviewed by Professor John E. McDonough, Professor of Public Health Practice in the Department of Health Policy and Management. Dr. Lauterbach studied medicine at RWTHAachen University, the University of Texas at San Antonio, and the University of Düsseldorf, followed by epidemiology at the Harvard T.H. Chan School of Public Health. He was elected to the Deutscher Bundestag (the German Federal Parliament) in 2005 as a member of the Social Democratic Party of Germany. Currently, Dr. Lauterbach is an adjunct professor of Health Policy and Management at the Harvard T.H. Chan School of Public Health.
The Road from Medicine to Politics
Professor McDonough started the session by asking Dr. Lauterbach about his unusual career path from medicine to politics. “I was always interested in issues of justice in health care and prevention in healthcare”, Dr. Lauterbach explained. As a gifted student from a working-class background, Dr. Lauterbach made a last-minute change to study medicine at university. He became interested in what made people ill and what can be done to prevent them from becoming ill, a pursuit that brought him to the Harvard T.H. Chan School of Public Health (HSPH) to study epidemiology. During his time at HSPH, he started to focus on the social determinants of health and became an advocate for disease prevention in those who are disadvantaged in society.
Upon returning to Germany, he took on the role of Director of the Institute of Health Economy and Clinical Epidemiology at the University of Cologne. His research led him to become a top health advisor for the German government. In this capacity, his three intended goals were to 1) make the health system more efficient; 2) make it more equitable; and 3) put more preventative interventions in place, such as secondary prevention with disease management programs.
Over time, Dr. Lauterbach recognized that instead of advising policymakers, he could be more influential by being in parliament himself as a policymaker. He ran for the Deutscher Bundestag, the national Parliament of the Federal Republic of Germany, and was successfully elected in 2005. He has been representing the Leverkusen district of Cologne ever since. With his unique combination of expertise in medicine, epidemiology, and health policy research, Dr. Lauterbach is a leading political figure in German health policy development.
As he originally trained as a physician-scientist, not a politician, Dr. Lauterbach initially felt a little disadvantaged compared to his more seasoned colleagues, who had been in the upper league of German politics for decades. But he quickly learned how to be a politician.
What motivated him? He recognized that he had been given a unique opportunity to fight for the policies he cares about — the reasons he ran for parliament in the first place. The Social Democratic Party of Germany, the political party to which he belongs, has been the junior coalition partner with the Christian Democratic Union of Germany, of which Chancellor Angela Merkel is the leader. For nearly 20 years, Dr. Lauterbach has been actively involved in this coalition government as a health policy expert, which afforded him a long term perspective on politics.
Turning the focus to the pandemic, Dr. Lauterbach shared his thoughts that Germany has largely mastered the first wave of COVID-19. It has fewer deaths in total and per capita than most other European countries. Currently, Germany is actively preparing for a possible resurgence in the fall by focusing on two fronts: re-establishing a strong economy through a stimulus plan and preparing for a possible second wave in the fall.
A National Crisis Needs a National Strategy
Asked how he would explain Germany’s success in dealing with this crisis compared to other countries in Europe, the United Kingdom, and the United States, Dr. Lauterbach thinks this comes down to luck and avoidance of major mistakes. Germany’s “luck” was that Italy and Spain experienced the surge before they did, unfortunately. What Germany’s leaders saw made them realize that, unlike the flu, COVID-19 is a looming major catastrophe, so they quickly had to get ready.
Dr. Lauterbach described how the two coalition partners in the German government, the Christian Democrats and the Social Democrats promptly started working together: “We immediately addressed the public in a bipartisan way…it’s not, let’s say, politics as usual…we have to address this as a nation”.
Together with the other opposition parties, they addressed COVID-19 as a national emergency — it was not politics as usual. They put politics aside and worked together to devise a national strategy. The government implemented a large-scale testing scheme for anyone showing symptoms. This meant conducting as many as 50,000 tests per day at the start and soon after ramped up to 100,000 tests per day. A rigorous lockdown was put in place, closing schools and businesses, all of which were explained to the public in various venues including traditional media, social media, and even podcasts. Their policies were data-driven and clearly articulated by scientists, as well as officials from different levels of government. Even Chancellor Merkle, herself a scientist prior to becoming a politician, is well-versed in explaining concepts of epidemiology to the public.
Further, the German healthcare system is resourced with a large capacity to care for those who would become ill. Germany has the highest number of intensive care unit beds per capita (38.7 ICU beds per 100,000 inhabitants) in the world. To prepare for COVID-19, the German health ministry further increased the health system’s capacity by 12,000 beds to a total of 40,000. Compared to most of the world, they also have the highest number of ventilators (25,000 units) and extracorporeal membrane oxygenation (ECMO) capacity (755 units) to support the lungs and hearts of the most severely affected patients.
Importantly, there was no disagreement between the opposition and the government parties early in their response. By asking the public to “stay home” and “immediately get… quarantined and tested” if people were experiencing signs and symptoms, the politicians made it clear to the population what they should do.
Transparency Helps Public Health Communicate the Right Message
Dr. Lauterbach summarized Germany’s success in three key lessons for health systems around the globe.
Lesson #1 is transparency. He emphasized that “number one, transparency about what you know and what you don’t know…(be) honest and open about…our knowledge of the pandemic”. The government has to be open and honest about what they know and what they don’t know. Politicians have to explain to the public what could happen, including the worst-case scenario, and what they advise everyone to do to ensure the worst case doesn’t come true. His point was clear: “Don’t mess around with the public in an emergency situation!” Lauterbach described scientists and politicians as working “shoulder to shoulder” to explain to the public what is known and why the policy changed. Transparency is key throughout the German government’s response.
