Have We Gotten Vaccine Hesitancy All Wrong?

By Noah Rothman

Friday, March 12, 2021

 

Joe Biden “projects hope.” That was the almost uniform impression the press took away from the president’s televised national address on Thursday following the passage of a behemoth COVID relief bill. If you missed all the hope the president was attempting to convey, that’s only because it was buried under the mournful expressions of grief over the losses we’ve all experienced in the last twelve months and the admonitions that everything could still get much worse.

 

If there were signs of optimism in Biden’s speech worthy of celebrating, they were in the extent to which he was willing to admit that his benchmarks for emerging from the pandemic were overcautious.

 

“When I came into office, you may recall I set a goal that many of you said was kind of way over the top,” Biden said of his pledge to seek 100 million doses by mid-April. It’s unclear who “you” refers to here. Honest observers noted at the time that 100 million doses in 100 days was the trajectory that the nation was already on by Inauguration Day, and we’re likely to achieve that objective by this weekend.

 

Biden further said that he hopes to reach the point at which it’s possible to safely gather in your back yard with close family by July 4 of this year—revising his earlier estimates that we would approach the outer orbit of normalcy by Christmas. If you’re inclined toward optimism, you can assume the White House will cautiously endorse and take credit for slightly larger gatherings by the summer when the evidence suggests that’s what people are doing already.

 

The Biden administration cannot acknowledge the world as it increasingly is, in part, because they are justifiably scared of it. “If we don’t stay vigilant,” the president warned, “we may have to reinstate restrictions to get back on track.” The advent of remarkably effective COVID vaccines is what will prevent that unfortunate outcome. As Biden implicitly acknowledged by advising the states to extend access to vaccines to all Americans of majority age by May 1, the challenges confronting mass vaccination will soon hinge more on demand than supply.

 

This is a matter that has vexed the press and the political class for a while, but the problem has always been discussed in demographic and partisan terms. And that may have been a terrible mistake.

 

For several months, pollsters and policymakers have warned of a pervasive vaccine hesitancy among African Americans. Both the administration and media outlets have been quick to excuse this as an outgrowth of “historical experiences” in relation to the disparate and discriminatory conditions black Americans have endured in the health-care system.

 

With the inauguration of the Biden administration, however, that hesitancy became more pronounced among white poll respondents—typically Republican and evangelical voters. Suddenly, the public-policy community began to treat vaccination skepticism as a partisan issue rather than a racial one, and with far less sympathy.

 

But a new NPR/PBS NewsHour/Marist poll released on Friday calls into question the framework we’ve applied in evaluating vaccine hesitancy across demographics.

 

That poll found “little difference in reluctance to take the coronavirus vaccine among Black and white people.” Specifically, it showed a statistically negligible distinction between the number of blacks and whites who want to be immunized or already were (73 and 70 percent respectively) and those who don’t plan on getting a shot (25 and 28 percent). And while self-described Republicans are less likely to say they want to be vaccinated, 56 percent of GOP voters in this survey say they want a shot and nearly a quarter insist they’ve already gotten one.

 

The more pronounced divides in this survey aren’t racial or even partisan but geographic.

 

Compared with voters who live in either a big or small city or even the suburbs, respondents who lived in small towns or rural settings were more likely to express vaccine apathy. Residents of these more sparsely populated areas of the country were also more likely to say they had never even tried to make an appointment for vaccination.

 

If the phenomenon is more geographic than demographic, it would account for why more Republicans are disinclined toward vaccination just as much as the fact that Donald Trump is out of office. It would make sense that a whopping 40 percent of men without a four-year college degree don’t plan to get vaccinated—a demographic that tends to vote Republican and is overrepresented in rural America. And it would contextualize why rural America, unlike every other region of the country, prioritizes reopening the economy over politics that mitigate the virus’s spread by a staggering 59 to 34 percent.

 

It’s possible that this isn’t a function of ignorance or pathology among residents of small-town America but a perfectly logical personal risk assessment. The less dense your surroundings, the less threatening this virus may seem to you. Efforts to address this persistent hesitancy as though it was purely a function of racial proclivities have largely failed.

 

“Even when vaccine distribution centers are more evenly distributed, researchers find that communities of color are still missing out,” FiveThirtyEight’s Alex Samuels observed. “The fact that vaccine registration systems are largely online is partly to blame, as there is often a racial divide in who has reliable internet access.” That’s a logistical challenge—one that has roots in infinitely complex social conditions in which race is one of many factors. Likewise, stubborn tribal signaling surely contributes to the substantial minority of Republicans who proclaim that they will never get a COVID shot. If this poll is any indication, that, too, may be a logistical challenge predicated on an individual risk assessment.

 

All the standard caveats apply: It’s just one poll, and the breakdown of subsamples to the narrowest possible margins forces us to be cautious when citing the findings. But if this poll is accurate and race isn’t as indicative of views toward the vaccine as is geography, it leads us toward a number of intuitive conclusions and a more complex view of the world. Moreover, it’s a conundrum that cannot be addressed through comprehensive policy prescriptions or the self-satisfied scolding of holdouts.