When public health gets political

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Note: This post was published earlier at the Iowa blog BleedingHeartland.com

Despite a strong start at vaccinating its populace against Covid-19, my former home state of Iowa has begun to slip in the national rankings in its percentage of vaccinated residents. In Texas, some hospital workers have taken their management to court to fight suspensions for refusing the vaccine, despite experiencing over 52,000 deaths of Texans from Covid in those same hospitals. What is going on here? Sometimes a simple scatter-graph tells a great story:

Vaccination vs vote share

Sources: The Cook Political Report and the CDC Covid Data Tracker for June 14, 2021. Graphic by the author.

This chart arrays the current rate of vaccinations in each state (those receiving at least one dose of one of the vaccines) against the percentage of the vote that Joe Biden received in his 7-million-vote-margin presidential win last November. The blue dots are the states Biden won, and the red states are Trump states. I have run numerous correlation studies in my day, and with the ever-present caveat that correlation does not necessarily imply causation, this is a pretty amazing trend.

A federal judge quickly threw out the suit of those suspended Texas hospital workers. While employees primarily based their objections on YouTube-influencer questions of vaccine safety, the judge relied on arguments that (1) this is a private healthcare business and requiring a variety of immunizations is standard practice for these businesses; (2) people are still getting sick with Covid, an extremely virulent disease, and then going to Texas hospitals for care; and (3) the vaccine has been demonstrated as remarkably safe in sanctioned trials and now hundreds of millions of vaccinations.

Even though the Covid vaccines were developed in record time with at least some significant input from members of the previous administration, Trump’s refusal to enthusiastically endorse the vaccine after his electoral loss and his own decision to be vaccinated in secret has clearly helped to inspire a politically-based opposition to this lifesaving medical intervention. Can there be a clearer demarcation than the red dots versus the blue dots in the above graph?

One of my earliest memories is getting first the Salk polio vaccine injection in about 1955, followed by the “sugar cube” Sabin vaccine in the early 1960s. I have to wonder what would have happened if political opponents of President Eisenhower had prevented their children from receiving this vaccine, which was both less safe and less effective than the Covid vaccine. I still remember the pictures of people in “iron lungs” after having been stricken with polio, and I have personally known people permanently disabled by the disease. And yet, this is exactly what is happening today. The “commonweal” of public health has taken a back seat to political resentment and by anti-science myths propagated by social media.

The District of Columbia factor

There is at least one other significant factor besides political climate going on here, as can be seen in the outlier District of Columbia dot at the far right in the above graph. If the D.C. data point is included in a correlation calculation, you get a correlation coefficient of 0.79, which is very high (1.00 would be perfect correlation). If you remove the D.C dot, however, the correlation coefficient rises significantly to 0.86. You just do not see many of these mathematically clear correlations in most of real life.

What we are likely seeing in Washington, D.C., is a suspicion of vaccines in general, and this vaccine in particular, in some communities of color, as well as long-time obstacles to America’s poor people accessing basic healthcare services. You can see this as well in the very low rankings of Louisiana, Alabama, and Mississippi, who show up on virtually every other measure of poor healthcare outcomes as well.

Wyoming, West Virginia, and Idaho live up to their reputation here as the most contrarian states in the Union. The very blue states of Vermont, Massachusetts, and Hawaii, on the other hand, are making amazing progress in both vaccinating their citizens and quashing the coronavirus.

There are some other factors at work here besides political leaning and poverty.  My current home of Florida rises higher than several blue states in the vaccination rankings. My take is that older and wealthier Floridians got their vaccines early before getting sucked into the Republican anti-vaccination message. Masks were common early on among the old duffers like me in my neighborhood Publix supermarket, exceeding the political vote-share of my community. A conservative friend who lives in a gated golf course community near Tampa bragged in early January that their HOA president had secured vaccine doses for the entire community. This was during a time the rest of us were camping on phone lines and websites trying to enter local lotteries for vaccinations. While the Florida press highlighted several wealthy communities at the time that received similar treatment, this community was not mentioned, and I will not “out” my friend’s neighborhood here. [1]

And what about Iowa?

I had attributed my long-time home of Iowa’s early relative success in curbing the virus and good vaccination record, perhaps inaccurately, to lingering community values and concern for neighbors. The small rural Iowa university where I had taught went into a tight “lockdown bubble” early in the pandemic, frequently testing students, isolating exposed and infected students in a special dormitory, ending the fall semester before Thanksgiving, and moving many classes to Zoom format. I even came out of retirement to teach a Zoom course from Florida. This combination of mitigations salvaged the year. But I now hear growing vaccine hesitancy from this town and even from my own family there. I find this shift highly disturbing. Somebody is poisoning the community well.

Aside from further exposing the ever-present rich-vs-poor divide in American healthcare, this strange bifurcation of vaccination response is just one more example of the irrational madness that has gripped Republican politics. The Covid vaccines work, and they are safer than just about any other vaccine that we normally take without a second thought (and often require for our schoolchildren). At this point, virtually all Covid patients in hospitals are people who have not been vaccinated. In a country that is beginning to throw away doses!

People are still dying from Covid, and new variants of the coronavirus that continue to spread are more contagious than the one that gripped us a year ago. If you just include the subset of 35% of Americans who have not received the first dose of a vaccine (and as high as 62% in Wyoming) we are basically where we were last spring, with the coronavirus ready to regain its exponential rise among the unvaccinated. Especially when “birds of a feather flock together.”

I have written frequently over the last year about the dangerous exponential math of this virus if we ignore those basic mitigations available to us. Despite my concerns for the health of my anti-vaccination friends and family, the next year may see the “We are in this together” community ethic start to shift to a traditionally conservative rationalization of “It’s your own damned fault at this point” in the blue vaccinated communities.


  1. Florida governor Ron DeSantis, when challenged about this favoritism in the distribution of vaccines, did not deny it, rather threatened to pull vaccines from the less wealthy part of the county in which I live: “If Manatee County [note: my home] doesn’t like us doing this then we are totally fine with putting this in counties that want it and we’re totally happy to do that.”

2 thoughts on “When public health gets political

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