The Success of Top-Down Simplicity
In the early weeks of Covid-19 vaccinations, the shining examples of success were all places with politically conservative leaders. Globally, the countries with the largest share of vaccinated people were Britain, Israel and the United Arab Emirates. In the U.S., the states that got off to the fastest starts were Alaska and West Virginia.
This pattern made me wonder whether many progressive-led governments were spending so much effort designing fair-seeming processes that they were failing at the most basic goal of a mass vaccination program: getting shots into arms. That error has held down vaccination rates across much of continental Europe. And it appeared to be an early problem in California and New York.
But it has not turned out to be much of an issue in the U.S. Instead, the states with the highest vaccination rates are now mostly Democratic-leaning, and the states with the lowest rates are deeply conservative.
“The parts of the U.S. that are excelling and those that are struggling with vaccinations are starting to look like the nation’s political map: deeply divided between red and blue states,” Russ Bynum of The Associated Press wrote this week.
Why? There seem to be two main reasons.
1. The party of government
Democrats believe more strongly than Republicans in the power of government. Compare, for example, the chaos of the Trump administration’s virus response to the Biden administration’s. Democrats’ belief in the power of government certainly doesn’t ensure they will manage it competently, but it may improve the odds.
In the most successful state programs, one theme is what you might call centralized simplicity. In Connecticut, Gov. Ned Lamont gave priority to older residents, including people in their 50s, rather than creating an intricate list of medical conditions and job categories that qualified people for shots (and that more privileged families often figure out how to game).
In New Mexico — which has the country’s highest rate of fully vaccinated people, despite also having a high poverty rate — Gov. Michelle Lujan Grisham has overseen the creation of a centralized sign-up system. The state has one vaccine portal that all residents can use to sign up for shots, rather than the piecemeal, confusing systems in many other states, my colleague Simon Romero reports from Albuquerque.
South Dakota, the red state with the highest share of vaccinated residents, has also taken a centralized approach, NPR’s Ailsa Chang points out.
2. Vaccine skepticism
Vaccine hesitancy has declined substantially, polls show. But it is still notably high among registered Republicans.
Hesitancy is also somewhat higher among Black Americans than white or Hispanic Americans — and the south has a large Black population. “Most of the states where vaccination rates are lowest happen to be ones where the Black population is high and where the percentage who graduated from college was low,” CNN’s Harry Enten writes, “while the reverse is true in the states with high vaccination rates.”
Dr. Vernon Rayford, an internal medicine doctor in Tupelo, Miss., told The Times that he had noticed a difference in the sources of skepticism. White skeptics often express a general distrust of government. Black skeptics are particularly mistrustful of the medical system, which has a long history of giving them substandard care — and even outright harmful treatments.
Across much of Mississippi — the state with the smallest share of residents to have received a shot — vaccine appointments are going unfilled largely because of a lack of demand. Two big reasons for the skepticism, Dr. Brian Castrucci, a public health expert, told The Times’s Andrew Jacobs, are misinformation on social media and mixed messages from Republican governors about the urgency of vaccination.
“It’s time to do the heavy lifting needed to overcome the hesitancy we’re encountering,” said Dr. Obie McNair, an internal medicine physician in Jackson.
And the effects?
Vaccine rates still are not high enough — in any state — to have ended the pandemic. In Connecticut and New Mexico, combined, about 11 people have died on a typical recent day. But that toll has fallen more than 80 percent since mid-January, even more than in the rest of the country.
“I think we’re going to break the back of this thing,” Lamont, Connecticut’s governor, said last week.
Despite dire predictions, the number of suicides fell by 5 percent last year, although the decline appears to have been concentrated among white Americans.
India recorded more than 200,000 new infections yesterday. Workers are fleeing cities, potentially carrying the outbreak to rural areas less equipped to handle it.
If you have questions about how the Covid vaccines work against virus variants, here are some answers (and the outlook is hopeful).
Virus resources: Global Maps & Cases | Global vaccinations | Vaccine Q & A
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Lalena Fisher, Claire Moses, Ian Prasad Philbrick, Tom Wright-Piersanti and Sanam Yar contributed to The Morning. You can reach the team at [email protected].
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