Lesson #2 is testing and quarantine. Anyone with symptoms should be tested immediately so that the disease can be contained locally. Germany has created a large capacity for COVID-19 diagnostic testing to actively identify clusters of infections and intervene as soon as possible. Their laboratories were among the earliest developers of rapid testing assays. With a population of 83 million, they will have capacity to perform up to a million tests per day. They also plan to conduct up to 5 million antibody tests per month.
Lesson #3 is availability of hospital beds, including space in the intensive care units, and ventilatory support. Germany has a robust healthcare system, therefore they were able to mobilize and respond to public health crises with agility to ensure resources are available to manage the sickest patients.
Hope for the Best, but Plan for the Worst
As for the possible resurgence of the virus in the fall, Dr. Lauterbach thinks everything points towards a second wave from the perspectives of immunity and epidemiology. Colder climates and being indoors more are major risk factors for causing infections and becoming more ill. He explained the dispersion factor, also known as the k factor, and its effect on the so-called “super spreader events”, where a fairly small number of people can infect many others. Therefore, avoiding clusters of disease is key to avoiding a second wave. Overall, he agrees that the strategy to deal with the pandemic can be summed up as “hope for the best and plan for the worst”.
Looking beyond Germany, Dr. Lauterbach and Professor McDonough turned towards Sweden. Continuing his theme of transparency, Lauterbach felt that the Swedish approach was not an open, honest one because they were targeting herd immunity without clearly stating it. There was minimal protection for the population and even less for older patients. The lack of ventilatory support and intensive care unit beds for those who became ill in nursing homes contributed to the fatality of elders as being four times higher than that of Germany’s. Unfortunately, Sweden’s economy has not benefited from this approach, so Germany decided early on they would not follow this path. “It is naïve and wrong to think that it brings you a better economy if you permit more people to die”, asserted Dr. Lauterbach.
What about a vaccine? Dr. Lauterbach expressed some reservations on having a safe and effective vaccine against the coronavirus earlier than 12–18 months from now, especially since many of the current vaccine platforms being tested have not been shown to work in the past. He prefers to rely on more tested routes, which are safer but will take longer. In the meantime, as a strategy, Germany is not depending on getting a vaccine sooner than the anticipated 12–18 months.
U.S. Response to COVID-19: Room for Improvement
Professor McDonough then asked Dr. Lauterbach for his impressions on the U.S. response to COVID-19, the Centers for Disease Control and Prevention (CDC), and the political disagreements during this crisis. Dr. Lauterbach first expressed that he feels closely connected to the U.S., having spent many years there. He thinks the country as a whole — not the people — as well as the leadership at the CDC suffered some loss of reputation. He stated, “we were surprised to see that many of the leading scientists were not visible in the public response because they initially appeared to be not having been engaged by policy leaders”.
He finds the initial failure of the COVID-19 test from the CDC to be a surprise, given their exceptional, benchmark-setting quality of work done in the past. He is pleased to see Dr. Anthony Fauci take on the leading role in the U.S. response. However, contrasting the close cooperation between scientists and politicians in Germany, he finds the lack of visibility of leading scientists and the lack of engagement from policy leaders with scientists to be disappointing.
Besides politicians, it should be noted that the German public’s engagement with scientists is also more robust: leading figures such as Dr. Lauterbach and virologist Dr. Christian Drosten are well known in Germany, with large and active social media followings.
Nonetheless, Dr. Lauterbach remains hopeful, as many great academic institutions in the U.S. are at the forefront of producing highly valuable research to tackle the pandemic, research that he tries to catch up with every night!
Scientists: Politics Needs You
The final part of the interview focused on the leadership message Dr. Lauterbach has for the audience, as well as his reflections on dealing with challenges in public health. As a politician trained in science, he recommends that “We should have more scientists in parliament… scientists are badly needed in political life in my opinion, in Germany, in Europe, and possibly even in the US”. Why? As a scientist, he brings unique skills and knowledge that allows him to translate the newest clinical research to the policy ranks in his party and the government. Simultaneously, he can explain research to the public and to the media, which he finds very gratifying. Beyond the COVID-19 pandemic, societies will not be able to overcome major public health challenges, such as climate change, without scientists to guide a clear agenda in the administration.
For students of public health and emerging leaders who contemplate what they can take away from this politicized pandemic, Dr. Lauterbach’s final leadership message is an important call to action. The COVID-19 global pandemic has shown that scientists need to actively engage with politicians and learn to communicate directly with the public. This is vital, not so much for some esoteric scientific discovery, but for the health and well-being of society.
Story written by Miranda So, PharmD, a second-year student in the MPH-Epidemiology online/on-campus program at the Harvard T.H. Chan School of Public Health. She is a practising infectious diseases pharmacist at the University Health Network in Toronto, Canada, and an assistant professor at the Leslie Dan Faculty of Pharmacy at the University of Toronto. She specializes in tackling antimicrobial resistance and optimizing antimicrobial use in immunocompromised patients.
Story edited by Sherine Andreine Powerful, MPH, a Doctor of Public Health candidate at the Harvard T.H. Chan School of Public Health. A Diasporic Jamaican, she received her Bachelor’s degree in Latin American and International Studies from Yale University and holds a Master of Public Health degree in Population and Family Health, with a concentration in Global Health, from the Columbia University Mailman School of Public Health. Her interests, centered around the English-speaking Caribbean, include feminist global health and development leadership; gender and sexual health, equity, and justice; and pleasure, healing, and liberation.