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EXPLAINED: How Germany wants to contain the monkeypox virus

Health experts recently raised the alarm about cases of a rare virus in Europe. Here's what Germany is doing to limit the spread of monkeypox and what to do if you suspect you have it.

A woman washes her hands at a clinic in Essen
A woman washes her hands at a clinic in Essen. Photo: picture alliance/dpa | Jonas Güttler

What is monkeypox and how is it transmitted?

Monkeypox is a viral zoonosis (a virus transmitted to humans from animals) that causes small lesions on the skin, headaches and fever. It’s similar to chickenpox or smallpox, though the illness tends to be less severe than smallpox.

The symptoms of the disease caused by the virus are generally mild and clear up in 2-4 weeks without treatment, but can occasionally result in more serious illness if the patient has a weaker immune system.

The disease is called monkeypox because it was first discovered in macaques – a type of monkey – in a Denmark laboratory in 1958. Around 12 years later, the first human cases were discovered in the Democratic Republic of Congo in West Africa.

Scientists believe that, rather than monkeys, the disease could have been transmitted to humans through close contact with rats or other rodents in sub-Saharan Africa. 

Since then, the disease has spread to other countries but has generally been contained within the West African region. In the past few weeks, however, cases have emerged in Europe and North America.  

Why are people concerned about it in Germany?

After the first case was discovered in the UK at the beginning of May, experts assumed that the virus was likely to be present in other European countries.

This prognosis turned out to be accurate, and Germany reported its first case of the virus on May 20th. Since then, six cases in total have been discovered in the Bundesrepublik, including one in Munich and three in Berlin. A further patient with the virus is currently being treated in isolation at Freiburg University Hospital, while authorities have reported evidence of infections in Saxony-Anhalt as well. 

The Health Ministry and Robert Koch Institute (RKI) have said they expect more cases to emerge as time goes on.

“We are in the early stages of this outbreak,” Lothar Wieler, the head of the RKI, said on Tuesday. 

Much is still unknown, he said, but the situation is being closely monitored. Samples from many more people are being analysed, and authorities are also looking for contacts of people with a proven infection. 


Is this another Covid pandemic? 

Thankfully, no. So far, around 250 cases of the virus have been reported to the World Health Organisation (WHO) in 16 countries worldwide. Though this figure is worrying, the WHO has said that the risk to the general public is still very low.

Speaking to journalists on the sidelines of German Doctors’ Day in Bremen, Health Minister Karl Lauterbach (SPD) emphasised that the developments should be taken seriously. But, he said, the difference between Covid-19 and monkeypox are vast.

“What we are currently experiencing with monkeypox is not the beginning of a new pandemic,” he told DPA. Since the pathogen is well known to health experts, countries are well-equipped to bring the situation under control with good contact tracing and caution, he added.

Lothar Wieler and Karl Lauterbach

Lothar Wieler, the head of the Robert Koch Institute (RKI) and Health Minister Karl Lauterbach (SPD) speak at a press conference about monkeypox on Tuesday, May 24th. Photo: picture alliance/dpa | Sina Schuldt

One major difference between Covid-19 and monkeypox is the way it is transmitted.

According to experts, monkeypox is much harder to transmit to another person than the coronavirus. While Covid-19 can be passed on through airborne droplets and particles, monkeypox infections generally occur after sustained and close physical contact with an infected person or animal.

Of the recent cases that have become known to the RKI, most had been infected at large events “that were connected with sexual activities”, Wieler explained.

What should people do if they suspect they have monkeypox?

On Tuesday, the RKI issued recommendations that anyone who suspects they have monkeypox should self-isolate for 21 days.

If people notice small, red lesions appearing on their skin, they should contact their doctor or local health authority, who may require tests to be carried out and will likely ask for information about contacts. 

The contacts of infected people should also isolate for 21 days, the RKI said.

Generally, monkeypox is most identifiable through changes to the skin. The illness starts with red lesions, which pass through different stages and eventually crust over after the incubation phase of the virus is complete. 

Other symptoms of the disease include headaches, fever, chills, muscular aches and exhaustion. 

Experts also say that prevention is better than cure. Richard Pebody, head of the pathogens team at WHO Europe, recommends regular hand-washing, good hygiene and safe sex as practices to prevent the spread of the illness. 

What is the Health Ministry doing to contain the virus? 

Germany wants to control the spread of monkeypox by tracing contacts and quickly isolating infected people. 

Speaking in Bremen on Tuesday, Lauterbach said that the situation required a “tough response” and that the spread of disease could be contained if outbreaks were caught early. 

Now that the RKI has formulated isolation guidelines for both contacts and infected people, these will are set to be passed onto the 16 German states in the form of a recommendation.

The states will then be responsible for implementing and enforcing the rules.

Woman self-isolates with monkeypox

A woman self-isolates at home. The RKI recommends 21 says of isolation for people with monkeypox. Photo: picture alliance/dpa | Sebastian Gollnow

In addition, health experts are currently investigating whether existing vaccines should be rolled out to certain segments of the population.

This is a view supported by Klaus Rheinhardt, the head of the German Medical Association. Rheinhardt said on Tuesday that he thought vulnerable groups should be inoculated with the smallpox vaccine, which is believed to be highly effective against monkeypox.

This could include people with illnesses that weaken their immune system. Experts believe that the majority of people who died after a monkeypox infection in West Africa were HIV patients. 

Germany currently has around 100 million doses of smallpox vaccines in storage. Smallpox vaccination was compulsory in West Germany until 1975 and in East Germany until 1982, but the vaccination campaigns were phased out shortly before the eradication of the virus. 

