Least vaccinated US counties have something in common: Trump voters


About 31% of adults in the United States have now been fully vaccinated. Scientists have estimated that 70% to 90% of the total population must acquire resistance to the virus to reach herd immunity. But in hundreds of counties around the country, vaccination rates are low, with some even languishing in the teens.

The disparity in vaccination rates has so far mainly broken down along political lines. The New York Times examined survey and vaccine administration data for nearly every U.S. county and found that both willingness to receive a vaccine and actual vaccination rates to date were lower, on average, in counties where a majority of residents voted to reelect former President Donald Trump in 2020. The phenomenon has left some places with a shortage of supply and others with a glut.

For months, health officials across the United States have been racing to inoculate people as variants of the coronavirus have continued to gain a foothold, carrying mutations that can make infections more contagious and, in some cases, deadlier. Vaccinations have sped up, and in many places, people are still unable to book appointments because of high demand. In Michigan, where cases have spiraled out of control, Gov. Gretchen Whitmer, a Democrat, recently urged President Joe Biden to send additional doses.

But in more rural — and more Republican — areas, health officials said that supply is far exceeding demand.

In a county in Wyoming, a local health official asked the state to stop sending first doses of the vaccine because the freezer was already stuffed to capacity with unwanted vials.

In an Iowa county, a clinic called people who had volunteered to give shots to tell them not to come in because so few residents had signed up for appointments.

In a county in Pennsylvania, a hospital set up a drive-thru in the park, stocked with roughly 1,000 vaccine doses. Only about 300 people showed up.

And in interviews with more than two dozen state and county health officials — including some who said they were feeling weary after a year of hearing relatives, neighbors and lifelong friends tell them that the virus was a hoax or not particularly serious — most attributed low vaccination rates at least partly to hesitant conservative populations.

“I just never in a million years ever expected my field of work to become less medical and more political,” said Hailey Bloom, a registered Republican and the public information officer for the health department that covers Natrona County, Wyoming, which Trump won by a wide margin last year.

The health department, Bloom said, set up a clinic in a former Macy’s at the local mall and was prepared to give 1,500 shots a day, four days a week. But it has never been able to fill all the slots, she said; usually, 300 or 400 people show up.

Bloom, like many other county officials, said she feared that reaching herd immunity might not be possible in her community. “It’s terrifying to think that this may never end,” she said. “So much hinges on these vaccinations.”

About 27% of Natrona County’s adult residents have been fully vaccinated, and the federal government has estimated, based on census survey data, that about 32% of its residents may be hesitant to get a shot.

The relationship between vaccination and politics reflects demographics. Vaccine hesitancy is highest in counties that are rural and have lower income levels and college graduation rates — the same characteristics found in counties that were more likely to have supported Trump. In wealthier Trump-supporting counties with higher college graduation rates, the vaccination gap is smaller, the analysis found, but the partisan gap holds even after accounting for income, race and age demographics, population density and a county’s infection and death rate. The Times’ analysis used data current through last Friday.

When asked in polls about their vaccination plans, Republicans across the country have been far less likely than Democrats to say they plan to get shots. Most recently, last week, Monmouth University and Quinnipiac University polls indicated that almost half of Republicans did not plan to pursue vaccinations. Only around 1 in 20 Democrats said the same.

Using survey data collected in March, the federal government recently created new estimates of hesitancy for every county and state in the United States. U.S. Department of Health and Human Services modelers used demographic factors and state-level responses of adults who said they would “probably not” or “definitely not” get a COVID-19 vaccine from the Household Pulse Survey, then used Census data to estimate the share of residents who might say that in every county.

In more than 500 counties, at least one-quarter of adults might not be willing to get vaccinated, according to the estimates, and a majority of these places supported Trump in the last election.

In the 10 states where the government projected that residents would be least hesitant to get a COVID-19 vaccine, voters chose Biden in the 2020 election. Trump won nine of the 10 states where the most residents said they would probably or definitely not get the vaccine. (He did not win Georgia, which is among those states.)

Dr. Jean Stachon, the health officer in Sweetwater County, Wyoming, where federal officials have estimated that about 31% of residents may be reluctant to receive a vaccine, said her department has made the tough philosophical decision to prioritize getting shots to the willing. At least once, that has meant opening a vial even when there were not enough interested people to use up all the doses in it.

“It pains me to think that the governor of Michigan is begging for vaccines,” she said, “and we’ve got vials and vials in our freezer.”

Stachon, who has been both a registered Democrat and Republican in the past and considers herself politically independent, said she had not given up hope. Sweetwater has fully vaccinated about 29% of its adult residents. Trump won the county by a margin of more than 50 points last year.

