Attitudes Toward Vaccination in the German General Population Before and During the COVID-19 Pandemic

Trends From Representative Population Surveys by the German Federal Center for Health Education (BZgA), 2012–2021

Especially during the COVID-19 pandemic, acceptance and uptake of vaccinations have been a fundamental prerequisite for population-wide protection from infection (1). This article explains fundamental attitudes towards vaccination and the vaccination behavior of the general population aged 16–85 years on the basis of data from repeated representative surveys (2012–2021) (2).

Methods

The German Federal Center for Health Education (BZgA) every two years carries out representative population surveys by means of computer aided telephone interviews (CATI) regarding attitudes, knowledge, and practice regarding recommended vaccinations. Participants are persons with sufficient knowledge of the German language. The sample is representative and weighted by region, age, sex, and general school education on the basis of official data from the Federal Statistical Office (population update, microcensus).

Because of the pandemic an additional extracurricular data collection was undertaken in 2021. For the questions that had been asked in the same form in at least four out of six years of data collection, a trend analysis was carried out. It was tested whether over the entire time period a statistically significant (P<0.05) linear increase/rise or a linear decrease/fall in the results can be confirmed. The current collection (N=5007, 15 July to 1 September 2021) also includes questions about COVID-19 vaccination (2).

Results

Most survey participants classified immunizations for adults as important. This is the case for the recommended standard vaccinations as well as for the COVID-19 vaccine, which has been available since the end of 2020 (Table). 81% of those surveyed in 2021 can be categorized as vaccination supporters (“supportive”/”tendentially supportive”). 15% have reservations regarding vaccinations and 4% are (tendentially) opposed to vaccination. Older survey participants (60–85 years) are more inclined to be supportive of vaccination. Among survey participants with formally higher school leaving certificates, the proportion of vaccination supporters is higher than among persons with a low or moderate educational level. Participants without a migration background are also more likely to be supportive than persons from a migration background. The proportion of those who (tendentially) support vaccination has statistically significantly increased from 2012 (61%) to 2021 (81%). In the surveys of 2012–2020, higher proportions of participants in eastern Germany (Brandenburg, Mecklenburg-Western Pomerania, Saxony, Saxony-Anhalt, and Thuringia) reported being (tendentially) supportive of vaccination (2020: 84%) than people in western Germany (2020: 78%). In the current survey these rates are at the same level for the first time (81%) (Figure). The most frequent reason for vaccination uptake is indications from other people. These are mostly from doctors (72%), family members (30%), or the media (28%) (figures not included in the figure).

Figure

Descriptive trends in attitudes “(tendentially) supportive” regarding vaccinations compared over time (2012–2021) and by region (east/west)

Table

Assessed importance of vaccinations: rated as “particularly important/important” compared from 2012 to 2021

Discussion

The general acceptance and willingness to be vaccinated have followed a positive trend since 2012 (2). This long-term trend has seemingly endured throughout the pandemic and was not negatively affected by the public discussion of COVID-19 vaccination. This is also shown by data from the KV Impfsurveillance (the vaccination surveillance of the Association of Statutory Health Insurance Physicians at state level), which show an increase in vaccination rates for respiratory pathogens (for example, influenza: slight increase in vaccination rate since the winter 2018/2019 especially in those aged 60–79) (3).

Since 2020 the results in eastern and western Germany have evened out, when previously vaccination support had been greater in the east (2). Whether and how this trend continues will have to be investigated in follow-up studies. The rating of the importance of vaccination against COVID-19 (87% “particularly important”) is consistent with the results of the BZgA’s CoSiD survey (4). According to this most of the population (≥16 years) has a fundamentally positive attitude towards COVID-19 vaccination. But this result contrasts with actual vaccination rates. A socially desirable response behavior among participants regarding their attitude towards COVID-19 vaccination cannot be ruled out. It is also possible that persons with a positive attitude towards vaccination are generally more likely to participate in surveys. A further limitation of this study lies in the fact that no representative conclusion can be drawn from these data for the population with a migration background, as survey participants had to have sufficient knowledge of German in order to be included in the survey.

From the BZgA survey 2020 it is known that 35% of participants have a need for information regarding vaccination (among others, regarding the mechanism of action and the duration of the protective effect, as well as possible adverse effects). For this reason, knowledge about and trust in vaccinations in the population need to be strengthened further, and in a more targeted manner. This is the case for standard vaccinations (2) and, with regard to the pandemic, especially for the COVID-19 vaccination (2, 4, 5). In promoting acceptance of and willingness to undergo vaccination in the population, doctors have a central role, as has people‘s social environment and information from the media (radio, television, newspapers, social media). Appropriate health communication should consider this and use the necessary channels in a targeted manner—or in a manner that fits the target audience—or create references.

Conclusions

Since 2012 the general acceptance of and support for vaccination among adults in Germany has increased steadily (2012: 61%; 2021: 81%) and statistically significantly (2), which is also reflected in the estimated vaccination rates of the Robert Koch-Institute (3). Whether the evening out between east and west we showed for the studied data will remain stable or whether a reverse trend will set in after the waning of the pandemic should be kept under close observation. Measures to promote general vaccination acceptance and willingness should also consider that personal advice from doctors has the greatest effect on vaccination readiness.

Linda Seefeld, Nina Horstkötter, Britta Reckendrees, Oliver Ommen, Michaela Goecke, Freia De Bock, Martin Dietrich

Conflict of interest statement
The authors declare that no conflict of interest exists.

Manuscript received on 23 June 2022, revised version accepted on 2 September 2022.

Translated from the original German by Birte Twisselmann, PhD.

Cite this as:
Seefeld L, Horstkötter N, Reckendrees B, Ommen O, Goecke M, De Bock F, Dietrich M: Attitudes toward vaccination in the German general population before and during the COVID-19 pandemic: Trends from representative population surveys by the German Federal Center for Health Education (BZgA), 2012–2021. Dtsch Arztebl Int 2022; 119: 836–7. DOI: 10.3238/arztebl.m2022.0317

References

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3. Rieck T, Steffen A, Feig M, Siedler A: Impfquoten bei Erwachsenen in Deutschland – Aktuelles aus der KV-Impfsurveillance. Epid Bull 2021; 50: 3–23 .

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