“Vaccinations are victims of their own successes” – Interview with Prof. Dr. Malte Thießen

Interview: Dr. Philip Jost Janssen & Linna Umme

GESIS Blog: Malte, you call epidemics the “most social of all diseases,” the “seismograph of the social,” why?

Thießen: Because epidemics potentially affect everyone. Contagion makes pandemics and epidemics a problem for society as a whole and, even worse, during a pandemic, fellow human beings suddenly become risks. This becomes particularly clear, for example, in the exclusions we experienced in 2020: “Chinese”-looking people were insulted and treated with hostility, thrown off of trains, or not allowed into restaurants. So, during a pandemic, we sometimes fall back into seemingly ancient patterns. This is the reason why epidemics get down to the nitty-gritty: containment measures, distance rules, and vaccination programmes are where we negotiate notions of healthy and sick, right and wrong, or in short: social norms and social orders.

For social scientists pandemics are therefore a stroke of luck: we can use the pandemic as a seismograph of the social with which we can examine the tectonics of societies and their shifts.

GESIS Blog: Even at the beginning of the pandemic, in early 2020, before the first vaccines against COVID-19 were on the market, the prospect of vaccination raised high hopes and was seen as a way out of the pandemic. However, the ensuing vaccination campaign also led to numerous conflicts in Germany: First, in view of scarce resources and prioritisation, there was talk of “vaccination envy” and “vaccination tailgater” – now, at the beginning of 2022, in view of the insufficient vaccination quota, opponents of vaccination are increasingly coming under public criticism. Does the debate about vaccination reveal deeper social tensions and conflicts?

Thießen: In fact, vaccinations always raise the social question because we never vaccinate only for ourselves, but always for others or for herd immunity. That is why tensions that can be observed as early as the 19th century always break out when it comes to vaccination. For example, it is about the relationship between the individual and the common good: what must the individual do to protect society? How much solidarity must the individual show? What is more important – the freedom of the individual or the security of society?

This tension is most evident at the moment in the issue of compulsory vaccination, which is being debated in Germany and Austria. For here, too, a very fundamental question is at stake: who is allowed to decide about the body – the state or the citizen?

“In short, vaccination is always political and raises social questions.“

GESIS Blog: The vaccination debate thus also sheds a light on citizens’ perceptions of their rights and duties – and those of the state.

Thießen: Indeed, and last but not least, vaccinations highlight the tension between the state and the economy: Who is actually responsible for the safety of vaccines – pharmaceutical companies or state institutions? Who decides on patents and the distribution of vaccines? Is it permissible to make a profit on the safety of infectious diseases, and if so, how high should these profits be if at the same time many people are unprotected?

In short, vaccination is always political and raises social questions. Vaccinations are therefore often just a projection screen for completely different issues and an outlet for fears and hopes.

GESIS Blog: In view of medical progress and the successful containment or eradication of diseases, have we forgotten how to react to disease outbreaks?

Thießen: For us, epidemics seemed to be something ancient or medieval, a threat from distant times or at least distant continents; for many of us, epidemics seemed to be a problem in Africa and Asia, but not in “hygienic Europe”. This self-assurance fell at our feet at the beginning of 2020 and explains why we were not warned at the beginning of the corona pandemic – although all the experts had warned again and again about pandemics.

GESIS Blog: Vaccination has played an important role in the control of past epidemics. Why do the risks of vaccinations sometimes seem to be more present in public discourse than their benefits?

Thießen: In the 21st century, we have become victims of our medical successes to a certain extent. Thanks to vaccination programmes and antibiotics, many of the former “widespread diseases” have no longer played a major role for us since the 1970s. At least in Europe and the global North, we have forgotten about infectious diseases to a certain extent. And vaccinations are also victims of their own successes: precisely because more and more vaccinations are being offered and they are so successful, precisely because they push back infectious diseases and enable us all to live much safer lives, the sensitivity to side effects is high.

From a historical perspective, this is a long-term development. Although vaccines have become safer and safer over the course of the 20th century, the potential side effects of vaccinations and vaccine damage have played an increasingly important role.

GESIS Blog: The safer and more successful vaccines become (in general), the more attention is paid to potential side effects?

Thießen: This is due to the fact that vaccination always involves an individual risk assessment: What is more threatening – the infectious disease or the potential side effects of the vaccination? The more successful vaccinations are, i.e., the more infectious diseases are forgotten, the more serious potential side effects of vaccinations appear.

Another problem is the prevention paradox: vaccinations are not a cure for an acute disease, but protection against a potential threat in the future. While we have the benefit of a medicine for a disease immediately in mind and therefore have less fear of side effects, the benefit of a preventive measure seems not so obvious.

GESIS Blog: Do you see recurring fears, motives, and lines of argumentation of vaccination sceptics and opponents in historical observation?

Thießen: Vaccination scepticism is as old as vaccination itself. On the one hand, it has to do with the primal fear of vaccinations. The idea of injecting something potentially threatening into one’s body in order to be protected already required explanation in the 19th century in the case of the smallpox vaccination. In the case of today’s corona vaccines, a new primal fear of the 20th and 21st centuries plays a role: the fear of genetic mutations. This fear has been very present since the 1980s against the background of demonstrations against nuclear power plants or nuclear wars, because of the experience of Chernobyl, but also because of a pop-cultural processing of fears of radiation, etc. A recurring motif is also the fear of genetic mutations.

