A recent study shows that there are worrying gaps in the immunisation of small children in Germany. While some parents refuse vaccinations on ideological grounds, by far the majority apparently just forget to attend appointments. 

47 percent of two-year-olds in Germany fully vaccinated

Children in Germany are not vaccinated consistently enough. Although parents who reject vaccinations for ideological reasons (so-called “anti-vaxxers”) dominate attention in the media, by far the bigger problem is parents who have no reservations about vaccines, but just simply forget about them, especially when it comes to follow-up appointments and booster jabs. 

This conclusion was drawn by a recent study conducted by the Techniker Krankenkasse (TK), one of the largest providers of statutory health insurance in Germany with more than 10,5 million insured members. Of the children who were born in 2016 and insured by TK, only 47 percent had been fully vaccinated by the age of two. 

Majority of children only partially immunised

While only 3,6 percent of the cohort did not receive any vaccines at all (presumably for ideological reasons), a full 50,4 percent were only partially vaccinated. This occurs when a vaccine is given in a “course” of several jabs to provide full protection, but a child only receives one or two doses. 

The figures relating to the measles vaccine were particularly alarming. Measles is an especially dangerous disease in toddlers, as long-term episodes can cause brain inflammation, which invariably ends in death. Nonetheless, 11 percent of TK-insured children were only partially vaccinated by the time of their second birthday, and seven percent were completely unvaccinated. 

City dwellers more likely to be sceptical about vaccines

The TK data shows significant regional differences: while in Hesse 69 percent of two-year-olds have incomplete vaccinations, in Mecklenburg-West Pomerania, only 37 percent are not fully protected. The data did not, however, show how many children might have been vaccinated later than the recommended age of two.

The TK also carried out a representative survey to find out where the real vaccine opponents live, with quite surprising results. Vaccine scepticism is particularly high among those who live in Germany’s cities, with nine percent of all city dwellers saying that they would reject vaccinations, compared with just two percent of those living in rural areas. Overall, almost one in five said they did not feel well-informed about vaccines. 

Compulsory vaccinations not the answer?

Speculating about the reasons for missing vaccinations, Professor Cornelia Betsch from the University of Erfurt says that “practical hurdles” in particular play a role. For example, there are no appointments outside of working hours, or they are only available at the hospital, rather than the doctor’s office. People are often also unaware of the risks associated with being unvaccinated. 

However, Betsch rejects compulsory vaccinations - which Germany intends to introduce next year for measles - as counterproductive. She believes the regulation could lead to defiant reactions. A better alternative would be to simplify access to vaccinations - and remind parents about their appointments. Privacy laws in Germany currently make this difficult. 

Vaccinations in Germany

In order to reduce or even completely eradicate diseases such as measles, a high vaccination coverage in the population must be achieved. This also benefits children who cannot be vaccinated due to pre-existing conditions, as it drastically reduces the risk of them contracting the disease (known as “herd immunity”).  

Particularly important to this is the so-called primary immunisation, which is carried out in the first two years after birth. By introducing dead or weakened forms of common pathogens, the vaccine prompts the body to remember how to fight a disease in the future, thus ensuring life-long protection. 

The Standing Vaccine Commission (STIKO), an independent body of doctors and scientists, recommends the following 13 vaccinations for children under the age of two: 

• Tetanus
• Diphtheria
• Pertussis (whooping cough)
• Haemophilus influenzae b (Hib)
• Hepatitis B
• Poliomyelitis (polio)
• Pneumococcus
• Rotavirus
• Meningococcus C (meningitis)
• Measles
• Mumps
• Rubella
• Varicella (chickenpox)