In Grant County, North Dakota, home to about 2,400 people, the federal government has estimated that 31% of the population may not be willing to get a shot. Trump won the county by a wide margin last year.

“People tell me, ‘I would like to wait’; it’s the No. 1 thing I’m hearing,” said Erin Ourada, the administrator for Custer Health, which serves Grant and four other counties. “I keep seeing Grant County sit at the bottom of the list. It makes me sad.” About 13% of adult residents there have been fully vaccinated.

Actual vaccination data has revealed a pattern similar to what polling and the federal estimates have shown. The Times analyzed data from the Centers for Disease Control and Prevention and the U.S. Census Bureau and found a party split that was significant, though smaller.

In counties where a majority of residents voted for Trump in the 2020 election, adult vaccination rates were lower, on average, than in counties where a majority of residents voted for Biden. The rate was especially low in counties where Trump dominated, falling below 1 in 4 residents in counties where the former president won by a margin of 50 or more points.

The divide in vaccination rates remained even after accounting for a variety of factors, including infection rates, population density and educational attainment.

The vaccination data may not match the split predicted in the polling data because of the way the rollouts have been organized in the United States, with all states giving preference to older Americans early on and with younger adults in many states qualifying only recently. A recent poll showed that older Republicans were less resistant to becoming vaccinated than younger Republicans.

The rate of full vaccination for older adults in Republican-leaning counties was 5% lower than the national average, the Times analysis found, but the rate for younger adults was 18% below average. It is an indication that the partisan divide in vaccinations may actually grow wider as younger people become eligible for the vaccine nationwide.

It is possible that some of the differences in vaccination rates are driven by distribution issues and eligibility rules, said Jed Kolko, chief economist at Indeed.com, who has studied partisan aspects of the pandemic. But as eligibility becomes more universal, “the more the differences will be about hesitancy alone,” he said.

The share of vaccine doses that each state uses may provide clues about how hesitancy will unfold going forward.

At the beginning of March, all states were able to administer a similar share of doses delivered to them. But now some states are lagging behind. On average, the 10 states where residents were least hesitant to get the COVID-19 vaccine, according to federal estimates, have administered 82% of the doses that they have received. The 10 states where residents were most hesitant have used 72%.

Dr. Lisa Cooper, director of the Johns Hopkins Center for Health Equity, said she was not surprised that conservative-leaning people might be less likely to want a vaccine.

“These are people who were fed untruths about how this virus wasn’t real,” Cooper said. “I think it is carrying through in the vaccination realm, too.”

To be sure, there are counties that supported Trump in the last election and now have above-average vaccination rates.

Some officials in those counties said their rates have lately plateaued.

In Tama County, Iowa, where Trump won by a wide margin last year and the vaccination rate is above the national average, the health department runs a clinic a few days a week at a former juvenile correctional facility.

Until recently, staff and volunteers were regularly giving shots to about 120 to 150 people in a day, according to Shannon Zoffka, executive director of the department and a registered Democrat. When the state expanded its eligibility rules to include all adults, she expected the phones to be ringing off the hook. Instead, she said, about 120 people made appointments for the entire past week.

“When you hit that saturation point, you don’t realize it’s coming,” she said. “It just happens.”

Likewise, some counties that supported Biden are now lagging behind in vaccination efforts. In Hudson County, New Jersey, which supported Biden by a wide margin last year, about 25% of adult residents have been fully vaccinated.

David Drumeler, deputy county administrator and a registered Democrat, said that there was not enough supply to meet the demand and that many residents, some of whom do not have cars, were having difficulty getting to mass vaccination sites elsewhere in the state. Drumeler said that the county was strictly policing a residency requirement in the county to make sure its supply was reaching its intended target.

“It’s so frustrating to be so low on the percentage of folks getting vaccinated when all our shots are getting into arms,” Drumeler said. “But hesitancy is not a hurdle we are encountering yet.”

The situation is quite the opposite in Potter County, Pennsylvania, where Trump won by a wide margin and where a recent drive-thru vaccine clinic failed to draw large crowds.

Kevin Cracknell, who has spent 13 years as a registered nurse in the intensive care unit at the local hospital, said his biggest fear was that very few people in the area would get vaccinated and, as a result, waves of infection would continue to sweep through the community for years to come.

Cracknell, a registered Democrat, recalled a time this past January when patients with the virus — people he knew from town — began to fill the beds in his hospital.

“It’s like no other virus I’ve seen in my life,” he said. “The damage it does to the lungs.”

Cracknell let out a long breath. “Most of my patients supported Trump,” he said. “I love them to death. I want them to succeed. I want them to be healthy.”

So far, only about 15% of adults in the county have been fully vaccinated.

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