Americans' willingness to get a COVID-19 vaccine varies significantly by underlying partisan and ideological positioning. This is not surprising, given a great deal of evidence showing the ways in which partisanship and ideology serve as a lens through which Americans view much of the world around them. But it has significant implications for campaigns and communication strategies designed to increase vaccine uptake in the U.S. in the months ahead.
The way in which the public views the world and comes to judgment on issues and policies can be substantially different than the ways used by scientists and medical professionals. Although scientific experts have underlying worldviews, assumptions and paradigms, they have been trained to follow objective processes for evaluating evidence and arriving at and revising conclusions under the aegis of the scientific method, involving theory, hypotheses, data and constant revision. Thus, experts charged with increasing COVID-19 vaccination rates may assume that presenting scientific and medical information about the vaccine's efficacy and safety will be all that is needed to accomplish their objective.
But this is by no means a safe assumption. A particularly useful example comes from a look at Americans' assessments of the national economy. Objective economic measures -- parameters such as gross national product, unemployment, inflation, the stock market and growth -- are the same regardless of the observer's political persuasion. Yet Gallup currently finds that Republicans' and Republican-leaning independents' assessment of the economy as "excellent" or "good" is 48 percentage points higher than Democrats' and Democratic-leaning independents' view.
Further, the direction of this gap flips when a president of a different political party takes over the White House, much more so than would be expected based on changes in the actual economy. By February 2017, just after Donald Trump was inaugurated as president, Republicans' economic confidence had risen by 73 points from where it was in October 2016, just before the election. Democrats' fell by 23 points in the same period.
The economy is an issue about which, at least in theory, the public has access to readily understood, objective indicators. The public clearly either pays differential attention to the indicators that fit their political orientation, or just makes optimistic or pessimistic assumptions if their party's president is in office.
This brings us to the COVID-19 vaccine. There is a 25-point difference between Democrats and Republicans in expressed willingness to get the vaccine in Gallup's latest survey -- Democrats being the more positive. Pew Research similarly shows a 19-point difference in willingness to get a vaccine between Democrats and Republicans, and a recent survey from Kaiser Family Foundation found a 30-point partisan difference in those who said they would "definitely" or "probably" get the vaccine.
Determining the effectiveness and safety of the vaccine involves science and complexities beyond the average person's threshold of understanding, meaning that Americans need to rely on summaries, assessments and interpretations made by others. As is the case with views of the economy and most other issues, Americans bring preexisting assumptions and orientations to this task, and are open to following cues from political and media thought leaders as they figure out their personal position on getting the vaccine.
Republicans' hesitancy to get vaccinated, I believe, reflects in part their long-standing suspicion of elites and of government mandates (Gallup recently reported that Republicans have been less positive about getting vaccines in several situations, going back to questions Gallup asked about getting Asian flu vaccinations in 1957). It may also reflect agreement with Republican President Donald Trump's more skeptical positions on the coronavirus over the past nine months.
Interestingly, while Republicans' more negative views on getting vaccinated have varied some in Gallup's tracking this year, Democrats' views have been much more labile. In July and August, for example, Democrats' interest in getting the vaccine was predictably higher than Republicans'. Then, in a September survey, Democrat's willingness to be vaccinated dropped and Republicans' increased so the two almost matched (53% vs. 49%, respectively). This shift was short-lived, and Democrats have now reverted to their previous, much more positive position. Pew Research and Kaiser Family Foundation research found the same over-time patterns.
This shift among Democrats is at least in part the result of changing political cues. As Gallup's Megan Brenan wrote in reporting the trend results:
"This sharp decline [in September] followed an announcement by AstraZeneca that its vaccine trials were halted because of adverse participant reactions. Additionally, statements by President Donald Trump and Democratic vice presidential nominee Kamala Harris may have affected Americans' views. Trump said in early September that a vaccine could be available before Election Day, raising questions about pressure being put on the FDA to expedite approval. For her part, Harris said she would not get a vaccine on Trump's advice alone and expressed concern about the potential for political interference in the vaccine approval process."
Strategies for Increasing Republican Willingness to Get a Vaccine
My point here is that politicians and health professionals who are focused on the objective of increasing public willingness to get the vaccine need to first recognize why some partisan and ideological segments of the population are much more opposed than others. Borrowing from Stephen Covey, they should "seek first to understand, then to be understood." Efforts to increase vaccine uptake certainly can profitably enlist scientists and medical professionals to provide the latest information on efficacy and safety -- but must also reflect political and ideological realities. This is particularly true in reference to Republicans, a large segment of the population whose skepticism could have a major negative impact on the effort to maximize vaccine uptake. But the influence of politics is also evident from the September finding that Democrats' broad willingness to be vaccinated can change sharply based on what they are seeing and hearing.
Gallup has asked respondents who said they would not agree to get the vaccine to explain why in their own words. The results show in part that Republicans are significantly more likely than others to say it is because they don't trust vaccines in general. Verbatim responses also show that those who exhibit vaccine hesitation (including many Republicans) frequently use the word "trust" in their explanation, as in "I don't trust the vaccine" or "I don't trust the system" (read, government). Along these same lines, recent Kaiser Family Foundation research finds that Republicans who say they are hesitant about getting the vaccine are significantly more likely than Democrats to say it is because the risks of getting COVID-19 have been exaggerated.
The smaller number of Democrats who are hesitant are most likely, in Gallup's research, to say they are worried about the vaccine being rushed too quickly into use, and that they need to confirm it is safe. (The Kaiser poll did not separate out Democrats' reasons because there were too few of them who were hesitant to get the vaccine to provide reliable estimates.)
Those interested in increasing COVID-19 vaccine uptake will need to invest in further research to understand more precisely what is behind the thinking of groups that are below average in expressed willingness to be vaccinated.
As noted, Republicans may be a particularly important group in this regard because of their initial vaccine hesitancy. Some possible strategies to address reluctant Republicans could therefore include:
- focusing on communication from grassroots players such as doctors and nurses and local officials, rather than emphasizing messaging from elites and those at the top
- using Republican spokespeople and examples where possible (such as Vice President Mike Pence getting the vaccine on television)
- emphasizing direct communication from individuals' own personal doctors and local healthcare professionals
- attempting to be aware of and addressing inaccurate information and messaging on social media
There is, in theory, less payoff in targeting Democrats given their currently high willingness to get the vaccine -- but the increase in vaccine hesitancy among Democrats in September underscores the value in a focus on maintenance of their currently positive attitudes. Strategies for Democrats could include continuing to use Democratic-friendly spokespeople to stress the thoroughness of the vaccine development process, even while under an extraordinarily rushed timetable, and a focus on the safety of the vaccine.
Overall, Americans' expressed willingness to get a COVID-19 vaccine is to a significant degree related to their underlying political orientation, reflecting preexisting assumptions and worldviews as well as political and ideological cues carried through selected exposure to media and political thought leaders whose opinions resonate with these viewpoints. Although one may be excused for thinking that politics should not be a part of the vaccination process, the data clearly show that it is. Americans who are ideologically conservative and politically Republican are the most resistant to getting a vaccine, while Democrats' currently high degree of willingness to be vaccinated has been shown to be quick to change. These facts of life need to be a part of campaigns designed to increase vaccine uptake.