Economics

Why Do Vaccination Rates Differ So Much Within Germany?

Five factors and regional differences account for large disparities

Vaccination rates in Germany's states and counties vary a lot. How does this happen, and why is the willingness to be vaccinated so high among some people while others are very skeptical? Answers to these questions are provided by a recent study from Professor Michael Frenkel and Maximilian Ambros of WHU – Otto Beisheim School of Management. They have investigated a number of mitigating factors and analyzed local effects.

The COVID-19 pandemic is one of the deadliest pandemics ever documented throughout history. It has had a firm grip on our lives for nearly two years. Countries all over the world are facing consecutive waves of infections. Fortunately, unprecedented efforts by the pharmaceutical industry have led to the development of vaccines at lightning speed. These vaccines have been available since the end of 2020 and many developed countries have been equipped with sufficient supplies since the second half of 2021. But governments around the world continue to struggle not only with the virus and its variants but also with insufficient vaccination rates. At this pace, herd immunity cannot be achieved.

In Germany, after a steep rise in vaccination rates from 0 to 65 percent by August 2021, progress in the vaccination campaign slowed. Within Germany, the vaccination rate continues to vary significantly across the board. For example, only 63.5 percent of all Saxons received at least one vaccination by January 6, 2022, while 87.7 percent of Bremen's population is already completely vaccinated. Causal factors for these substantial differences in vaccination rates are manifold.

What are the reasons behind the significant variation in vaccination rates within Germany?

Survey data collected thus far indicates that vaccination-based decisions depended especially on income and population density. However, such survey data is often biased as those who oppose vaccinations may not share their honest opinion. This phenomenon is known as social desirability. Respondents do not disclose their true beliefs because they assume that these would not be met with social approval.

WHU researchers therefore did not work with survey data. Instead, they used a new data set which depicts current vaccination numbers in German counties. They also examined - at the county level - the influence of the COVID-19 mortality rate, physician density, population density, proportion of the population older than 65, and proportion of foreigners in the population on the rate of initial vaccinations. The study established that vaccination rates can be explained particularly well by the following five factors:

  1. Counties that are or were heavily affected by COVID-19 show higher vaccination rates.
  2. Higher physician density leads to higher vaccination rates.
  3. Higher population density leads to higher vaccination rates, indicating a "city effect.”
  4. The higher the average age of the population in a county, the higher the vaccination rate.
  5. Location plays an important role. New federal states (formerly belonging to the GDR) have significantly lower vaccination rates than older states, meaning that variations in vaccination rates can also be found at state level. This explains, the significant discrepancy between the rates in Saxony and Bremen.

From these results, recommendations for action can be derived for political decision-makers to take measures to increase the efficiency and efficacy of the vaccination campaign.

Tips for practitioners
  • As a policy maker, direct your vaccination campaign efforts primarily towards regions in eastern Germany that have relatively low vaccination rates.
  • Focus vaccination campaigns on regions with low physician density, and make low-threshold vaccination offers, such as through vaccination buses.

  • The majority of vaccination offers target the older population. Make the topic of COVID-19 vaccination more relevant to young people as well.

Literature reference and methodology

For the study "What Determines COVID-19 Vaccination Rates in Germany?" data was collected in more than 300 German counties. In addition to local vaccination rates, physician density, population density, COVID-19 mortality rates, the proportion of the population over 65 years of age, and foreigners were also considered.  

  • Ambros, M./Frenkel, M. (2022): The Determinants of COVID-19 Vaccination Rates in Germany, in: Journal of Economics and Statistics (JBNST), accepted for publication.
Authors

Maximilian Ambros

Maximilian Ambros is a Research Assistant at the Chair of Macroeconomics and International Economics. His research focuses on the international developments of macroeconomic variables, such as interest rates. He applies a broad range of econometric tools to real-world data. Ambros holds a BSc in Economics from the Free University of Berlin and an MSc in Economics from the University of St. Gallen (HSG). Prior to joining WHU, Ambros worked in tech consulting and co-founded a company in Singapore.

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Professor Michael Frenkel

Professor Michael Frenkel is Associate Dean for International Relations and Professor of Macroeconomics and International Economics at WHU – Otto Beisheim School of Management. He is also the Director of the Center for EUropean Studies (CEUS) at WHU. His extensive international experience stems from working for several years as a consultant with the International Monetary Fund and from visiting professor positions held at Harvard University among others. Professor Frenkel also worked as a consultant to the World Bank and the European Commission. For many years, he was responsible for the economic education of young German diplomats with the Ministry of Foreign Affairs. Professor Frenkel has more than 100 publications in the fields of macroeconomics and international finance, and he serves on the editorial board of the Global Finance Journal, the International Journal of Business, the Journal of Economics and Statistics, and the Journal of Markets and Ethics.

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