The Morning Jolt

Health Care

America’s Vaccine-Hesitant Demographics

A man receives his second dose of a coronavirus vaccine at the Chief Andrew Isaac Health Center in Fairbanks, Alaska, March 30, 2021. (Nathan Howard/Reuters)

On the menu today: a deep dive into why the two key demographics of Americans who are particularly hesitant or reluctant to get vaccinated against COVID-19 are White Republican men and African Americans, and why, gradually, that skepticism appears to be eroding.

White GOP Men and African Americans: The Two Lingering Vaccination Holdouts

There are two key demographics of Americans who are particularly hesitant or reluctant to get vaccinated against COVID-19: White Republican men and African Americans.

Different polls will give you slightly different results, but the trend is generally consistent; some polls sort out respondents by political party but not by race, and vice versa. But generally speaking, African Americans are gradually growing more enthusiastic, with 55 percent telling the Kaiser Family Foundation last month that they already had been vaccinated or were interested in getting vaccinated, compared to 64 percent of whites and 61 percent of Latinos who said the same thing. Fifteen percent of whites, 10 percent of blacks, and 8 percent of Hispanics said they would definitely not get vaccinated.

But when the sample was sorted by political party, only 46 percent of Republicans already had been vaccinated or were interested in getting vaccinated, compared to 79 percent of Democrats and 57 percent of independents. The survey found that 25 to 29 percent of self-identified Republicans said they refuse to get the vaccine. Still, the numbers for vaccine willingness and enthusiasm appear to be gradually improving among all demographics.

(We should pause to point out that there is a small group of people who should not receive the COVID-19 vaccine, which is people who know they have a strong allergic reaction to one or more of the ingredients. The FDA recommends that anyone who had a severe allergic reaction to the first dose should not get the second dose. As usual, if you have questions, ask your doctor, not a political morning newsletter. Not only am I not a doctor, I also don’t play one on TV.)

Another point to keep in mind: the terms “vaccine hesitant” and “anti-vax” are not synonyms.

“They’re separate from vaccine hesitant [people],” says science journalist Melinda Wenner Moyer, who has written about vaccines and vaccine hesitancy for the New York Times. She describes anti-vaxxers as “people who are doggedly sharing misinformation and trying to convince other people that vaccines aren’t safe. But most people are not that. Most people are somewhere along this spectrum of maybe just having one question that makes them a little bit uncomfortable until they have the question answered.”

This morning, the New York Times looks at the more than 73,000 available vaccination-appointment slots in the state of Mississippi and focuses on the wariness among two groups of Americans:

A closer look at Mississippi’s demographics explains why hesitancy may be especially pronounced. The state reliably votes Republican, a group that remains highly skeptical of the coronavirus vaccine. Nearly half of all Republican men and 40 percent of Republicans over all have said they do not plan to get vaccinated, according to several recent surveys. Those figures have barely budged in the months since vaccines first became available. By contrast, just 4 percent of Democrats have said they will not get the vaccine.

Another factor in the state’s low vaccination rate may be Mississippi’s large Black community, which comprises 38 percent of the state’s population but accounts for 31 percent of the doses administered, according to state data. Vaccine hesitancy remains somewhat high among African-Americans, though the doubts and distrust — tied largely to past government malfeasance like the notorious Tuskegee syphilis experiments — have markedly declined in recent months.

Now take a look at the states that rank at the bottom in the nation in terms of percentage of the population that has received one shot: Mississippi, Alabama, Georgia, Tennessee, Louisiana, Indiana, Idaho, Wyoming, Missouri, Arkansas, and Texas.

What are those states full of? White Republican men and African Americans.

At the start of the month, Jim Henson and Joshua Blank of the Texas Politics Project at the University of Texas at Austin took a deeper dive into the numbers in their state:

More Republicans than Democrats did express hesitancy or outright refusal to get a COVID vaccine, but 1 in 4 Texas Democrats (27 percent) also expressed reluctance in a recent University of Texas/Texas Tribune poll. This is representative of a broader underlying problem: Skepticism about vaccines exists among a broad array of Texans.

Texans who view the coronavirus as less than a “significant crisis,” as indicated in previous polls, are unsurprisingly more likely to express hesitancy about getting vaccinated. Although Texas Republicans make up a large share of this group, it is by no means an exclusively Republican group. More than 1 in 4 voters who don’t view the virus as a significant crisis identify as Democrats or political independents.

A relatively high degree of reluctance to obtain the vaccine among Black Americans has already been widely noted and continues to be aggressively addressed by Black opinion leaders and public health officials. Texas is no exception. African Americans, a largely Democratic group, do appear to be less inclined than white Texans to say that they will definitely get a COVID vaccine: 38 percent of white Texans say they will do so, but only 28 percent of Black Texans.

It is safe to say that white Republican men and African Americans, generally speaking, are usually on the opposite sites of issues. And yet, both exhibit considerable skepticism of official authorities, for different reasons. (You may recall back in 2016, Tom Hanks appeared on Saturday Night Live as a Trump supporter appearing on “Black Jeopardy,” and the joke was how frequently his character agreed with the black contestants — in one case refusing to put his thumb print on his iPhone. “That’s how they get you. I read that goes straight to the government.”)

For people who see everything through a partisan lens, this represents a quandary. If you think vaccination against COVID-19 is a good and necessary thing, and reluctance or refusal to get the vaccine represents unreasonable paranoia that disregards extensive trial testing, and/or a nonchalance about the health threat that COVID-19 poses, then the skepticism of both groups should be equally troubling. In the end, someone eligible to be vaccinated who refuses is just another unvaccinated potential patient or carrier; the virus doesn’t care about the color of someone’s skin or the reasoning behind why they refused the vaccine.

