Ethnicity and the German vaccine rollout

Ensuring equal access to the vaccine isn’t going well ― even within the rich countries who have most of it. As of April 14,the vaccination rate for white people in the US was 1.6 times greater than that for Black people and 1.7 times higher than that for Hispanic people. A similar trend can be seen for ethnic minorities in the UK, with people identifying as Black African or Black Carribean being significantly less likely to have received a first dose of the vaccination than white people, according to a government report. Questions have arisen as to whether such divides will be reproduced elsewhere, including in Germany. A small snag: There’s no data.

In a country which has had a particular sensitivity towards collecting statistics based on ethnicity since the end of the Second World War, the figures that have filled many a headline in the US and UK simply do not exist. Yet this data gap makes it difficult to identify inequalities ― and even harder to tackle them. 

Access vs willingness: An important distinction  

Harriet Washington didn’t name her book "Medical Aparteid" for nothing. For the American writer and ethicist, the overrepresentation of white people amongst recipients of the COVID vaccine in the US is, sadly, no surprise at all. She is critical of the narrative that assumes that people of color are at fault for this and stressed that the lower proportions of vaccines delivered to people of color means that they are not getting the vaccine, not that they are rejecting it. 

African Americans, Hispanic Americans and Native Americans are underrepresented in the groups prioritized for the vaccine ― sometimes unfairly, Washington pointed out. While it is logical to protect frontline healthcare workers, we should not forget "the people who are feeding the patients, helping them wash, cleaning the floors and so on," among which people of color are overrepresented. "These people share the risk of infection with health care workers and they were not included in the prioritization for the vaccine," Washington pointed out.  

Time and internet access also affect how easy it is to get an appointment. Washington explained that she had the "luxury," which she said many other people of color don’t have, of being able to scroll through the many booking sites several times a day until she got a slot.

"The many headlines we see about African Americans not accepting the vaccine forget that there are all these hurdles, which you can’t get around if you’re an essential worker, in a low-status job without internet access."

That's why for Washington, the differences in levels of vaccination are a reflection of structural inequalities and racism in society.

The data gap in Germany 

"If it’s like this in the US, it could be here as well," said Dr. Laura Scholaske, who researches health inequalities at the German Institute of Integration and Migration Research. "We simply don’t know. In Germany, we don’t use the ethnicity concept to collect statistics." 

In Germany, the term "mit Migrationshintergrund," meaning "with a migration background," is an umbrella term used to describe a very heterogeneous group. It refers to people living in Germany who were not born with German citizenship or who have at least one parent who was not born with German citizenship. 

This group accounts for 26% of Germany´s population of 82 million, but the catch-all term tells us little about the social realities of groups of different origins, religions, and ethnicities within it. But as Scholaske pointed out, it is the only statistical category that researchers have at their disposal. 

Scholaske sees no reason per se for people with a migrant background to be more prone to vaccine skepticism than others. A study from 2017 showed that in general, people with a migration background do not show different levels of willingness to receive vaccinations, outside of the COVID context. However, the study was restricted to people who spoke German, and Scholaske thinks that language barriers may sometimes play a role in health inequalities.

Germany’s public health body, the Robert Koch Institute, confirmed via email that it is not known whether people from ethnic minorities are receiving COVID vaccines at a lower rate than whites, as is the case in other Western countries that do collect such data.

Time for a change?

The lack of data makes for a large research gap ― even aside from the pandemic. "If there is inequality and institutional racism and we don’t look at how they affect people, we have little chance of working against them," argued Joshua Kwesi Aikins, a political scientist at the University of Kassel in Germany. 

He called the term "mit Migrationshintergrund" "very problematic and too blunt," because it "lumps together people who experience racism with those who do not." People with a migration background may be white and experience no discrimination based on their ethnicity, while people who do experience racism, but whose families have been in Germany for two or more generations, are excluded.

In fact, gathering data based on ethnicity is possible in Germany if certain conditions are respected, contrary to common perceptions. Aikins is part of a team which developed the Afrozensus, a revolutionary study of the lives and social realities of people of color living in Germany, conducted by people who identify within that group. 

Participation was voluntary and consisted of an online survey and interviews, which focussed on the health and education of people of color. "There is a perception that gathering such data, rather than helping solve problems, contributes to them. We beg to differ."

A (deadly) lack of data in covid times

COVID-19 has reinforced existing inequalities in society. Data from the World Bank and International Monetary Fund show that people with a college education are less likely to lose their job in the pandemic than people without. By and large, those who already had higher incomes are more likely to keep them, while people with more precarious employment conditions, with lower wages, or whose work cannot be done from home, are more likely to see their incomes fall.

As Harriet Washington indicated, ethnic minorities are overrepresented in this latter category. Subsequently, they are more exposed to the risk of poverty due to the pandemic ― but also to the risk of COVID itself.

Racism therefore constitutes a co-morbidity of COVID, argued Joshua Kwesi Aikins. "This means that if you are affected by racism, you are more likely to be affected by corona ― both of getting sick and of dying from it."  

For Aikins, the pandemic has only highlighted the starkness of the need to understand the social realities different groups face.

"If we know that certain groups are more likely to contract COVID, they should also be targeted specifically for the vaccine rollout and make sure people of all backgrounds and genders are equally included," emphasized Aikins. "This is a worthwhile health policy for everyone! We need to prevent COVID spreading and mutating further."