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Covid vaccine mix-and-match: Why is it so common in Germany – and is it safe?

After Chancellor (and scientist) Angela Merkel got a second vaccine jab that was different to her first, Aaron Burnett looked into why mix-and-match vaccines are so common in Germany.

Covid vaccine mix-and-match: Why is it so common in Germany - and is it safe?
Chancellor Angela Merkel on June 25th, a few days after she got her second jab. Photo: picture alliance/dpa/Pool AP | Olivier Matthys

Angela Merkel and I have at least one thing in common now – we’ve both been jabbed with Covid-19 vaccines for our second dose that were different than the one we got for our first.

After both of us receiving AstraZeneca shots earlier this year, the German Chancellor and I were coincidently vaccinated with mRNA doses in the same week – a Pfizer-BioNTech injection for me and a Moderna jab for Merkel.

We’re not the only ones though. Mixing and matching vaccines has been fairly common at German vaccination centres and at doctors following what seemed like constant swings in expert health advice on the AstraZeneca shot earlier this year.

In late March, Germany restricted AstraZeneca’s use in people under the age of 60, due to rare but potentially severe blood clots.

Then only a few weeks later in April, a handful of German states lifted the priority list for AstraZeneca – allowing anyone over the age of 18 to book an appointment, no matter their health condition. This opened up the chance of getting a vaccine early to lots of people who didn’t belong to Germany’s risk groups. 

Rather than wait for a different vaccine, some German residents – like PhD researcher Shambhavi Chidambaram who lives in Berlin – sent out a flurry of emails to doctors to try and secure a dose.

“I thought the risk of getting a blood clot from the vaccine was much lower than the risk of falling ill with Covid, or giving Covid to someone else,” she says.

READ ALSO: ‘Chaotic and badly managed’: Your verdict on Germany’s vaccine rollout

Like Chidambaram, it was more important for me to get vaccinated quickly than to shop around for a particular type of shot.

A few weeks after getting a dose of AstraZeneca, I called my doctor to arrange my second appointment. “Our practice is short of AstraZeneca now. Will you take BioNTech?”

“I’ll take whatever you have,” I responded.

Aaron Burnett’s Vaccine selfie on June 22nd – the same day Angela Merkel’s spokesperson announced she had got her second shot.


Since that phone call, AstraZeneca’s EU deliveries came up short, Pfizer delivered ahead of schedule, and research teams in Germany, Spain, and the UK started looking at whether mixing and matching was safe.

“It’s historic. A mix-and-match vaccine regime like this has never been done before,” says Dr. Joana Barros-Martins, a researcher from Medizinische Hochschule Hannover and lead author of a preprint study looking at whether mixing and matching is safe. Her research team also wanted to see whether the body would have a higher immune response in a mix-and-match approach.

“Each vaccine has a different way of showing the immune system how to recognize the spike protein,” she tells The Local.

“That’s why it’ll be interesting to see how effective mixing and matching is over a longer time, like after we get three-month or six-month data.”

Although Dr. Barros-Martins cautions that researchers are waiting to see what longer-term results will look like, her team found that patients who had a first dose of AstraZeneca and got Pfizer for their second shot had an 11.5-fold increase in relevant antibody levels three weeks later.

READ ALSO: EXPLAINED – How can people in Germany get a Covid vaccine appointment?

That compares to patients who had two doses of AstraZeneca. Their antibody levels increased 2.9-fold over the same period. Scientists are still studying how mix-and-match patients compare with those who receive two doses of mRNA vaccines like Pfizer or Moderna.

Preliminary studies in Spain and the UK have found broadly similar results, although mix-and-match patients were more likely to experience mild vaccine-related side effects, such as fever.

Now as Germany continues to ramp up its vaccination campaign with a wide selection of vaccines, lots of people are thinking about getting a different second dose. 

Around 34.1 percent of the population is fully jabbed, and about 52.9 percent has received at least one dose. 

For Chidambaram, the benefits are clear – which is why she’s looking to get either Pfizer or Moderna for her second dose. It’s a request many family practices, including mine, seem happy to honour.

