Germany has roughly 400 local health authorities. The WHO, from its Berlin pandemic early-warning centre, is working — with AI among other tools — towards a target of every country detecting new outbreaks within 24 hours by 2030. The authorities on the ground, meanwhile, are still fighting over the basics, and the money meant to fix that largely did not land where it was supposed to.
In heise online's Digital Health podcast, Nicolai Savaskan — senior medical director and district medical officer at the Neukölln health authority in Berlin — and IT consultant Mesut Yavuz delivered an assessment. It is sobering.
Excel, Access, and the spelling of a name
During the COVID pandemic, infection reports often arrived at the authorities by fax and were retyped into spreadsheets by hand. Modern statistics software, standard at any university, could not be connected to the rigid administrative IT.
"What we had was Excel at most. And the most ambitious thing we could set up at that point was a database the local IT department allowed us — and that was Access," Savaskan recalls.
Because laboratory and practice reports often had to be reconciled manually, different spellings such as "Maier" and "Meyer" were enough to turn one person into two infection cases. That is not an anecdote; it is the core of the problem. If you cannot join records cleanly, you cannot protect precisely — care-home residents or dialysis patients, say — and you end up quarantining whole buildings instead.
€800 million, five percent of it shared
The "Pakt für den Öffentlichen Gesundheitsdienst" was supposed to fix this with €800 million for digitalisation, with the stated goal of promoting open standards and open-source solutions reusable across the country.
According to an analysis by Yavuz and Savaskan, only about five percent of the funding went to cross-state joint projects such as the "GA-Lotsen" from Frankfurt am Main. Most of it, they say, was used more like local economic development aid. Politically, it was often more attractive to announce high spending in your own federal state than to adopt a cheaper shared solution.
Yavuz describes the state of things this way: "If we're already driving electric cars today, in health authorities you sometimes still have to drive a carriage." And: "The systems are not interoperable. We can't drive on the same roads, we don't have the same tracks."
On top of that comes a funding cliff that is already visible: federal support for the nationwide contact-tracing software SORMAS ran out at the end of 2022. And the modern RKI reporting system EMIGA, according to Savaskan, is funded from the pact's money only until the end of 2026, with continued financing uncertain.
His conclusion follows: "If a pandemic broke out tomorrow, we would probably have very similar challenges."
The second front: polarisation as a risk factor
Technology alone is not enough — that is the pair's second argument. In the study "Political polarization and public health in Germany" in the journal Frontiers in Public Health, written with Alexandra Roth of the University of Lübeck, they argue that political polarisation can now act as an independent risk factor for public health: when medical recommendations are attributed to a political camp, trust in institutions falls — and with it the willingness to go along with protective measures.
Germany's public health service is especially exposed because, unlike self-governed hospitals and panel doctors, it sits directly inside the state administrative hierarchy and is subject to political direction. After the experience of National Socialism, practices and clinics were deliberately moved into state-distant self-administration; the health authorities stayed in the bureaucratic structure. In a crisis, expert assessment and political communication end up in tension.
The authors therefore call for structural reform: legally protected professional independence, closer ties to science, a binding technical code of ethics, and eventually self-administration for health authorities as independent public corporations. "Political, democratic control is not a contradiction to self-administration," Savaskan stresses. Yavuz adds: "Personnel, money and modern technology alone are not enough. People must also be able to credibly trust decisions."
What the rest of us should take from it
Germany's case is specific, its lesson general. Funding pots for public IT are easy to legislate and hard to spend in a way that produces anything reusable. Without binding interoperability rules and money that outlives the project, every grant produces another local island — and the next crisis meets the same paperwork, with a newer interface.
