BERLIN (BLOOMBERG, REUTERS) - Germany is being battered by a fourth Covid-19 wave, with low vaccination rates in its eastern states a big reason the virus has regained a foothold.
The four regions registering the lowest vaccination rates - Saxony, Thuringia, Brandenburg, and Saxony-Anhalt - are all in the formerly communist East. No state in eastern Germany has an inoculation level that exceeds the nationwide fully vaccinated rate of 67.5 per cent, with the exception of once-divided Berlin, according to health ministry data.
Chancellor Angela Merkel indirectly addressed the issue in her latest podcast published on Saturday (Nov 13), as the country's seven-day coronavirus incidence rate rose to the highest level since the pandemic began.
"Difficult weeks lie ahead of us, and you can see that I am very worried," Dr Merkel said, speaking in her weekly video podcast.
"I urgently ask everyone who has not yet been vaccinated: please reconsider."
"There is a very clear link between the vaccine rate and the number of cases," she added, without mentioning any of the eastern regions by name. "That has serious consequences," she added, including overstretched hospitals, patients having to be shifted around, and operations for other health conditions cancelled.
Germany's seven-day incidence rate - the number of people per 100,000 to be infected over the last week - rose to 277.4 on Saturday, data from the Robert Koch Institute showed. The record in the third wave of the pandemic last December was 197.6.
The East-West disparity reflects a legacy of alienation felt by Germans in the poorer states that joined the Federal Republic in 1990. There is lingering resentment among those who grew up under a communist regime, and many still harbour suspicions against central authority in Berlin.
Those attitudes are at least partly responsible for the country's lagging performance among western European peers, where nations such as Spain, Italy and Portugal have far outstripped Germany on vaccines. By contrast, inoculation rates in Eastern Europe are far lower.
Dr Merkel, who's called for stricter measures to contain the latest wave, lauded Portuguese Prime Minister Antonio Costa during a visit outside Berlin this week, calling his nation's vaccination rate "fantastic". Around 87 per cent of Portugal's population is fully immunised.
"If enough people get inoculated, that's our path out of the pandemic," Dr Merkel said on Saturday, urging people to "join in, and try to convince relatives and friends".
"If we stand together, and focus on our own protection and think considerately about others, then we can do much to protect our country this winter," she added.
German Health Minister Jens Spahn, who called the latest cycle a "pandemic of the unvaccinated", warned that some hospitals are already overwhelmed.
"We're already seeing the effects of too few vaccinations and too many infections in the intensive-care stations in some regions," Mr Spahn told reporters in Berlin on Friday, exhorting Germans to take more precautions and above all get vaccinated. "Otherwise it'll be a bitter December for the whole country."
Europe has become the epicentre of the pandemic again, prompting some governments to consider re-imposing unpopular lockdowns in the run-up to Christmas and stirring debate over whether vaccines alone are enough to tame Covid-19.
Germany and neighbouring Austria, whose fully-vaccinated rate is near 65 per cent, straddle a sharp divide among European Union member states, with low vaccine take-up in the once Soviet-dominated east lagging higher rates of inoculation in the west, particularly in countries that were hit hardest at the beginning of the pandemic.
Full vaccination rates among Germany's Western European neighbours range from France's 78 per cent to over 80 per cent in Spain, while to the east, inoculations are much lower. Poland stands at 53 per cent and the Czech Republic at 58 per cent. In Bulgaria, just 23 per cent have been vaccinated, according to Bloomberg's vaccine tracker.
Germany's east-west divide reflects a similar pattern. Saxony, a state of four million that borders Poland and the Czech Republic, registers 57.4 per cent as having received full protection. At the top is the western city-state of Bremen on the North Sea, Germany's smallest state with fewer than 700,000, of whom almost 80 per cent is fully vaccinated.
Coronavirus cases in Saxony have reached an incidence level of 621 new infections per 100,000 people over seven days. Bremen, where cases have also risen, is at just over 100 per 100,000. It trails only the northern state of Schleswig-Holstein, which has kept the fourth wave relatively in check.
The federal government and leaders of Germany's 16 states are due to meet next week to discuss tightening measures, though the three parties negotiating to form a new government have agreed to let a state of emergency in place since the start of the pandemic expire on Nov 25 as planned.
"It has always helped us when states and the federal government worked together and committed to uniform rules," Dr Merkel said.
The east-west divide is only one facet of Germany's tepid vaccination program, though - the wealthy southern states of Bavaria and Baden-Wurttemberg, without the Communist legacy, also lag.
But the psychology of vaccine resistance, often associated with general distrust of authority, is one that's been prevalent in the poorer east since reunification.
A study released in October by the research consultant Forsa showed that two-thirds of unvaccinated Germans cast doubt on the authority wielded by federal authorities in fighting the pandemic.
That view has been a hallmark of the east - and has engendered a broader sense of grievance and protest, said Forsa researcher Peter Matuschek. "There are a lot of reasons, including experiences with authority, living under authoritarianism, that have continued," Dr Matuschek said in an interview. "A lot also has to do with the experience of transformation after reunification."
Dr Matuschek tied vaccine resistance directly to the political environment, where Germany has followed a broader European pattern in which far-right politics have been associated with opposition to vaccines, including in Austria.
The anti-immigration Alternative for Germany party, or AfD, has become a political home for vaccine scepticism, hitting out at various Covid-19 restrictions and spearheading protests, many of which have turned violent.
Among unvaccinated Germans who cast their ballot in the Sept 26 federal election, 50 per cent voted for AfD, according to a Forsa survey of political preference of 3,048 people over 18. The pollster called political preference "the most important factor" influencing citizens' readiness to get the jab.
"Above all, it's ideological," Dr Matuschek said.
On Thursday, AfD was the only party in Germany's lower house of parliament, or Bundestag, to oppose rules requiring lawmakers to be vaccinated or show a negative Covid test to enter the chamber. Hours later, news broke that AfD co-leader Alice Weidel had tested positive and entered quarantine. She had repeatedly said she hadn't been vaccinated.
The AfD received the most votes in Saxony in this year's election, beating Dr Merkel's Christian Democratic Union, which has led the state since reunification. The party had more than 20 per cent support in Thuringia and Saxony-Anhalt as well as Saxony - all of them vaccination stragglers.
The political backdrop creates a grim outlook if Germany hopes to inoculate nearly 18 million people over the age of 12 who've so far resisted health officials' efforts - even as booster programs are up and running.
The holdouts include 3.5 million people aged 60 and above, or about 14 per cent of that bracket deemed at higher risk if they contract Covid-19.
Dr Christian Drosten, the head of virology at Berlin's Charite Hospital, offered some hope in getting Germany's vaccine program back on track. Setting aside ideological anti-vaxxers, he said, authorities could target groups that are unvaccinated because of a lack of information or access - such as immigrants and jobless citizens.
"These people are reachable if you make a concerted effort to bring the vaccine to them, or if you create an arrangement whereby they simply must get vaccinated," Dr Drosten said this week on Das Coronavirus-Update, a podcast put out by broadcaster NDR.