Exploring epidemic decision-making and the role of the public health institute in Germany

Abstract Background The nexus of politics and science played a crucial role during COVID-19. As pandemic measures are re-assessed, we explore evidence-informed decision-making in Germany during COVID-19 with a particular focus on Germany's National Public Health Institute (NPHI): What role did it play in the generation and coordination of evidence? To what extent and through which pathways did evidence inform political decisions? Methods This exploratory qualitative study is based on 10 audio-recorded expert interviews and 2 focus-group discussions conducted between January and July 2025. We purposively sampled policy makers, national and state-level public health experts, and scientific advisors to gain different insights on evidence-informed decision-making from outside and inside the NPHI in Germany, and analysed the transcribed data thematically. Results Experts outside NPHI greatly respected NPHI for synthesizing and sharing evidence for political decision-making. NPHI staff underlined stretched capacities through additional tasks such as communicating with the public, and noted own evidence generation with delays in modelling through fragmentation and digitalization gaps in the German data register. Press conferences with the Health Minister were seen as compromising NPHI's neutrality. Multi-level governance was perceived as potentially offering flexibility in the pandemic response, yet complicating coordination, leading to incoherent interventions across states and limiting direct exchange between actors across levels. Experts critiqued the handpicking of scientific advisors as intransparent while appreciating the pooling of transdisciplinary expertise through a high-level advisory panel. Conclusions In pandemics, the nexus science-policy-society needs optimization regarding governance, transdisciplinary collaboration, transparency in political decision-making and science communication and adequate resources for the work expected of public health actors. Key messages • Coordinated interdisciplinary advice, and transparent decision-making are crucial in health crises especially when decisions diverge from evidence provision by NPHI and other scientific bodies. • The nexus between science, politics and the general population needs to be strengthened through better science communication, participation and adequate resources for public health institutions.