READ ALSO: Monkeypox: German health expert calls for isolation measures

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For members


What to know about Germany’s plans to raise health insurance fees

Germany is struggling to fill huge gaps in its health funds following the pandemic and is planning to raise health insurance fees next year. Here's who it could affect and how much more people could have to pay.

What to know about Germany's plans to raise health insurance fees

What’s going on?

In the aftermath of the Covid pandemic, Germany is struggling to fill a large gap in its healthcare reserves.

According to Health Minister Karl Lauterbach (SPD), the statutory health insurance funds are facing a deficit of €17 billion next year, placing Germany’s healthcare finances under severe strain.

Lauterbach says this is largely due to the generous spending policies of the previous government both before and during the Covid crisis. As well as pouring billions of euros into free tests, the healthcare system was overwhelmed by patients during the most severe waves of the pandemic. 

To tackle this shortfall, the Health Ministry has drafted a set of proposals for raising additional funds. 

One of these proposals is to increase the level of health insurance contributions that people have to pay each month. The funds raised from this would account for around 10 percent of the total rescue package. 

READ ALSO: How to make the most of reward schemes on your German health insurance

How much more could people have to pay?

Lauterbach has pitched a 0.3 percent rise in monthly contributions. This would be added to the so-called additional contribution, which is currently set at a maximum of 1.3 percent, on top of the 14.6 percent general contribution that is paid as standard. 

For people in employment, contributions are divided equally between the employer and the employee. That means the extra 0.3 percent would translate to 0.15 percent extra per month in reality. 

In concrete terms, that’s an extra €1.50 for someone with a gross income of €1,000 per month, or €4.50 extra for someone with a gross income of €3,000 per month. 

Self-employed people – who generally have to bear the full brunt of the health insurance costs themselves – will fare a little worse under the plans. They’ll be expected to shell out €3 extra per month for every €1,000 of gross profit. 

Would everyone have to pay this much? 

No. Firstly, the changes would only affect those who are registered with one of the statutory health insurance companies such as TK or AOK. People who are privately insured will continue to pay the contribution set by their insurer.  

Secondly, unlike the general contribution of 14.6 percent, statutory insurance funds have the option to decide how much of the additional contribution they want to charge. 

That means that, while 1.6 percent could become the new maximum, there’s no guarantee that companies will choose to charge this. Depending on their financial situation, they may decide to keep the additional fees lower to remain competitive, or alternatively hike the fees to the maximum in order to shore up their reserves or offer better services. 

In other words, people will still pay a minimum contribution of 14.6 percent of their income but could pay a maximum of 16.2 percent (assuming that their health insurance company chooses to charge the full additional contribution). Most will pay something in the middle. 

READ ALSO: Reader question: How can I change my German health insurance provider?

Health insurance cards from AOK.

Health insurance cards from AOK. Photo: picture alliance/dpa | Karl-Josef Hildenbrand

What other plans are on the table?

As we mentioned, raising health insurance contributions is likely to cover just a small fraction of the deficit. To cover the rest, Lauterbach is proposing a range of other measures, including:

More state funding

In 2023, the federal government will step in with increased funding for the health insurance funds. Instead of the usual spending of €14.5 billion per year, the traffic-light coalition will shell out €16.5 billion on topping up the healthcare funds next year and will also provide a further €1 billion in the form of an interest-free loan.

Money from healthcare reserves

Statutory health insurance companies will have to dig into their savings to the tune of €4 billion to help cover the deficit. At the same time, €2.4 billion will be taken out of a pool of money known as the ‘Health Fund’ (Gesundheitsfond), which is built up through a combination of health insurance contributions, taxpayer funding and other forms of insurance such as pensions insurance. 

Increased discounts on medicines

Under German law, pharmaceutical companies are required to provide statutory health insurance companies with a discount of at least seven percent on certain types of medicine. This will be hiked to 12 percent for one year. 

A pharmacist scans a prescription

A pharmacist scans a prescription. Photo: picture alliance/dpa | David Inderlied

Furthermore, pharmacies will be required to provide the insurance funds with a discount of €2 (rather than the previous €1.77) per packet of prescription drugs. This will last for at least two years. Meanwhile, a moratorium on raising the price of medicines will be extended to 2026. 

Restrictions on bonuses for doctors

Doctors’ surgeries will no longer be given financial incentives for taking on new patients. 

Is this all set in stone?

Not yet, although it is likely to be passed in a parliamentary vote. So far, the cabinet has already waved through the changes, and on Friday they were debated for the first time in the Bundestag. 

READ ALSO: Why large families are set to pay less for German care insurance

What are people saying?

In a seething speech in the Bundestag on Friday, Bavaria’s state health minister Klaus Holetschek (CSU) criticised Lauterbach’s plans to raise health insurance contributions, arguing that it would “send the wrong signal” to patients. 

He also laid into the proposals to cut doctors’ bonuses for taking on new patients, arguing that this would lead to a cut in services.

However, the FDP health expert Andrew Ullmann said Lauterbach’s plans could help to avoid a hike in contributions that could cost people hundreds of euros per months. “That would not be responsible in times of inflation and energy crisis,” he said.

Health Minister Karl Lauterbach (SPD)

Health Minister Karl Lauterbach (SPD) speaks at a debate in the Bundestag on the measures to bail out the health insurance funds. Photo: picture alliance/dpa | Annette Riedl

In his speech in the Bundestag, Lauterbach said the rise in health insurance contributions was ultimately fair since employers would be expected to pay half. He also defended his plans to dig into the health insurance funds’ reserves. At some of the health insurance funds, board members “earn significantly more than the Federal Chancellor”, he claimed. 

Pointing to his proposals to shift some of the financial burden onto pharmaceutical companies, the SPD politician said he would “stand up to lobby pressure” and refuse to change course.