The Turning Point Germany Shifts Focus of Vaccine Drive to the Undecided and Skeptics

As the availability of vaccines against COVID-19 increases, authorities in Germany are facing a new obstacle: hesitancy among the population. Now leaders are betting on everything from mobile vaccine buses to concert vouchers and a bicycle lottery to convince people to get their jabs.
Rhineland-Palatinate Governor Malu Dreyer with a student at a vaccine event in Mainz on Wednesday

Rhineland-Palatinate Governor Malu Dreyer with a student at a vaccine event in Mainz on Wednesday

Foto:

Boris Roessler / dpa

From her first look out the window of her official car, Rhineland-Palatinate Governor Malu Dreyer of the center-left Social Democratic Party (SPD), can already see that the project is likely to be a success. The governor drives down a street in the university area of Mainz in the western German state, past a line of students stretching about 250 meters (800 feet). Dreyer learns that the first of them arrived at 6:30 a.m. to line up for a COVID-19 vaccination. "Usually, you never see students on campus this early," she says contentedly.

The visit to the make-shift vaccination center at the university has a symbolic value for the leader of Rhineland-Palatinate. She says the campaign to immunize people against COVID-19 is at a "turning point." The waiting lists at the vaccination centers are getting shorter. In some regions, doctor’s offices are already ordering less vaccine from the pharmacies than they could theoretically receive. Now, Dreyer has set about launching the next phase of the campaign. "Now we’re in the acquisition process," she explains during her visit to the university on Wednesday morning. "We want to aggressively promote getting vaccinated."

It appears that those efforts to campaign for people to get vaccinated will also be needed across Germany. Earlier this week, the Robert Koch Institute (RKI), Germany’s center for disease control, reported that at least 85 percent of all 12- to 59-year-olds will need to be fully vaccinated to keep the rapidly spreading delta variant of the coronavirus in check. Among people over the age of 60, the vaccination rate would need to be at least 90 percent. So far, however, only about 40 percent of people in Germany have been fully vaccinated.

DER SPIEGEL 28/2021

The article you are reading originally appeared in German in issue 28/2021 (July 10th, 2021) of DER SPIEGEL.

SPIEGEL International

The problem with the vaccination drive in Germany is no longer limited supplies. In July alone, Pfizer/BioNTech and Moderna plan to deliver over 4.5 million doses a week of their sought-after mRNA vaccine to Germany. Experts in Germany’s state government are largely confident that all adults will have the option of getting vaccinated this summer. The Federal Health Ministry even recently named the end of July as its ambitious goal.

But what if too few people seek to get vaccinated? "We see that the number of new registrations is flattening," says Clemens Hoch, the health minister in Rhineland-Palatinate. In the Rostock District, in the northern German state of Mecklenburg-Western Pomerania, the number of people skipping their second vaccination appointment has also risen, on some days to 43 percent, according to district spokesman Michael Fengler. Many, he says, found a way to get their second shot faster through other means, like their family doctor or a doctor at their work. Others, though, are believed to have given their summer vacations a higher priority than getting their vaccination.

The faster the contagious delta variant spreads in Germany, the more critical the question becomes of how to reach those who haven’t yet tried to get an appointment – or people who are skipping their second dose, even though it is critical for ensuring strong protection against the variant.

"On a Silver Platter"

There are hardcore opponents to vaccines among the population, but they likely only comprise a single-digit percentage. As such, officials in German states are largely casting their sights on people who aren’t refusing to get a COVID-19 vaccine out of principle and are simply undecided. According to polling by RKI, 17.1 percent of under-60s who have not yet been vaccinated are still undecided about whether they will take the step. "We need to reach these undecided people by serving them their vaccine on a silver platter," says Frauke Hilgemann, the state secretary for health in the eastern state of Mecklenburg-Western Pomerania.

One way of doing that is through the kinds of events now being organized in many parts of the country. In Rhineland-Palatinate, the state government just distributed 30,000 BioNTech doses to colleges, universities and polytechnic institutes, where they can be administered without appointments. Anyone between the ages of 18 and 27 who lives or studies in the state is welcome to drop-in and get vaccinated.

Heiner Garg of the pro-business Free Democrats (FDP), the health minister for the northern German state of Schleswig-Holstein, is focusing on mobile vaccination teams that will crisscross his state and vaccinate select groups: harvest workers, students, people living in villages. There are also "open house" events at the vaccination centers of Schleswig-Holstein allowing walk-ins for vaccinations.

Jabs at the Supermarket

Bavarian Governor Markus Söder of the conservative Christian Social Union (CSU) party says he could "imagine that we will create opportunities for people to be vaccinated at certain leisure events or at large catering operations" to make it easier for people to get their jabs. Rhineland-Palatinate Health Minister Koch has similar ideas: He suggests having operators of nightclubs park a vaccination bus in front of their doors and making it mandatory that people get a shot before they enter if they haven't been vaccinated yet. "We’re prepared to deliver the vaccines for that," says Hoch.

In Mecklenburg-Western Pomerania, the state government has launched an advertising campaign on social media showing young people partying and families celebrating a return to a more carefree life. Mobile teams are also being sent to supermarkets, strawberry farms and parking lots to make it as easy as possible to get a vaccination. In the towns of Ludwigslust and Parchim in the state, local vaccination centers are offering a "vaccine Happy Hour," where people can receive a first jab without an appointment.

