Advertisement

SKIP ADVERTISEMENT

Least Vaccinated U.S. Counties Have Something in Common: Trump Voters

About 31 percent of adults in the United States have now been fully vaccinated. Scientists have estimated that 70 to 90 percent 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 re-elect former President Donald J. Trump in 2020. The phenomenon has left some places with a shortage of supply and others with a glut.

States with larger Trump vote shares are likely to have more adults who are vaccine hesitant ...
… and have a smaller share of residents already vaccinated than states with larger Biden vote shares.
Source: Estimates of vaccine hesitancy by state come from the Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation. Data on the share of state residents who have been vaccinated comes from the Centers for Disease Control and Prevention and reflects vaccinations through April 16. Election data is from Edison Research.

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 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-through 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 lifelong friends, family and neighbors 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, Wyo., which Mr. Trump won by a wide margin last year.

The health department, Ms. 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.

Ms. 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 percent of Natrona County’s adult residents have been fully vaccinated, and the federal government has estimated, based on Census survey data, that about 32 percent 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 Mr. 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.

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, on Wednesday, Monmouth University and Quinnipiac University polls indicated that almost half of Republicans did not plan to pursue vaccinations. Only around one 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 a quarter of adults might not be willing to get vaccinated, according to the estimates, and a majority of these places supported Mr. 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 Mr. Biden in the 2020 election. Mr. 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.)

Federal government estimates of Covid-19 vaccine hesitancy

Estimated share of adults who may be

hesitant to get the vaccine

10%

15%

20%

25%

30%

Wash.

Maine

Mont.

N.D.

Vt.

Minn.

Ore.

N.H.

Idaho

N.Y.

S.D.

Wis.

Mass.

R.I.

Mich.

Conn.

Wyo.

N.J.

Pa.

Iowa

Neb.

Nev.

Ohio

Del.

Md.

Ind.

Utah

Ill.

W.Va.

Colo.

Calif.

Va.

Kan.

Mo.

Ky.

N.C.

Tenn.

Okla.

Ariz.

N.M.

Ark.

S.C.

Miss.

Ala.

Ga.

La.

Texas

Alaska

Fla.

Hawaii

Estimated share of adults who may be

hesitant to get the vaccine

10%

15%

20%

25%

30%

Wash.

Maine

Mont.

N.D.

Vt.

Minn.

Ore.

N.H.

Idaho

N.Y.

S.D.

Wis.

Mass.

R.I.

Mich.

Conn.

Wyo.

N.J.

Pa.

Iowa

Neb.

Nev.

Ohio

Del.

Md.

Ind.

Utah

Ill.

W.Va.

Colo.

Calif.

Va.

Kan.

Mo.

Ky.

N.C.

Tenn.

Okla.

Ariz.

N.M.

Ark.

S.C.

Ala.

Ga.

Miss.

La.

Texas

Alaska

Fla.

Hawaii

Estimated share of adults who may be

hesitant to get the vaccine

10%

15%

20%

25%

30%

Wash.

Maine

Mont.

N.D.

Vt.

Minn.

Ore.

N.H.

Idaho

N.Y.

S.D.

Wis.

Mass.

R.I.

Mich.

Conn.

Wyo.

N.J.

Pa.

Iowa

Neb.

Nev.

Ohio

Del.

Md.

Ind.

Utah

Ill.

W.Va.

Colo.

Calif.

Va.

Kan.

Mo.

Ky.

N.C.

Tenn.

Ariz.

N.M.

Okla.

Ark.

S.C.

Ala.

Ga.

Miss.

La.

Texas

Alaska

Fla.

Hawaii

Estimated share of adults who may be

hesitant to get the vaccine

10%

15%

20%

25%

30%

Wash.

Maine

Mont.

N.D.

Vt.

Minn.

Ore.

N.H.

Idaho

N.Y.

S.D.

Wis.

Mass.

R.I.

Mich.

Conn.

Wyo.

N.J.

Pa.

Iowa

Neb.

Nev.

Ohio

Md.

Del.

Ind.

Utah

Ill.

W.Va.

Colo.

Calif.

Va.

Kan.

Mo.

Ky.

N.C.

Tenn.

Ariz.

N.M.

Okla.

Ark.

S.C.

Ala.

Ga.

Miss.

La.

Texas

Alaska

Fla.

Hawaii

Estimated share of adults who may be

hesitant to get the vaccine

10%

15%

20%

25%

30%

Wash.

Maine

Mont.

N.D.

Vt.

Minn.

Ore.

N.H.

Idaho

N.Y.

S.D.

Wis.

Mass.

Mich.

Wyo.

Conn.

R.I.

N.J.

Pa.

Iowa

Neb.

Nev.

Ohio

Md.

Del.

Ind.

Utah

Ill.

Calif.

Colo.

W.Va.

Va.

Kan.

Mo.

Ky.

N.C.

Tenn.

Ariz.

N.M.

Okla.

Ark.

S.C.

Ala.

Ga.

Miss.

La.

Texas

Alaska

Fla.

