Vaccine choice follows politics in US. Why doesn’t it in Germany?

Online marketer David Becker and his wife chose not to vaccinate against COVID-19. And even after they were both diagnosed with the disease, from which they have since recovered, they say they do not regret their decision.

Mr. Becker, who has attended three demonstrations for the preservation of civil rights, characterizes the German government’s vaccine-approval process as hasty, for a technology that’s unproven. And he says the governmental pressure to vaccinate is unfair. “I find it absolutely cruel for politicians to put so much pressure on unvaccinated people.”

He is part of small but vocal minority in Germany. But unlike his fellow vaccine skeptics in the United States, he is not giving away where where he sits on the political spectrum by his position. He says that prior to the pandemic, he wasn’t interested in politics.

The dividing lines between Americans who vaccinate and those who do not coincide rather neatly with polarized political lines. But Germany’s divide does not. Here, the factors that correlate with vaccine doubts are complex. They include the country’s long-standing preference for naturopathic remedies and an anti-authoritarian bent in society stemming from the post-Nazi era.

Overall, a distrust of or discomfort with strong authorities, such as government or scientific institutions, is a common narrative. And the factors in Germany may help explain vaccine hesitancy in a way that moves beyond politics and toward more fundamental causes, regardless of national context.

“We are all very frustrated that Germany’s only got about 70% vaccinated,” says Jochen Mayerl, a sociologist at the Chemnitz University of Technology. “It’s not the super lowest in Europe, but it’s not good. As sociologists we talk about behavioral models: Who has a vaccination and intention, and who doesn’t? Overall [the research] shows there’s a norm and a social desirability to vaccinate, and that’s good news.”

Cultural correlations with vaccine doubts

Germany’s vaccination rate, though high compared with the U.S., lags many of its neighbors in Western Europe, even as the continent now enters an intense fourth COVID-19 wave with the omicron variant looming. The country is beginning to impose new restrictions on public life for unvaccinated people and is considering mandatory vaccination starting in 2022.

There’s a clear link between social or government distrust and lower vaccination rates, say experts. A map of Germany shows clear trends: the further north and west toward the border with France, the Netherlands, and Belgium, the higher the vaccination rates – which currently peak at about 84% in the cultural hub of Bremen. Go south and east toward Poland, the Czech Republic, and Austria, and vaccination rates dip as low as 61%.

“The higher the political trust, the higher the vaccination rate, and then you can take it the other way around with low political trust,” says Dr. Mayerl.

That distrust, or disenfranchisement, can manifest differently. The rise of populism has been fueled by groups suffering from a feeling of social decline or marginalization, and in Germany, far-right strongholds are in the East and South.

“You have to look at the East. All people had to be vaccinated,” says Dr. Mayerl, referencing the policies of authoritarian socialism in former East Germany. “And today these people no longer want to be offered an authoritarian government saying, ‘You must do this.’ They want to be free. They never want to be in this situation again.”

Migrants are another group that show lower vaccine uptake, and Germany has roughly 14% foreign-born migrants, a higher proportion than its neighbors to the west, such as France.

Then there’s a long-held comfort with homeopathy, which was developed by a German practitioner during the 18th century. Today, roughly half of Germans have reported using homeopathic remedies, which are sold in every corner pharmacy. Homeopathy is also accepted and paid for by German health insurance plans.

“Germany’s southern regions show a stronger tendency toward alternative medicine,” says Joost Van Loon, a sociologist at the Catholic University of Eichstätt-Ingolstadt. “In the South, there is a prevailing skepticism against science and institutionalized science.”

Going a bit further, sociologists speak of a strong “contra culture” underlying German society. And that’s led some populations to see scientific authority as an extension of authoritarian politics, says Dr. Van Loon.

A mandatory vaccine – which the new coalition government seems ready to support – would be seen as a strike at the heart of human dignity, a concept that’s deeply rooted in German society, says Dr. Van Loon.

Overall, trends in vaccine uptake in Germany mirror a complex situation in which “party divisions play a rather small role,” says Malte Thiessen, historian at the LWL Institute for Westphalian Regional History.

“For example, in debates about vaccinations, conservatives can have both positions. Within liberal parties there is support for the right to self-determination, while on the other hand, there are economic and progressive liberals who view mandatory vaccinations as a prop for the national economy.”

“I’m busy analyzing my own standpoint”

Discussions with those who choose not to vaccinate reveal themes of distrust, whether of doctors, government, health authorities, or even the vaccine approval process itself. 

Thorsten Otto, an engineer who lives in Hamburg, cites poor experiences with doctors and his employee liability insurance company as a reason not to vaccinate. He’s also skeptical about politicians, pointing out that Germany’s health authority under Chancellor Angela Merkel ordered masks from a company directly connected with the health minister.

Sarah Schumacher, an economist who lives in Stuttgart, says she’s never attended an anti-vaccination demonstration and would never tell anyone not to get vaccinated. She simply believes that “science learns through trial and error,” and there hasn’t been enough time to test this vaccine. She hasn’t gotten vaccinated yet, though she’s inching closer.

“I’m busy analyzing my own standpoint,” says Ms. Schumacher, “and slowly, the real dangers of an infection are outweighing the possible dangers of vaccination side effects.”

Thomas Ehrhorn, a local chairman of the right-wing party Alternative for Germany, supports that freedom to choose. “Every person has to be allowed to do their own risk assessment. There has to be freedom of opinion, and no one who chooses not to get vaccinated should be at a disadvantage.”

As Germany weighs further restrictions on unvaccinated people, including mandatory vaccinations, these voices are likely to get more fiery.

“From a historical perspective, mandatory vaccination not only mobilizes vaccination enemies, but also skeptics and those who are still unsure,” says Dr. Thiessen, the historian. “This group is a minority, so the division of society would still be manageable. But it is unrealistic to assume that a mandatory vaccination would solve all problems.”