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Germany battles vaccination fatigue

July 6, 2021

Appointment cancellations are piling up at vaccination centers, while the delta variant continues to spread. What will it take to achieve herd immunity?

A person receiving a COVID-19 vaccine in Germany
Some 77 million doses of COVID-19 vaccine have been administered in GermanyImage: Ying Tang/NurPhoto/picture alliance

The slogan of the campaign that has been encouraging people to get vaccinated over the past six months is "Germany rolls up its sleeves." The German government has spent €25 million ($230 million) on posters, TV commercials and online ads — and right now, Germans need to roll up their sleeves more than ever.

Germany — with more than 56% of its population vaccinated with one dose, and 39% fully vaccinated — is making giant strides towards a crucial point in combatting the pandemic: the point when herd immunity can be achieved by vaccinating 85 to 90% of the population. This goal can only be reached if skeptics and refusers can be convinced to get vaccinated. 

So far, the campaign has not managed to persuade them.

A coronavirus vaccine advertisement in Hamburg, Germany
'Germany rolls up its sleeves': The vaccination campaign has not met with the success its organizers hoped forImage: imago images/Hanno Bode

Vaccination campaign misses target groups

"It is precisely the people who are uncertain or negatively biased against vaccination who have not been reached by the campaign," said Steffen Egner, the founder and managing director of MediaAnalyzer. His market research institute surveyed 500 people on the impact of the "Germany rolls up its sleeves" campaign. He says that if he had to give the campaign a grade, it would be a C or a D, because it has failed to foster a willingness to vaccinate among those who have doubts.

"We just don't know enough about the vaccine skeptics right now. And that's the huge difference from most advertising campaigns, where the brands know exactly who their clientele is," Egner said.

Just one in five of the undecided appreciate the TV ads, because they say the message doesn't speak to them emotionally. "A campaign like this has to be properly targeted, and it needs to provide a clear motive, such as regaining freedom," he said.

Marketing researcher Steffen Egner
Marketing researcher Steffen Egner says campaigns must better understand their targets to workImage: privat

Raising awareness among vaccine skeptics 

Christine Falk says she can convince undecided people to get vaccinated in just fifteen minutes, simply by raising their awareness. The president of the German Society for Immunology, she always makes the same point when she talks to vaccine skeptics.

"This virus plays Russian roulette with people's lives, and you can never tell who it will hit hard. Vaccination is the best shield you can give yourself. Anyone who doesn't get vaccinated can expect to get infected sooner or later," she tells them. 

Christine Falk, preseident of the German Society for Immunology
Immunological expert Christine Falk: Not getting a COVID vaccine is like playing Russian rouletteImage: Christine Falk

Why are people cancelling vaccination appointments?

Despite this, vaccination fatigue seems to be spreading in Germany, with vaccination centers reporting a rise in appointment cancellations, especially for second vaccination appointments. In response to an inquiry from DW, the Association of Statutory Health Insurance Physicians in the North Rhine region reported that 6% of vaccination appointments are now no-shows.

In Berlin, one in five appointments has been canceled or postponed in recent weeks. The German Red Cross also reported appointment cancellations in Saxony. In the state of Brandenburg, as well, second appointments are increasingly going unused, while the state health ministries of Lower Saxony and Mecklenburg-Western Pomerania confirmed the trend.

The president of the Berlin branch of the German Red Cross, Mario Czaja, has proposed fines of €25 to €30 for failing to show up for a vaccination appointment. In  private practice, such measures are already commonplace. Some top government figures have joined the calls to issue fines for missed vaccination appointments.

But the North Rhine-Westphalian Ministry of Health in Düsseldorf told DW that there could be many reasons for the trend. "If people don't show up for their for second appointment at vaccination centers, it doesn't necessarily mean that they aren't getting vaccinated. Some choose to get vaccinated where they can get the quickest appointment, for example in a doctor's office or with a company doctor."

Second vaccination even more important with the delta variant

Given the potentially more contagious and more fatal delta variant, which already accounts for at least half of new infections in Germany according to the country's Robert Koch Institute, forgoing the second vaccination could have fatal consequences. "The second vaccination is so effective because the antibodies improve measurably. You need the second vaccination to create an immunological memory of the virus," Falk said. "Especially with delta, the protection multiples with a second shot." 

Is a quick end to the pandemic possible?

The president of the German Society for Immunology is already thinking one step ahead and, like German Health Minister Jens Spahn, is advocating a third vaccination in the fall or winter, especially for high-risk groups.

"In retirement homes, you could say the vaccination has worked very effectively, and that is enough. But I don't want to rely on that, especially with the delta variant. It is better to be on the safe side. We can already see with transplant patients that a third vaccination makes a difference."

How useful are incentives for vaccination?

People in high-risk groups don't need a lot of motivation to get vaccinated. But some politicians want to establish a bonus system to win over skeptics. In the US, the undecided have been wooed with donuts, marijuana and even hunting permits.

Christine Aschenberg-Dugnus of Germany's Free Democrats (FDP) has proposed offering free tickets to amusement parks or museums.

But Stefan Schulz-Hardt, of the German Psychological Society, is worried by these proposals. He says that although incentives can prove effective, they are counterproductive. "This appears to signal that something questionable is going on, and that people have to be rewarded for taking part. It can provide fuel for opponents and make people who are indifferent move to the other side."

Germany ends vaccine priority system

All experts agree that Germany must now target the undecided and the skeptics; but they agree that attempting to win over avowed vaccine refusers is futile. 

"They are almost always people who believe in conspiracy theories or are generally mistrustful. There is a correlation with populist and especially with right-wing beliefs," pointed out Schulz-Hardt.

The German government now wants to launch a new advertising campaign featuring celebrities and influencers. Perhaps they can succeed where politicians and health authorities have not. 

This article has been translated from German.

While you're here: Every Tuesday, DW editors round up what is happening in German politics and society, with an eye toward understanding this year's elections and beyond. You can sign up here for the weekly email newsletter Berlin Briefing, to stay on top of developments as Germany enters the post-Merkel era.

Oliver Pieper | Analysis & Reports
Oliver Pieper Reporter on German politics and society, as well as South American affairs.