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The South’s Resistance to Vaccination Is Not As Incomprehensible As It Seems

The psychological forces driving “red COVID” have deep historical roots.

A person in PPE opens the back doors to an ambulance in the dark.
An EMS medic prepares to transport a COVID-19 patient to a hospital on Aug. 24 in Houston. John Moore/Getty Images

On Monday, David Leonhardt’s morning newsletter for the New York Times introduced a grim new term into our pandemic vocabularies: “Red COVID.” The partisan gap in the effects of the pandemic, the newsletter explained, had widened. “Every reliably blue state now has a higher vaccination rate than almost every reliably red state,” Leonhardt wrote. Some of the red dots on the Times’ chart of states with low vaccination rates are not in the South—Wyoming, for example. But most of them are: Texas, Florida, Kentucky, Mississippi. After a late summer and early fall where the delta variant hit the former Confederacy hard, generating awful news stories from hospitals in Mississippi and Florida, it seems like “Red COVID” is also, mostly, “Southern COVID.”

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In light of this, a thought experiment by Angie Maxwell, a professor of political science and director of the Diane Blair Center of Southern Politics and Society at the University of Arkansas, has been on my mind. In her book The Indicted South: Public Criticism, Southern Inferiority, and the Politics of Whiteness, Maxwell, through a provocative analysis of Southern history and psychology, explores the idea that the white South has a collective “inferiority complex” that explains its very specific tendency toward backlash.

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Can this idea help explain the low vaccination rates in the South and the disastrous way COVID has played out in the region? Is there anything we could learn from this history about how to encourage vaccination without further triggering the reaction of retreat and retrenchment that Maxwell describes playing out other times when the South has become the focus of intense critique?

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I asked Maxwell to explain. Our conversation has been edited and condensed for clarity.

Rebecca Onion: What’s the idea behind your argument about a white Southern inferiority complex? Where do you see the dynamic of criticism and retrenchment, over the years?

Angie Maxwell: The phrase inferiority complex was coined by the psychoanalyst Alfred Adler in the early 20th  century. He said that we all feel a sense of inferiority sometimes, but for that to develop into a “complex,” there have to be a couple of elements: a consciousness that you are deemed inferior, which comes at some kind of moment when you realize, “People think I am less than.” Then there are some environmental conditions that make that person who has that moment of realization more likely to develop a “complex”: lack of education, poverty, authoritarian religion. In the wider South, as a region, all three of those environmental conditions are prevalent. That moment of public consciousness, in this case, often looks like public criticism—times when there’s been intense scrutiny of the region.

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In writing this history I looked at a few of those moments, then looked at what the result of that public criticism was. Adler explains that individuals that develop an inferiority complex usually respond with one of three different compensations. First, they might deem someone else inferior. Second, they change the rules by which they are deemed inferior. Third, they retreat or escape from the society or institution or community that’s deemed them inferior.

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I argued that the whole experience of white Southerners is this cycle of criticism, then backlash and entrenchment, or changing the rules. This pattern might help us understand the resistance to change, defensiveness, and reflex to turn toward privatization that has dominated white Southern culture in the last 120 years.

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Can you describe one example of what that resistance might have looked like, in one of your histories?

In the 1925 Scopes trial, the state of Tennessee had passed the Butler Act, which banned the teaching of evolution in public schools. The ACLU looked for a test case to challenge this, and some community leaders in the town of Dayton, Tennessee, decided it could be a big publicity stunt for the community—to bring interest in a community that was kind of dying off. So they got John Scopes, the football coach and science teacher, to use a textbook with evolution in it, in school, to be the test case.

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What people thinking of the Scopes trial today don’t realize is how intense the public scrutiny was, of the region, during the trial. Telegraph wire was laid across the country to cover the trial live. It was on the front page of the New York Times, the L.A. Times, international newspapers like the London Times. Clarence Darrow, the most famous defense attorney in the country, came to defend Scopes, and William Jennings Bryan, the populist leader and former secretary of state under Woodrow Wilson, and three-time candidate for president, came to aid the prosecution. This was a celebrity trial.

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The scrutiny took on an especially biting tone for two reasons. One, H.L. Mencken, the famous writer and journalist at that time for the Baltimore Sun, came to cover the trial, and he had a long history of just excoriating the South.

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You cite this South-hating Mencken quote, from 1917: “If the whole of the late Confederacy were to be engulfed by a tidal wave tomorrow, the effect upon the civilized minority of men in the world would be but little greater than that of a flood on the Yang-tse-kiang. It would be impossible in all history to match so complete a drying-up of a civilization.”

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Yes! When he was covering the trial, Mencken visited a Pentecostal church outside of Dayton and wrote about all the people there speaking in tongues and everything, a few days before the trial. And really wrote it up as This place is fundamentally crazy. He didn’t stay for the whole trial, but he set the tone for the media coverage. The New Republic had [the headline] “Tennessee vs. Civilization.” Part of the dynamic was that journalists outside of the South who resented the international attention wanted to make clear that this wasn’t an American problem—this was a Southern problem.

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It’s not that the criticism was entirely unfair. But Dayton was not an overtly religious community. It had diversity in its denominations: Episcopal Church, Baptist Church. The speaking-in-tongues, extreme kind of religion was a tiny demographic. And again—this whole thing was set up as a publicity stunt to bring in spectators and money.

At the end of the trial, Scopes was found guilty, which was sort of what his side wanted, because they wanted to appeal. But Clarence Darrow called William Jennings Bryan to the stand, and Bryan testified on the literal truth of the Bible, how Jonah survived inside the whale, and so on. After hours on the stand, he mentioned the idea that the seven days of creation could be interpreted as different time periods, and Darrow seized on that, and said Oh, this could be any kind of time period? Not a 24-hour day? So this was the moment the media covering the trial basically said, This is the gotcha. Civilization and science are victorious.