Hawaii

Source: Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation

Dr. Jean Stachon, the health officer in Sweetwater County, Wyo., where federal officials have estimated that about 31 percent 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.”

Dr. 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 percent of its adult residents. Mr. Trump won the county by a margin of more than 50 points last year.

In Grant County, N.D., home to about 2,400 people, the federal government has estimated that 31 percent of the population may not be willing to get a shot. Mr. 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 percent 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 Mr. Trump in the 2020 election, adult vaccination rates were lower, on average, than in counties where a majority of residents voted for Mr. Biden. The rate was especially low in counties where Mr. 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.

Counties where more residents voted for Trump often have lower vaccination rates

Alabama
20%
40%
60%
vaccinated
Trump
Biden
Arizona
Trump
Biden
Arkansas
Trump
Biden
California
Trump
Biden
Colorado
Trump
Biden
Connecticut
Trump
Biden
Florida
Trump
Biden
Georgia
Trump
Biden
Idaho
Trump
Biden
Illinois
Trump
Biden
Indiana
Trump
Biden
Iowa
Trump
Biden
Kansas
Trump
Biden
Kentucky
Trump
Biden
Louisiana
Trump
Biden
Maine
Trump
Biden
Maryland
Trump
Biden
Massachusetts
Trump
Biden
Michigan
Trump
Biden
Minnesota
Trump
Biden
Mississippi
Trump
Biden
Missouri
Trump
Biden
Montana
Trump
Biden
Nebraska
Trump
Biden
Nevada
Trump
Biden
New Hampshire
Trump
Biden
New Jersey
Trump
Biden
New Mexico
Trump
Biden
New York
Trump
Biden
North Carolina
Trump
Biden
North Dakota
Trump
Biden
Ohio
Trump
Biden
Oklahoma
Trump
Biden
Oregon
Trump
Biden
Pennsylvania
Trump
Biden
Rhode Island
Trump
Biden
South Carolina
Trump
Biden
South Dakota
Trump
Biden
Tennessee
Trump
Biden
Texas
Trump
Biden
Utah
Trump
Biden
Vermont
Trump
Biden
Virginia
Trump
Biden
Washington
Trump
Biden
West Virginia
Trump
Biden
Wisconsin
Trump
Biden
Wyoming
Trump
Biden
Note: Shows share of adults who are fully vaccinated and includes states with at least five counties. Some states, including Virginia and Georgia, have a higher share of missing data in the county data they report to the C.D.C. than other states, resulting in county figures that appear lower over all. Vaccination rates for all counties in Hawaii, as well as some counties in California and Virginia, are not included in the C.D.C. data set and are not in the visualization. Alaska does not report election results at a county level. Figures are artificially low in three Massachusetts counties because of missing residency information, per the C.D.C.·Sources: Centers for Disease Control and Prevention, Texas Department of State Health Services, Edison Research.

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 percent lower than the national average, the Times analysis found, but the rate for younger adults was 18 percent 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.

Vaccination rates by age group and 2020 election results

2020 county margin

Biden

+20

Biden

+10

Trump

+10

Trump

+20

Ages 65 and older

Ages 18 to 64

+12%

10%

more vaccinated

than national avg.

+6%

+5%

+3%

+2%

Near

avg.

+1%

–6%

–10%

–11%

–20%

–19%

2020 county margin

Biden

+20

Biden

+10

Trump

+10

Trump

+20

Ages 65 and older

Ages 18 to 64

+12%

10% more vaccinated

than national avg.

+6%

+5%

+3%

+2%

Near

avg.

+1%

–6%

–10%

–11%

–20%

–19%

Note: The Times excluded seven states where significant federal data was missing.

It’s possible that some of the differences in vaccination rates are driven by distribution issues and eligibility rules, said Jed Kolko, the 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. On average, the 10 states where residents were least hesitant to get the Covid-19 vaccine, according to federal estimates, have administered 82 percent of the doses that they have received. The 10 states where residents were most hesitant have used 72 percent.

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,” Dr. Cooper said. “I think it is carrying through in the vaccination realm, too.”

Average share of delivered doses reported as used

20
40
60
80
100%
All other states
10 least-hesitant states
10 most-hesitant states
Jan. 1
Feb. 1
Mar. 1
Apr. 16
Extra doses in Pfizer vials and inconsistencies in data reporting may result in the percentage of doses used adding up to more than 100.·Source: Centers for Disease Control and Prevention

To be sure, there are counties that supported Mr. 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 Mr. 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, the 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 Mr. Biden are now lagging in vaccination efforts. In Hudson County, N.J., which supported Mr. Biden by a wide margin last year, about 25 percent of adult residents have been fully vaccinated.

David Drumeler, the 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. Mr. 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,” Mr. Drumeler said. “But hesitancy is not a hurdle we are encountering yet.”

The situation is quite the opposite in Potter County, Pa., where Mr. Trump won by a wide margin, and where a recent drive-through 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.

Mr. 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.”

Mr. 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 percent of adults in the county have been fully vaccinated.