Is Vaccine Hesitancy About More Than Race and Partisanship?
64 percent of the people who live in Prince George’s County in suburban Washington, D.C. are black, while just 12 percent are non-Hispanic white. About 65 percent of the people there ages 18 and over are fully-vaccinated from COVID-19, according to CDC data. This is higher than the percentage of people 18 and over nationally who are fully-vaccinated (60 percent.) In Woodford County, Kentucky near Lexington, about 55 percent of people voted for Donald Trump last November, compared to 42 percent who voted for Joe Biden. About 72 percent of the adult population in Woodford County is fully vaccinated, the highest percentage of any county in Kentucky.
About 22 percent of Louisville-Jefferson County residents are black. Biden won the county 59-30. About 64 percent of our adult population is fully-vaccinated, about even with Prince George’s County and significantly less than Woodford. So a heavily-black place and a pretty-Republican one have higher vaccination rates than majority-white, Democratic-leaning Louisville.
What do all of those numbers tell you? It could be that Woodford and Prince George’s have amazing vaccine outreach or unusually pro-vaccination residents. They are no doubt outliers.
After all, we have lots of data showing that black people and particularly Republicans are taking the vaccines at lower rates, compared to white people and Democrats, respectively. But I worry that those data points are almost too broad and obscure a more complicated story.
Here are some other factors likely at play:
1. What state you live in
You are way more likely to be vaccinated if you are black and live in Maryland or Massachusetts compared to Alabama or Mississippi---and that same pattern exists if you are white too. White people in Alabama and Misssipppi of course are overwhelmingly Republican, so that in part explains the vaccination gap. But not black people in those states. Of the 11 states with the lowest vaccination rates, about half have large black populations. But what 9 of the 11 have in common is having backed Trump in 2020 and having Republicans in total control of the state government (Louisiana has a Democratic governor, Georgia Republicans control the state government but Biden won the state last year.) It is likely that deeply-conservative states haven’t invested a lot of resources in getting everyone vaccinated and that is affecting even their non-conservative residents.
2. Whether or not you have a lot of trust in government and other institutions
I’m not an expert on vaccines. But lots of people and institutions that I trusted said I needed to take the vaccine--so I did. I think it’s likely that if the CDC, Anthony Fauci, Kamala Harris, Barack Obama, Mitt Romney and the science writers of the New York Times all suggested I should try cocaine that I would at least research the idea a bit.
We don’t have great measures for trust in institutions, but I think one proxy for trust is having a four-year college degree. There is a lot of evidence that more educated Americans are more confident in our society’s institutions, likely because those institutions are working better for college grads, who tend to get paid more and have more steady jobs than those without degrees.
In terms of getting COVID-19 vaccinations, white college graduates (86 percent) are much more likely to be vaccinated or say they will soon get a vaccination than white people without degrees (65 percent), black college graduates (76) more than black people without degrees (59 percent), according to PRRI polling. Polling from Civiqs found that Republican college graduates are more likely to be vaccinated (53 percent), compared to Republicans without a degree (40 percent.)
But vaccine rates being much higher among college graduates is going to have a skewing effect, because of who has college degrees. About half of the people who voted for Biden in 2020 have at least a four-year degree, compared to about a third of the people who voted for Trump. (As a group, the Americans who vote tend to be more educated than non-voters.) About 36 percent of non-Hispanic white people have a four-year-degree or more, compared to 21 percent of black people and around 32 percent of Americans overall.
Prince George’s County and Woodford County, while having a lot of black people and Republicans respectively, have about the same percentage of residents with college degrees as Louisville, around 33 percent. But remember I am using college degrees as a proxy for trust in institutions. So there are a ton of people in all three of these communities without degrees who have been vaccinated. This would be hard to prove, but I suspect those who have been vaccinated are non-college graduates who also have a lot of trust in institutions. For example, it is likely that if we surveyed the black people at St. Stephen Church who have attended the most services over the last several years and voted in the most presidential elections (so they have trust in institutions like the church and the Democratic Party), we would find high vaccination rates, even among the non-college graduates in that group.
For Republicans, their party affiliation probably does tie into their lack of trust in institutions.