In the eastern state of Saxony, Social Minister Petra Köpping of the SPD is considering setting up mobile vaccination centers near sporting events or at supermarkets belonging to the chain Aldi. Last weekend, the Saxony branch of the Red Cross brought 500 doses of Pfizer/BioNTech into a football stadium in the city of Aue, allowing anyone to get the vaccine. The lines were long and, in the end, 413 people got vaccinated.

Mobile Vaccination Drives

But even these special programs are no guarantee that authorities will reach the populations with particularly low vaccination rates: people with low incomes or people living in areas with socio-economic challenges.

Since early May, the city of Cologne and its head vaccination doctor, Jürgen Zastrow, has been trying to get as many people jabbed in the city’s socio-economic problem areas as possible. When the vaccination bus first parked in front of the high-rise apartment buildings in the city’s Chorweiler district, they received a lot of attention.

Jürgen Zastrow, Cologne's chief vaccine officer: People offering vaccinations in socio-economically depressed neighborhoods were turned away as if they were pests.

Jürgen Zastrow, Cologne's chief vaccine officer: People offering vaccinations in socio-economically depressed neighborhoods were turned away as if they were pests.

Foto: Theodor Barth / DER SPIEGEL

In the first days, there were long lines. Then the vaccine supply ran out. By the time supplies had been replenished, the residents’ interest had evaporated. "We are very disappointed by the result," says Zastrow. In some parts of the city, he says, as many as 3,000 people were anticipated, but only about 300 showed up.

"In these environments, it is incredibly difficult to reach people," Zastrow says. He says some men believe the vaccine leads to impotence, and women are afraid of becoming sterile. And some believe that a probe is being inserted into people along with the vaccine. The city is hitting a wall, Zastrow says.

Zastrow and his people have tried a lot. They have gone from door to door at people’s homes. About half of the people didn’t open their doors. Others only shook their heads and turned away the vaccination providers as if they were pestering them. He says that only about 10 percent actually agreed to come and get their jabs on the vaccination bus.

Several politicians are looking closely at the United States where, in some areas, vaccinations are being encouraged with rewards like donuts or even marijuana. Or to France, where the government is putting up posters of hot-and-heavy couples alongside the words, "desirable side-effects," and sending vaccination teams to beaches this summer.

Former German Family Minister Franziska Giffey of the SPD recently suggested the government should use free tickets to museums and concerts to encourage people to get vaccinated. In Saarland, Governor Tobias Hans of the center-right Christian Democratic Union (CDU) is considering organizing a lottery with a bicycle or foreign-language course as a prize. Meanwhile, Oliver Schenk, the chief of staff for the governor of the eastern state of Saxony, has brought up the idea of meal vouchers for people willing to get vaccinated.

High Vaccine Skepticism in Saxony

Saxony is trailing behind all other states in terms of the percentage of its population that has received a first dose of COVID vaccine, and it needs to ramp up its vaccination campaign up to full. But that’s not easy. Researchers at the Dresden University of Technology investigated vaccine skepticism in the state in May and determined that "a considerable proportion of those older than 18" are "still decidedly skeptical” about vaccination. According to their findings, 9 percent "tend" toward not getting the jab, while 12 percent "definitely” do not want to be vaccinated. According to the RKI, a national average of just under 4 percent firmly reject vaccination.

According to the study, younger people are overrepresented among Saxony’s vaccine skeptics, and these include many women. The researchers have found that many graduated from non-college-track secondary schools, have a below-average income and no children. Those who "tend" not to want a vaccine or "definitely” do not want one are also generally more likely to be on the right of the political spectrum and are often supporters of the far-right Alternative for Germany (AfD) party. The scene’s geographical focus is eastern Saxony – in the cities of Bautzen, Görlitz, Chemnitz and in the Erzgebirge (Ore Mountains) region.

These are also regions where political forces have been actively using the COVID pandemic to stir people up for months. In the Erzgebirge, for instance, the Freie Sachsen (or Free Saxonians) – a political party that is being monitored by the state branch of Germany’s domestic intelligence service, the Office for the Protection of the Constitution, and has been classified as right-wing extremist – has been agitating people on the issue. The party became famous through its COVID-related actions, with weekly protests in the region and slogans like, "Stop the Corona Dictatorship."

Donuts will hardly be enough to convince such hardliners to get vaccinated. But payments of up to 500 euros, as some economists have brought up as possible premiums for the undecided, are also problematic: How are you going to explain the unfairness of such payments to those who got vaccinated earlier of their own accord, without expecting any kind of reward?

Garg, the health minister in Schleswig-Holstein, rejects the idea of providing incentives using taxpayer money. He says the fight against the pandemic is a common task. "If companies want to encourage their employees to get vaccinated by offering them rewards, then that’s a great addition," he says. "But we as a state are currently not planning that."

Nonetheless, the FDP politician believes that developments in the coming weeks and months are likely to increase the pressure on the unvaccinated. Once all people in Germany have the option of being vaccinated, he says, restrictions will likely be removed for people who have been immunized. However, those who refuse to get vaccinated will have to continue living with limitations – having to wear masks to protect risk groups, for example.

Peter Tschentscher of the SPD, who is the mayor of the city-state of Hamburg, paints a similar picture. He says the infection rate could soon rise again because of the delta variant. "If COVID-19 restrictions become necessary again," he says, "those who are fully vaccinated should be exempt from them."

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