This essay was adapted from Donald Moynihan’s newsletter, Can We Still Govern? Subscribe here.
For at least a year now, there has been strong but largely circumstantial evidence that right-wing anti-vaccine rhetoric was having deadly consequences in the United States.
Despite early wide-scale access to COVID-19 vaccines, the U.S. has outstripped its peer countries when it comes to the all-important measure of mortality known as “excess deaths.” Meanwhile, U.S. life expectancy has continued to drop dramatically due to the coronavirus even as longevity measures have begun rebounding elsewhere.
One seemingly obvious explanation for this grim piece of American exceptionalism is that Republicans, egged on by right-wing political and media elites, have been avoiding simple public health measures to protect themselves like getting vaccinated, and dying at elevated rates as a result.
This problem wasn’t exactly hard to pick up on just by paying attention to social media or reading the news. But the story appeared to be borne out by more careful data analyses, too. Some of the key clues:
• When it comes to the public’s beliefs about the pandemic, such as whether there should be more or fewer COVID restrictions, the gap between left- and right-leaning voters has been much higher in the U.S. than elsewhere.
• COVID cases and deaths are higher in more Republican counties.
• Republicans are more likely to believe misinformation about vaccines.
• Republicans are substantially less likely to get vaccinated.
• Researchers have found that exposure to conservative media, particularly Fox News, made people more vaccine hesitant.
This body of evidence had some limitations, though. For instance, the fact that red counties tended to have higher death rates than blue ones might not mean that conservatives were more likely to die from COVID if lots of Democrats who happened to live in right-wing parts of the country were perishing too. Or, if more Republicans were dying, it might also be because they were different from Democrats in ways that affect COVID outcomes but were not directly driven by ideology. They might just be older, in worse health, or in a community with poorer health resources, for example.
Recently, however, a new working paper by three Yale public health and economics researchers—Jacob Wallace, Paul Goldsmith-Pinkham, and Jason Schwartz—is offering the most definitive and direct evidence I’ve seen yet confirming that Republicans have indeed been more likely to die because of COVID. The study, released by the National Bureau of Economic Research, also confirms the scale of these deaths and points to the central role vaccine hesitancy has likely played in the tragedy.
Much prior work on this topic relied either on surveys of beliefs or evidence about vaccination rates and deaths at the county level. The new paper, in contrast, uses information from voter registration files in Florida and Ohio to connect individual-level data on the political affiliation and age of people who died during the coronavirus crisis. Using this information, it calculates and compares excess death rates of Republicans and Democrats in 2020 and 2021—meaning it looks at how many more people in each party died during the pandemic above what you would ordinarily expect based on their demographics and historical trends. Because they’re using a measure that takes the age of population into account, the researchers’ results shouldn’t be affected by the fact that Republicans tend to be a little older than Democrats.
Technically, excess deaths measure how many additional people have passed away from all causes, rather than just COVID. But public health experts like to use them to track the virus’s toll because causes of death aren’t reported uniformly everywhere, and it avoids the issue of whether coronavirus fatalities are under-recorded in some places but not others. (In studies like this one, it also spares researchers the task of tracking down how each individual died, which isn’t feasible.) It’s a standard and sound approach—unless you think something else besides the global pandemic has been causing a big spike in deaths over the past couple years.
So, what did the authors discover? “Overall, the excess death rate for Republicans was 5.4 percentage points, or 76 percent, higher than the excess death rate for Democrats.”
The figure below illustrates the key finding of the paper: It shows a spike in excess deaths around the time of the pandemic, and then a growing difference between Republicans and Democrats in the rate of excess deaths.
Crucially, the graphs also show the gap between Democrats and Republicans turned noticeable only after vaccines became widely available. In other words, absent the vaccines, the effect of partisan ideology was not very large. But once people could choose to protect themselves with a shot, Republican and Democratic outcomes diverged.
The figure below reiterates this point. Before vaccine availability, excess deaths are similar for Democrats and Republicans. After vaccines become available, the two groups separate: The excess death rate gap between Republicans and Democrats increases from 1.6 percentage points to 10.4 percentage points.