The Republican Party of today, led by Trump and Fox News, is organized around an anti-college, anti-media, anti-institutions ethos as much as keeping taxes low. So even Republican college graduates get a steady diet of “don’t trust anyone” messages.
3. Your personal networks
There’s another reason I took the vaccine early: peer pressure. My attitude when the vaccine rollout started was essentially, “I am not old and am healthy-ish, so I will take the vaccine sometime in the future.” But many of my friends were in a mad rush to figure out how to get the vaccine as soon as possible, which no doubt influenced my behavior. A May poll from the Survey Center on American Life found that Democrats who said only a few or none of their friends were vaccinated were fairly unlikely to be vaccinated themselves at that point (about 35 percent), compared to a 93 percent vaccination rate among those who said most of their friends were also vaccinated. Republicans had a similar gap, with those whose peers were vaccinated more likely to have gotten shots.
So many of the people who have been vaccinated might have arrived at their pro-vaccine stance because of their personal circles, rather than because of their partisanship, education or race. But of course, most American’s personal circles include a lot of people who share their party, race and education levels. So it’s hard to figure out the causation/correlation here.
So thinking about this peer data a bit, Louisville has broken down vaccine take-up by zip code. The zip code 40243 has the highest vaccination rate of any area with a large population, the zip code 40208 has very low vaccination rates. 40208 (Park Hill) is majority-black, with a high poverty rate and few college graduates, 40243 (Middletown) is overwhelmingly-white, with a low poverty rate and a lot of college graduates. It’s possible (and probably likely) that the black people in Middletown are more likely to be vaccinated than the white ones in Park Hill, because of this peer dynamic.
4. Your job
75 percent of Americans whose employer has given them paid time off to take the vaccine, time off to recover from its effects and/or both have been vaccinated, according to Kaiser. That’s compared to a 51 percent vaccination rate among those whose work didn’t make it more conducive to get vaccinated. Again, the correlation/causation is complicated here---are people who are in the kind of white-collar jobs where their employers are more flexible likely to get the vaccine anyway, or is it easier to get the vaccine if you aren’t worried about losing money? Probably a bit of both. But we know that black people in particular are less likely to be in white-collar jobs.
So let’s say that vaccine rates might reflect institutional trust, state and local government, job status, and peer pressure, in addition to partisanship and race. What does that mean for increasing vaccination rates?
This might be a slog
The COVID-19 vaccines were developed much faster than the normal process (but in a safe manner) and more than 60 percent of American adults have already taken one. That 60 percent number is disappointing, in light of the importance of getting everyone vaccinated, particularly with the Delta variant now spreading rapidly. That 60 percent number is fantastic if you consider how deep the institutional distrust in the United States is, particularly with one party stoking it. Convincing that other 40 percent is likely going to be hard and take a while. It will help that Republican elites have shifted recently to encouraging people to take the vaccines. The rising Delta cases and hospitalizations is likely to push some people towards vaccinations simply out of fear. It will be useful if government and business mandates force some people to get vaccinated.
But that won’t do all the work---it’s likely that some conservative-leaning people, instead of following the guidance of Republican elites telling them to take the vaccine, will just start distrusting the pro-vaccine Republicans like they already distrusted everyone else. We will likely simply have to have months of public health officials going to areas with low vaccine rates and offering vaccines, even if only a few people take them each time. Those officials are to something extent trying to build not just trust in the vaccines, but a broader institutional trust.
2. You can probably help
Just based on what I know about who reads this newsletter, (college graduates, people with high levels of institutional trust, etc.), I am likely reaching a pro-vaccine bubble with a nearly 100 percent vaccination rate with this email. But your social circle is not just your coworkers or your neighbors. The people who follow you on Twitter are probably also in the pro-vaccine bubble, but perhaps not your friends from high school or where you grew up who follow you on Facebook. Someone you see at a family reunion might not have been vaccinated. And if you run a company, you should require people to be vaccinated, for their safety and yours, and offer paid time for them to get the shot and to recover from it, for their wallet and yours.
This is an occasional newsletter on policy, government and elections in Louisville and Kentucky. You can sign up for future editions here.