[ExI] Political ideology, vaccine hesitancy, and death

[John Clark]

*I asked Mr. GBT the following question: *

*ME: During the pandemic was there a relationship between a person's
political party or ideology, vaccine hesitancy, and death by Covid? *


*And the following was GPT's answer, but please note that GPT included some
excellent graphs that vividly illustrated the vastly different death rates
between Democrats and Republicans after the Covid mRNA vaccine became
available, but the antique steam powered web server that hosts this mailing
list does not allow graphs to be posted, at least not by me. However if you
want to see them you can on my Extropolis
<https://groups.google.com/g/extropolis> List because I am free to post
graphs of any size over there. *

*GPT: *"Yes. *In the United States, there was a substantial relationship
among political affiliation, COVID-vaccine hesitancy/uptake, and
mortality—but the timing is crucial.*

The clearest evidence comes from studies that looked specifically at what
happened *before versus after COVID vaccines became widely available*.
What happened

Early in the pandemic, there wasn't much of a Republican–Democrat mortality
difference once researchers accounted for age, location, and other factors.
In fact, Democratic-leaning urban areas were hit extremely hard during the
first waves.

But after vaccines became available to essentially all adults in spring
2021, a striking divergence appeared.

A particularly good study, published in *JAMA Internal Medicine*, linked
voter-registration records to death records for *538,159 people in Florida
and Ohio*. It found:

   - *Before May 2021:* there was essentially no statistically significant
   Republican–Democrat difference in excess mortality.
   - *After May 2021:* *Republicans had substantially higher excess
   mortality than Democrats*.
   - In the researchers' adjusted analysis, the *Republican excess-death
   rate was 43% higher than the Democratic rate after vaccines became broadly
   available.*
   - The disparity was *largest in counties with lower vaccination rates*.

That timing is extremely informative because it corresponds almost exactly
to the point at which vaccination ceased to be primarily a question of
*availability* and became increasingly a question of *whether people choose
to get vaccinated*.
And there really was a political difference in vaccination

Numerous studies found that Republican identification was associated with
greater COVID vaccine hesitancy and lower vaccination uptake. One
county-level analysis found political affiliation to be among the most
important predictors of vaccine hesitancy, with Republican-leaning counties
generally exhibiting greater hesitancy.

So there is a fairly coherent chain:

*political identity → attitudes toward COVID vaccination → vaccination
behavior → different risk of severe COVID/death*

The mortality study is particularly persuasive because the partisan
mortality gap *wasn't prominent before vaccines were available, but emerged
afterward and was greatest where vaccination rates were lowest.* That
pattern is difficult to explain as merely "Republicans happened to be less
healthy."
The JAMA study had an important limitation: the researchers *didn't have
individual vaccination records*, so they couldn't say, for example, "this
particular Republican died because he was unvaccinated." They inferred that
vaccination differences were an important contributor from the
population-level patterns.

Nevertheless, the evidence becomes considerably stronger when you put
several observations together:

   1. Republicans were, on average, *more vaccine hesitant*.
   2. Republican-leaning areas generally had *lower vaccination rates*.
   3. The partisan mortality difference was *small or absent before
   vaccination was widespread*.
   4. It became *large after vaccination became widely available*.
   5. The difference was *largest in areas with low vaccination rates*.
   6. Other studies found higher COVID mortality in Republican-leaning
   counties even after accounting for demographic differences.

That's a remarkably consistent pattern.
An important distinction from your previous question

This is also why your friend's argument that *"COVID became less deadly
because the virus evolved, not because vaccination helped"* doesn't fit the
data very well.

The virus certainly *did evolve*, and later variants had different
characteristics. But if declining lethality were the primary explanation
for the dramatic decline in deaths, you wouldn't expect mortality to
diverge so sharply according to *political affiliation and vaccination
prevalence* after vaccines became available.

The partisan mortality pattern is actually one of the more striking pieces
of real-world evidence that *vaccination was making a substantial
difference in who died*, even though it wasn't the *only* reason mortality
eventually fell.

There is an especially interesting quantitative result here: the
researchers found that the Republican/Democratic mortality gap *essentially
appeared at the point when vaccination became widely available*. That makes
the political/vaccine connection much more compelling than simply observing
that "red counties had more deaths. I looked up the actual study's weekly
data/figure, and the pattern is quite striking. . It reports weekly
estimates graphically, plus aggregated periods.

The study by Wallace, Goldsmith-Pinkham, and Schwartz in *JAMA Internal
Medicine* examined *538,159 deaths of registered voters aged 25+ in Florida
and Ohio*, using 2017 voter-registration records linked to mortality
records.
What the weekly pattern looked like

The important part is the timing:
Period Republican excess mortality Democratic excess mortality Adjusted
Republican–Democrat gap
Apr. 2020–Mar. 2021, before widespread adult vaccine eligibility *19.4%*
*18.8%* *−0.9 percentage points*
Apr.–Dec. 2021, after widespread eligibility *25.8%* *18.1%* *+7.7
percentage points*

The researchers' definition of excess mortality is essentially *observed
deaths divided by the number of deaths expected from pre-pandemic patterns*.
So, for example, 25.8% means roughly 26% more deaths than would have been
expected absent the pandemic.

And the really interesting part is what happened *week by week*:

   - *Winter 2020–21:* both Republicans and Democrats experienced a large
   surge in excess deaths, and the two curves were fairly close.
   - *Spring 2021:* the curves came back down and remained relatively close.
   - *Summer 2021:* the Republican curve began rising noticeably above the
   Democratic curve.
   - *Fall 2021:* the separation became substantially larger.


The *43% figure* I mentioned previously comes from comparing the *adjusted
excess-death rates* after vaccines became widely available: Republicans'
excess mortality was estimated to be *43% higher than Democrats'*.
Why I think the timing is more important than the 43% number

Imagine that Republicans had simply had substantially higher mortality
throughout the entire pandemic. That wouldn't tell us much about
vaccination.

But that's *not what happened*.

Before vaccines were broadly available:

Republican excess mortality: *19.4%*
Democratic excess mortality: *18.8%*

That's essentially the same.

After vaccines became broadly available:

Republican excess mortality: *25.8%*
Democratic excess mortality: *18.1%*

That's a very large divergence. And the researchers found that the
divergence was *largest in counties with low vaccination rates and became
much smaller in highly vaccinated counties.*

That is exactly the pattern you would expect if differences in vaccination
were contributing substantially to the mortality difference.
There is an important caveat

This particular study *cannot prove that an individual Republican died
because he or she was unvaccinated*. The researchers didn't have individual
vaccination records. They had political affiliation for individuals but
vaccination rates only at the county level.

Also, the effect was *much stronger in Ohio than Florida*; in Florida, the
overall Republican excess-mortality difference wasn't statistically
significant.

So I would phrase the conclusion carefully:

*The evidence strongly supports an association between political
affiliation, vaccination behavior, and COVID mortality, and the timing of
the association is unusually suggestive of a causal role for vaccination.
But this particular study cannot quantify exactly how many Republican
deaths were caused by vaccine refusal.*

And this is actually a very good answer to the argument you raised in your
previous question. *The virus becoming less lethal cannot by itself explain
why the mortality curves of Republicans and Democrats, which were nearly
identical before widespread vaccination, suddenly separated after vaccines
became available."*

* John K Clark*
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