The paper does have a few limitations. First, it’s still a draft that has yet to go through peer review. However, NBER working papers tend to be high-quality, and absent some glaring data error, it’s hard to see the key findings being reversed. Second, it only uses data from two states, Florida and Ohio; in theory, it is possible that death patterns in the rest of the country are different (though it’s not immediately obvious why that would be the case).
Most crucially, the study also does not include data on whether individuals who died were vaccinated. As a result, the authors cannot quite prove beyond any shadow of a doubt that COVID was deadlier for Republicans specifically because fewer of them chose to be inoculated against it.
But, combined with what we know from other sources, the paper certainly points very, very strongly toward that conclusion. After all, why else would the death gap between Democrats and Republicans only have opened up after vaccines became available to the public? Notably, in counties with the very highest vaccination rates, the study’s authors find almost no difference in excess deaths between Republicans and Democrats. One plausible, if ever so slightly speculative, interpretation of this finding is that in places where conservatives acted more like liberals and actually got their shots, they were less likely to die.
As the authors write, their overall “results suggest that the well-documented differences in vaccination attitudes and reported uptake between Republicans and Democrats have already had serious consequences for the severity and trajectory of the pandemic in the United States.”
Now about the political implications of all this.
The U.S. government’s response to COVID was far from perfect and deserves to be scrutinized. But public health is a coproduction between a country’s citizens and government, which relies on ordinary people to follow official guidance. Most other developed countries did a lot better with that task than the United States.
At this point, it seems safe to say that one of the key reasons why the U.S. failed where other countries succeeded is because right-wing leaders and media sought to sabotage the effort—in particular by casting doubt on the effectiveness and safety of vaccines.
After all, vaccine hesitancy was a fringe position before the pandemic, found both on the left and the right. It only became mainstreamed as a conservative view during the pandemic.
Once Joe Biden became president, Republicans amplified the claims that vaccines posed a threat to freedom and aligned themselves with anti-vaccine activists. In some cases, state lawmakers discouraged outreach efforts. And as Matt Gertz of Media Matters has documented, the right-wing campaign against vaccines is still ongoing. Fox News is still raising doubts about vaccinations because, as one insider told the Daily Beast last year, “it’s great for ratings.” The midterms haven’t forced the most prominent vaccine-skeptical politicians to change their tune, either. Wisconsin Sen. Ron Johnson has pushed doubts about the shots despite being up for reelection in November.
Indeed, embracing vaccines has become politically risky. One of the Trump administration’s most positive achievements was in pushing for rapid vaccine development. But Donald Trump himself has struggled to take credit. When he mentioned he got a booster shot at one of his rallies, he was booed. It turns out that when you plant the seed of anti-science doubt—recall Trump giving credence to the false claim that vaccines cause autism—it is hard to reap the benefits of science.
The fact that an audience full of Republicans was ready to boo Donald Trump, of all people, for saying a kind word about vaccines brings up one hard-to-answer question. Did Republican voters turn against vaccines because their favorite politicians and talking heads told them to? Or did Republican politicians and talking heads turn against vaccines because that’s what their audience already wanted to hear?
In all likelihood, the answer is a bit of both. One way to think about this issue is to look at how liberals versus conservatives differed in public health attitudes around the world. What we find is that conservatives are indeed more skeptical about public health measures than liberals in lots of countries. But the gap between liberals and conservatives is much larger in the U.S. There is also some evidence that Republican voters were more attentive to partisan cues about the pandemic than their Democratic peers. In the end, the rhetoric of Republican elites and the appetite for it from voters probably created a terrible feedback loop.
Even if we believe that right-wing elites were merely responding to, rather than cultivating, the preferences of their audiences, this hardly absolves them of blame. People in positions of power and trust raised questions about vaccines while protecting themselves by making sure to get their shots. By lumping vaccines into their steady stream of fear-based political messaging—about the dangers of immigrants, “critical race theory,” or crime—they were the ones actually putting their own supporters at mortal risk. Just imagine the segment on Tucker Carlson if Democrats did something similar to their own voters.
The people who encouraged vaccine hesitancy probably won’t face any sort of reckoning for the role they played. But we need to be honest about the reasons why these deaths happened. Right-wing elites made a choice to engage in rhetoric and feed conspiracies. Some may have truly believed their own words. Some did it for votes and ratings. The consequences for their supporters were deadly.