“I know studies are still ongoing, but there doesn’t seem to a downside in terms of serious health risks,” she says. “Since there’s clearly a potential benefit and Germany has a high vaccine supply right now, it seems like a sensible decision.”

Aaron Burnett is a German-Canadian journalist specializing in international security, as well as European and Canadian politics.

Member comments

  1. Well, I’m so glad that you residents of Berlin got looked after so well. Here in the NRW doses are still in short supply, and older people and people with pre-existing conditions still don’t have even their first shot, while you (Young & healthy) have had both. Is that fair? I think not.

    1. What a load of crap – there’s nothing special about vaccine supply in NRW compared to anywhere else in the country. It has better vaccination rate than Berlin too.

      Old people had many months of priority to get vaccinated – while the rest of the world waited for your self-entitled generation to learn how to use computers to book a vaccination appointment.

      With Delta variant hitting younger people harder than before – everyone should have the access to vaccine if they want to.

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Are people who’ve had the single J&J jab no longer fully vaccinated in Germany?

Germany's federal vaccine agency says that people who've had one dose of the Johnson & Johnson (J&J) vaccine should no longer be classed as being fully vaccinated.

People queue for a vaccination in Quedlinburg, Saxony-Anhalt.
People queue for a vaccination in Quedlinburg, Saxony-Anhalt. Photo: picture alliance/dpa/dpa-Zentralbild | Matthias Bein

People who’ve had J&J, sometimes known as Janssen, used to have full vaccination status after a single dose of the vaccine. 

Since January 15th, however, a single dose of J&J should no longer count as full vaccination, according to the Paul Ehrlich Institute (PEI), the country’s vaccine authority. 

In autumn last year the German government began recommending a second mRNA jab for people who’d had J&J – which many people thought was the booster vaccination. 

However, according to the PEI’s update on proof of vaccination within the Covid Protective Measures Exemption Ordinance and the Coronavirus Entry Ordinance, the second shot is needed to complete ‘basic immunisation’.

It is unclear at this stage if it means that people returning or coming to Germany from abroad with only one shot of J&J will be counted as partially vaccinated and therefore need to present tests or face other forms of barriers to entry. 

We are also looking into what this means for the various health pass rules in states, such as the 3G rules for transport. 

The Deutsches Ärzteblatt, a German-language medical magazine, said: “Special rules according to which one dose was recognised as a complete vaccination with the Johnson & Johnson vaccine are no longer applicable.”

The Local has contacted the German Health Ministry for clarification on what this means for those affected. 

According to the latest government figures, 5.3 million doses of Johnson & Johnson have been given out in Germany so far in the vaccination campaign. 

The news will come as a shock to those who don’t know that they need another jab, or haven’t got round to getting their second vaccine yet. 

All other jabs – such as BioNTech/Pfizer, Moderna and AstraZeneca – already require two jabs. 

People in Germany are seen as fully vaccinated two weeks after their second dose. 

What about boosters?

As The Local Germany has been reporting, the German government said in December that people who’ve had J&J need a third shot three months after their second dose to be considered boosted.

A German Health Ministry spokesman told us last week that due to more vaccination breakthrough infections affecting people who’ve had the J&J vaccine, extra protection was needed.

“Therefore, after completion of the basic immunisation as recommended by STIKO, i.e. after administration of two vaccine doses (preferably 1x J&J + 1x mRNA), following the current recommendation of the STIKO, a further booster vaccination can subsequently be administered with a minimum interval of a further three months, as with the other approved Covid-19 vaccines,” the Health Ministry spokesman said. 

However, there has been much confusion on this front because some states have been accepting J&J and another shot as being boosted, while others haven’t.


It is unclear if the new regulation will mean that states will all have to only accept J&J and two shots as being boosted. 

North Rhine-Westphalia, for instance, updated its regulations on January 16th and now requires that people who’ve had J&J and one shot have another jab to be boosted. 

Having a booster shot in Germany means that you do not have to take a Covid-19 test if you’re entering a venue, such as a restaurant or cafe, under the 2G-plus rules.

The Paul Ehrlich Institute said that proof of complete vaccination protection against Covid takes into account “the current state of medical science”.