On Monday, at least 2,181 Americans died from COVID-19. Over the past week, average daily COVID deaths in the United States have risen to 2,369 — the highest death rate the country has seen in nearly a year. Given the lag time between spiking cases and fatalities, it’s likely the deadliest days of the Omicron wave still lie ahead.
This is a catastrophe. Each individual COVID death sends ripples of woe through families and communities. Each condemns the bereaved to an infinity of sinking-stomach feelings that crop up without warning at the smallest invitation: when they drive past a restaurant their brother used to love or walk into a living room to find their wife’s chair empty. And yet, today, the tragedy inherent in any COVID wave is compounded by the present one’s singular preventability.
COVID-19 vaccines have been available to all American adults for nine months now. And although the initial two-dose vaccine regimen offers little protection against symptomatic infection from Omicron, it is still roughly 70 percent effective against hospitalization and provides even higher levels of protection against death. Recent data from Utah show that unvaccinated people in that state were more than 16 times more likely to die of COVID between mid-December and mid-January than the vaccinated were. Studies from the United Kingdom and Spain have yielded similar results.
The maddening truth of the present crisis is that the vast majority of COVID deaths in the U.S. today were easily preventable. In most of these cases, averting the loss of life merely required persuading individuals to secure a vaccine that was available at their local pharmacy or health clinic. Yet America has found this task exceptionally difficult.
According to the New York Times, only 63 percent of Americans are fully vaccinated (a status that, for now, does not require a booster shot, which provides greater protection against infection, hospitalization, and death). In Canada, that figure is 79 percent. In the U.K., it is 72 percent. In France — which has a robust anti-vaccine movement of its own — 76 percent of the population is vaccinated. Booster uptake in the U.S. has been even more abysmal; while 55 percent of Britons have received three shots, and 46 percent of the French have done the same, the share of boosted Americans is just 25 percent.
These disparities cannot be fully explained by America’s age structure. It is true that the U.S. is among the youngest of developed countries and that old people are more likely to get vaccinated than young people in virtually all nations. But Australia has an even lower median age than the U.S. and nevertheless boasts a “fully vaccinated” rate of nearly 80 percent.
Why then has the U.S. proved so exceptional in its resistance to vaccination? It is plausible that our nation’s aberrantly weak labor protections and exclusionary health-care system have contributed to the problem. As Julia Raifman and Aaron Sojourner have highlighted, low-income Americans are less likely to be vaccinated than higher-income Americans — and the unvaccinated poor are more open to receiving a shot than the unvaccinated rich.
Given that higher-income workers in the U.S. generally enjoy paid-leave benefits while lower-income workers are often both bereft of such benefits and more vulnerable to layoffs, it’s reasonable to suspect that, in an America where the government guaranteed all workers paid leave, vaccine uptake would be somewhat higher. Similarly, to the extent that poor Americans’ lower vaccination rate reflects their greater disconnection from or distrust in medical authorities, a universal health-care system might have lessened vaccine hesitancy. Data from Pew Research shows that exclusion from the health-care system correlates with vaccine hesitancy. As of August 2021, 75 percent of Americans with health insurance were vaccinated, compared with just 57 percent among the uninsured. In any case, robust labor rights and national health insurance are worthy policy objectives on the merits. And the Biden administration should certainly mobilize all available resources toward overcoming the remaining barriers to vaccine accessibility, whether rooted in income, job security, transit, language, or any other dimension of social marginalization.
Yet accessibility issues don’t seem to be the primary cause of undervaccination in the U.S. In the latest version of the Census Bureau survey cited by Raifman and Sojourner, only 1.7 percent of the unvaccinated said the reason they had not secured a shot was that it’s “hard for me to get a COVID-19 vaccine.” A similarly tiny fraction cited concerns about cost. Most expressed some variety of distrust in the vaccines’ safety.
This is consistent with most other polling on the issue. Last July, an Axios-Ipsos survey found that 63 percent of the unvaccinated would not be “at all likely” to get the vaccine, even if they were provided with paid time off to do so.