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But a few days later, Bryan, who was devastated that he didn’t get to redeem himself in his closing argument, since the defense moved for an immediate verdict, literally died. Just a few days later!

All of that, the intense scrutiny and the extreme circumstances, basically resulted in a movement for private religious education. There was an organization that decided they wanted to create a memorial to William Jennings Bryan, and they built a private Christian university called William Jennings Bryan College, in Dayton. It opened its doors five years later, in 1930, and took off, became a model for private Christian higher education. The anti-evolution movement was no longer about majoritarianism, winning the passage of legislation to ban the teaching of evolution in public schools; it became about creating an entirely separate world of private higher education.

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And that’s an example of what can happen when you’re deemed inferior, and you recognize it. This is about the desire to retreat from the public battle, into kind of a private space where you can do whatever you want to do. We see that pattern, also, right after Brown v. Board: just privatize, so you won’t be judged.

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These aren’t in your case studies, but since we are talking about Southern public health, I’m curious about hookworm and pellagra, which were two diseases that were acute in the South before they were controlled in the middle of the 20th century. Was there a similar dynamic there—Northern critique, Southern rejection?  

I did look at how Eleanor Roosevelt, who had a column called “My Day” that was syndicated across the country, wrote about a trip to the South in 1950, and in her column she really criticized the region for all of its disease, its lack of public health. And a radio host from those days named W.E. Debnam wrote a response to her and published it, and it sold almost 140,000 copies. It was called—get this—Weep No More, My Lady: A Southerner Answers Mrs. Roosevelt’s Report on the “Poor and Unhappy South.” In it, Debnam blamed Reconstruction, and what it did to the South, for how the South was, in 1950.

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Reconstruction is a huge reference point for all of this. The whole idea that the South, unique among regions, had had Union troops occupying it, forcing white Southerners to let freedmen vote and become senators and state representatives … this stripped the South of its social hierarchy, in the biggest social, political, and economic shift in American history, for the little over a decade that it lasted.

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To Black people in the South, it felt like the most shocking, wonderful turn—America is what it says it is! To white Southerners, the outcome of their formerly enslaved workers becoming their senators was not even in their imagination, before they lost the war. It felt like sci-fi apocalypse, to them. It felt like the ultimate public criticism.

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OK, we went all the way back in time, and now let’s come back forward to COVID. The delta variant has hit the South, and the rest of “red America,” a lot harder than other places. Do you think the South’s relative refusal to vaccinate, while the criticism from blue states and the North has gotten incredibly intense, can fit into the pattern you’ve identified: Northern criticism, Southern retrenchment?

People have been talking a lot about partisanship in vaccine resistance. But there are 60 percent of Republicans that have been vaccinated, right? Not 10 percent! 60 percent! So it’s not just partisanship. There are demographic reasons why groups are resistant to the vaccine, but I think there are also historical and kind of cosmological reasons that account for why most of the states with the lowest vaccination rate seem to be falling—well, the majority of them—below the Mason-Dixon Line.

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Lower incomes, lower education levels are unvaccinated at higher rates. Those things are true in the South, and the circumstances fit, but in the South there is also the historical lack of access to health care, because a lot of the South is rural and poor. There’s a lack of access to doctors, a lack of health insurance, a lack of a concept of preventive health care. All of those numbers lag in the South. Look at how the population of older folks in the South who’ve gotten the vaccine is much higher. Part of that is because elderly people are dying at higher rates; it’s also because they have Medicare and have regular doctors.

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The other thing is a strong belief in prayer—God will protect, you’re going to die from something, the rewards of heaven are not to be feared. Then of course there’s just plain racism and othering of other races and ethnicities, because for a while when COVID started, there was such a significantly higher death rate and hospitalization rate for nonwhite people, and in blue states. The initial notion was, This just isn’t as hard on white people and doesn’t exist in red states.

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When it comes to the inferiority complex idea, and how that can account for some of this hesitancy and resistance, what I see is a territorial kind of thinking—not among all white Southerners but among a portion that’s maybe not as educated or that lives in super homogenous communities—that resorts to conspiratorial thinking to deal with the COVID issue. This is one of the compensations to an inferiority complex. You change the rules: These people recommending the vaccine don’t know what’s really going on. You’re smarter, you have more information, you have inside information. You’re not the dumb one, they’re the dumb ones. This can be very powerful to a population that feels criticized a lot of the time.

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The realization that this dynamic of public critique and resistance has a deep history has me feeling even less hopeful about vaccination rates rising in the South. What do you think can be done, if anything, to break into this vicious cycle and get more people vaccinated?

There are two things that I’d recommend, being aware of the role public criticism and ridicule plays, and the defensive compensations that come with it. The first thing is: internal messengers, who could lean into the con and give an explanation as to why it makes sense to get the vaccine now. Saying something that gives people a way out, to save face: The old COVID wasn’t really that bad, even though they told us it was, and back then I wouldn’t have done it either. But this new delta, it’s hitting young people hard. Something to make it OK for people to show up and say, OK, now I think it’s the right thing to do.

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The other thing is mandates. I don’t usually like government mandates. I think they should be rare. But I feel like a mandate in this case is a way for people to save themselves. A lot of these people are marks of a con, and a mandate, as much as they may hate you for it, could very well save their life, and save the lives of others. In the South, there are some things the government has had to force to make happen. There’s a backlash to that, a resentment, which is why I say that the mandates should be rare. But on something like this, where it affects other people … Mandates are the way.

There will be a political backlash; there will be a price to pay. But it’s worth it.

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