Another recurring motif is the idea that vaccination is an unnatural immunisation that offers considerable disadvantages compared to natural immunisation. As early as the 19th century, representatives of naturopathy, homeopathy, esoteric, and anthroposophical circles favoured alternative methods: air, exercise, and toughening up and going through the illness was seen as a natural and better way to a healthy body. Such ideas still live on today.

The right-wing criticism of vaccination also has its roots here. As early as the 19th century, some folk representatives regarded vaccination as an intrusion into a natural, even Germanic way of life. In Germany in particular, vaccination is often given an anti-Semitic slant – as the poisoning of the “people’s body”, the “Volkskörper”. In the “Third Reich,” such interpretations were of course particularly popular.

“The acceptance of vaccinations is always also a reflection of trust in state institutions, in science, and in pharmaceutical companies.”

GESIS Blog: An important constant of vaccination scepticism, however, seems to be the fear of side effects.

Thießen: Yes, and for a long time these worries were not entirely unjustified. For one thing, earlier vaccines had much more frequent and often more severe side effects. The vaccination against smallpox, for example, but also the oral vaccine against polio had relatively frequent side effects. On the other hand, the handling of these side effects was not particularly transparent for a long time. Until the first half of the 20th century, side effects were often ignored by government officials and doctors as fake news by vaccination critics. Or the risk was dismissed as the unfounded concern of hysterical parents. It was not until the second half of the 20th century that a transparent approach to side effects prevailed, which also increased confidence in vaccination programmes.

This is precisely a constant to this day. The acceptance of vaccinations is always also a reflection of trust in state institutions, in science, and in pharmaceutical companies. This is why vaccinations continue to cause controversy to this day: because completely different, deep-seated fears or mistrust play a role. We should take many of these fears seriously if we want to increase vaccination acceptance – even if they often seem irrational and unfounded.

GESIS Blog: What instruments and strategies were used in the past to persuade the population to vaccinate, and can we take anything from this for the current debate, for example, about compulsory vaccination?

Thießen: In the course of the 20th century, voluntary vaccination became a successful model. This success has two backgrounds: Firstly, it has been found that compulsory vaccination has serious social side effects. Compulsory vaccination mobilises criticism of vaccination and stirs up fears even among those who could be won over to be vaccinated. Compulsory vaccination also consumes considerable human and financial resources. And it is a blunt sword, because sanctions hardly increase the vaccination rate. Many people simply buy their way out of the vaccination obligation by paying fines or by buying fake vaccination certificates, which in turn threatens society as a whole because, thanks to fakes, hidden sources of infection are emerging everywhere.

Secondly, when voluntary vaccination programmes are introduced, one notices that they are more effective. While smallpox vaccination was a compulsory measure in many European countries in the 19th century, later vaccinations were introduced on a voluntary basis – with great success: diphtheria vaccination from the 1920s and 1930s or polio vaccination from the 1950s and 1960s brought a higher vaccination rate than compulsory smallpox vaccination. Advertising, information, and low-threshold offers are simply more convincing than state compulsion.

GESIS Blog: Finally, let’s get back to the big picture. Again and again, one hears and reads about the pandemic as a caesura – about a world that is no longer the same after COVID-19. Is this perception typical of epidemics or a novelty of the current pandemic?

Thießen: I do consider COVID-19 to be a caesura. However, not because the virus is so different and so much more threatening than Spanish flu, Asian flu, or Hong Kong flu – to name just a few pandemics of the 20th century – but because our society is so very different today. Until the 1970s, the elderly and the pre-sick were considered the “collateral damage” of pandemics. That is why, for example, the Hong Kong flu, with its 50,000 deaths in West Germany alone in 1969/70, attracted hardly any attention. Today, this risk perception has changed fundamentally – and thank God, I think. It is because we now take optimal medical care and a fulfilled life into old age for granted that Corona is such a great threat to us.

Against this background, we were prepared in 2020/21 to accept measures that were previously unthinkable. There have been regional lockdowns or quarantine measures for cities since early modern times. An entire society in pause mode, however, has never existed like this before. In the Corona pandemic, health was more important than the economy for the first time – this had also always been the other way round in previous pandemics.

Corona was also an insult to our lifestyle. The return of the pandemic to our everyday lives threw all our notions of safety out the window and made us realise that pandemics are not the exception, but the norm.

In addition, there was a flood of images and reports on COVID-19 that is unparalleled in epidemic history. No pandemic is as well documented as Corona. This, too, will shape the image of a caesura in the future.

GESIS Blog: Thank you very much for this interview!

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Recent Publications by Prof. Dr. Malte Thießen:

• Security, Society, and the State: Vaccination Campaigns in 19th and 20th Century Germany. In: Historical Social Research 46 (2021) 4: 211-315. doi: 10.12759/hsr.46.2021.4.211-315.
• Immunity as Relativity: German Vaccination Campaigns and Debates in Times of COVID-19. In: Historical Social Research 46 (2021) 4: 316-338. doi: 10.12759/hsr.46.2021.4.316-338.
• Auf Abstand. Eine Gesellschaftsgeschichte der Coronapandemie. Frankfurt a.M.: Campus 2021.