In a CNBC/Change Research poll from September, meanwhile, 84 percent of the unvaccinated said their decision to opt out of immunization would not change even if the vaccines had “no side effects.”
The bulk of vaccine resistance appears to be rooted in ideology. Specifically, the resistance seems to derive from an ideological distrust in the medical Establishment in general and vaccines in particular. This low-trust ideological inclination is not exclusive to the American right; as noted above, it’s plausible that this orientation is more prevalent among those excluded from the health-insurance system. Further, it seems likely that the American medical Establishment’s long history of abusing and failing Black Americans informs the relatively high prevalence of vaccine hesitancy in some Black communities.
But a good deal of vaccine resistance appears to be rooted in partisanship.
In Pew Research’s polling from last August, the partisan gap in vaccine uptake was even larger than the gaps between the old and young, or the highly educated and less educated.
The most unnerving discrepancy in that chart is probably the one between Republicans and Democrats in the 50-to-64-year-old range. Some combination of self-interest and insulation from social media has kept the vaccination rate among senior Republicans at a relatively robust 80 percent. But Americans over 50 are also at serious risk from COVID-19, and partisanship appears to be dissuading many such Americans from protecting themselves.
Meanwhile, as Charles Gaba has documented, there is now a tight correlation between a U.S. county’s COVID death rate and its level of support for Donald Trump in 2020. This was especially true during last year’s Delta wave.
But it’s already true of the Omicron wave as well, despite cases being more concentrated in “blue” parts of the country thus far.
Some progressives are reluctant to emphasize this dimension of the COVID crisis — and not without reason. It is good ethical practice to focus on problems one has some power to address. Progressive voters have the power to hector the Biden administration into improving its Omicron response, as the White House demonstrated when it expanded access to free at-home tests in response to public outcry. By contrast, blue Americans have few tools for influencing GOP lawmakers’ rhetoric about vaccines or Tucker Carlson’s editorial judgment.
Furthermore, for too many Democrats, the fact that much vaccine resistance is rooted in partisanship is taken as an argument for callous indifference to the fate of the unvaccinated. This is wrong for many reasons. Political attitudes are largely heritable; they derive, in most (though not all) cases, from the communities and circumstances we are helplessly born into. People who voted for Trump and watch Fox News are as human as anyone else. No one deserves to die alone from a preventable illness.
This is one reason it’s worth being clear-eyed about the causes of the winter’s unfolding calamity. The individuals who have cynically abetted anti-vaxx ideology on the right — those who have secured shots for themselves and their loved ones while nevertheless disseminating conspiratorial lies about vaccines for fun and profit — deserve national opprobrium.
It is possible the conservative media has been reflecting its core audience’s vaccine skepticism more than it has been creating that doubt. After all, Trump himself has repeatedly endorsed the vaccines, and this has failed to move a large minority of his supporters. If Fox News refused to air anti-vaxx commentary, it’s plausible that it would lose market share to Newsmax or some other right-wing network willing to endanger the lives of its viewers. Nevertheless, it is still a choice to privilege one’s ratings above public health.
Even if consumer demand drives the conservative media’s hostility to vaccination, that hostility can still poison the minds of the previously unconverted. Last year, a working paper from researchers at the Swiss university ETH Zürich drew a causal connection between Fox News viewership and vaccine skepticism. To control for other variables, the scholars exploited random divergences in the channel number assigned to Fox News in different markets (the lower a network’s channel number, the more people tend to watch it). They found that even when controlling for partisan affiliation, ideology, and a region’s public-health policies, more exposure to Fox News was associated with more resistance to vaccination.
Progressives should continue to pressure the Biden administration to correct the (many) deficiencies in its Omicron response, and everyone should push back on attempts to dehumanize Americans on the basis of their partisan affiliation or vaccine status. But we should acknowledge that thousands of Americans are going to die in the coming weeks because of the pathologies of their preferred political party and the perfidy of their trusted news sources. The cynics who are knowingly leading their followers into harm’s way are complicit in an atrocity. And that fact should be known by everyone.