And yet a lot of people are invested in narratives where either white Republican men or African Americans are the heroes of the story, and everyone on the other side must be a villain. Thus, one side’s vaccine skepticism must be understandable and reasonable, and the other side’s vaccine skepticism must be baseless paranoia and ignorance.

Kali Halloway wrote an essay in the Daily Beast entitled, “Forget Black Vaccine Hesitancy — Worry About White Resistance“:

Black Americans’ justifiable suspicion of this or any vaccine can be traced to white supremacist medical terror including J. Marion Sims’ horrific gynecological experiments on enslaved Black women, the Tuskegee Trials, forced sterilizations of Black women, the current epidemic of unnecessary Black limb amputations, staggering levels of Black maternal mortality and ongoing unwillingness of the medical profession to properly address Black pain, among numerous other reasons.

The reasons floated for white Republican refusal to get vaccinated — a choice that will make herd immunity almost impossible and particularly imperils the health of vulnerable Black and brown communities — are both myriad and misinformation-based.

But I concur with this assessment from Elizabeth Yuko in Rolling Stone, that the common narrative that “it’s because of Tuskegee” feels pretty oversimplistic:

Much of the media coverage on African Americans and the Covid vaccine so far . . . [singles] out the entire demographic as being particularly vaccine hesitant. Typically, this assertion is explained with a quick reference to the U.S. Public Health Service (USPHS) Study of Untreated Syphilis in the Negro Male in Macon County, Alabama. Better known as the Tuskegee Syphilis Study — or simply “Tuskegee” — this research took place from 1932 to 1972 and involved the grossly unethical act of withholding treatment from approximately 600 African American male participants.

And while that may make for a tidy timeline of medical mistrust among Black Americans, it leaves out too much of the story. “The challenge I see with this narrative — and its continuation — is that it’s very myopic,” says Dr. Lisa Fitzpatrick, an infectious diseases physician and CDC-trained medical epidemiologist based in Washington, D.C. “It doesn’t talk about the breadth and depth of the issues facing people. It’s such an oversimplification.”

Reality is far more complex. It involves recognizing that Black Americans are not a homogenous population with a single, shared viewpoint; in which all members base their medical decisions in 2021 on a study that ended nearly half a century ago. It also requires understanding that medical mistrust — including vaccine hesitancy — is the result of ongoing, present-day health disparities, not exclusively historical medical mistreatment.

African-American distrust of the medical system probably reflects, in part, that they see and encounter doctors less frequently on average. In 2018, a Kaiser Family Foundation survey found that 20 percent of black Americans did not have a regular source of care besides the emergency room when they’re sick, compared to 14 percent of whites, 15 percent of Asians, and 26 percent of Hispanics. As of 2019, 11.4 percent of black Americans did not have health insurance, compared to 7.8 percent of whites, 20 percent of Hispanics, and 7.4 percent of Asians.

If you don’t have insurance, you’re not likely to see a doctor regularly. If you don’t see a doctor regularly, you’re probably less likely to develop a trusted relationship with a medical professional to whom you can go with questions and concerns. And if you don’t have a professional to whom you can go with questions and concerns, the medical community probably seems like this distant, opaque authority — and that’s all separate from high-profile public-health experts who seem to change their advice suddenly and with little explanation.

One other wrinkle worth mentioning: Several times last fall, Kamala Harris indicated that she would be doubtful of any coronavirus vaccine that Donald Trump said was safe. In the vice-presidential debate, Harris said, “If the public-health professionals, if Dr. Fauci, if the doctors tell us that we should take it, I’ll be the first in line to take it. Absolutely. But if Donald Trump tells us that we should take it, I’m not taking it.” And after her comments, vaccine skepticism increased among Democrats and dropped among Republicans: “From late August to now, the percentage of Democrats willing to take the vaccine has dropped from 78 percent to 53 percent. In the same time period, the percentage of Republicans willing to take the vaccine increased from 37 percent to 49 percent. The percentage of self-identified independents willing to take the vaccine declined from 59 percent to 47 percent.”

Harris may well have intended to only promote skepticism of a vaccine that was touted by Trump alone and no other public-health professionals. But that’s not necessarily how everyone in the general public interpreted her remarks. They may have walked away with the conclusion, “She’s saying you can’t trust the vaccine,” even if Harris didn’t intend to send that message. You would think Harris’s vaccination would help dispel that skepticism among African Americans. But you would also figure Trump’s would dispel skepticism among GOP men.

Also, whether or not it ties into vaccine skepticism, a lower vaccination rate among African Americans is probably connected to the complicated and generally lousy process for getting an appointment, particularly in the earliest stages of the vaccine rollout. Almost every state began by making their vaccine-appointment-registration process Internet-based — which required the initial target demographic of senior citizens to jump through all kinds of hoops on websites that were often glitchy and crashing. As of 2019, 82 percent of whites reported owning a desktop or laptop computer, compared with 58 percent of blacks and 57 percent of Hispanics. About 80 percent of whites, blacks, and Hispanics own a smartphone.

If your distribution system more or less overlooks and ignores a particular demographic, it would not be surprising if members of that demographic don’t trust the distribution system, the people running the system, or what the system is distributing.

ADDENDUM: Luke Thompson sorts through the sordid rise and fall of the Lincoln Project:

Many observers view the Lincoln Project as a study in doing politics in our digital age. Its founders were prolific tweeters, and the organization’s fundraising spiked in the wake of a presidential tweet. Yet for all its ostensible online savvy, for all the millions of social-media followers gleaned by its members, and for all the millions of dollars it raised online, the Lincoln Project was from birth to death a product of television. The primary validator and exponent of the group, the entity that blessed its mission and created its audience, remained Morning Joe. As soon as the Lincoln Project lost access to television, it began to wither and die.


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