28 United States The Economist July 17th 2021
The antivaxdelusion
I
n early may, with the Food and Drug Administration expected
to approve the first covid19 vaccine for teens any day, Michelle
Fiscus found herself fielding questions from Tennessee vaccine
dispensers on what this would mean in practice. Could 12 to 15
yearolds be vaccinated without parental consent, for example? Dr
Fiscus, the state official in charge of immunisations, sent back the
official legal advice on that. Referring to a 34yearold ruling of the
Tennessean Supreme Court, it noted that any sensible 14yearold
could request a vaccine of their own accord. What happened next,
according to Dr Fiscus, “can only be described as bizarre”.
Her memo was shared on social media, seized on by angry con
servatives and the Tennessee Department of Health duly accused
of machinating to destroy families and subvert children. Scenting
an opportunity, Tennessee’s Republican legislature summoned
the state’s publichealth officials to explain why they were “target
ing” the young and innocent in this “reprehensible” way. One law
maker demanded the health department be disbanded.
The department vowed to try less hard to vaccinate Tennesse
ans against covid19 and other diseases. According to reports and
internal emails shown to Lexington by Dr Fiscus, this has involved
ending all vaccine outreach to teens. Any Tennessean adolescent
who has received a first covid jab is no longer being sent a remind
er to show up for the second; the department has stopped sending
information about immunisations—against measles and menin
gitis as well as covid19—to schools. This week Dr Fiscus was asked
to resign. When the veteran paediatrician refused, she was fired.
America has a long history of antivax conspiracy theories. But
the vaccine denialism that has gripped the Republican Party in
Tennessee and everywhere is unprecedented. Past antivax move
ments have been disparate, fringe and, at least on an individual
basis, responsive to patient dissuasion. Their adherents have in
cluded rich Californian suburban moms, gulled by misinforma
tion about the risks of immunising babies, and poor African
Americans, with a partjustified suspicion of the medical profes
sion. The results, by and large, have been small measles outbreaks
and a marginal contribution to black Americans’ poor health.
Anticovid vax sentiment on the right, by contrast, is fuelled by
the country’s deepest divisions and the conservative entrepreneurs,inmediaand politics, who aggravate them. It explains why
America’s vaccination rate has slowed in recent weeks, despite the
availability of vaccines, an uptick in infections and deaths, and
the fact that a third of adults have not received a first dose. Surveys
suggest this large minority is overwhelmingly Republican. It rep
resents half the party’s voters, predictably dominated by its most
pessimistic and conspiracyprone groups, white evangelicals and
rural folk: the Trumpian base.
The problem looks even worse—politically, economically and
healthwise—where such voters are concentrated. Vaccination
rates are lowest wherever Donald Trump romped to victory last
November. In Tennessee, where he won 61% of the vote, 43% have
had a first dose. In Ohio, a more divided state with a pragmatic go
vernor in Mike DeWine, it is a slightly more hopeful 48%. But in
the most conservative Ohioan counties, the rate plummets. In
Holmes County where the former president won 83% of the vote,
15% of people have had a first dose. The chances of succumbing to
the virus in such places is correspondingly high; 99% of America’s
recent covid19 fatalities had not been vaccinated.
It is tempting to see this calamity as a predictable development
in the politicisation of American identity, whether concerning
race, sexuality or attitudes to health care. Yet it was not inevitable.
The one thing Mr Trump got impressively right in his handling of
the pandemic was his early investment in the vaccines his voters
now consider to be unnecessary or part of a Democratic plot to spy
on their innards. Poisoning the minds and jeopardising the bodies
of so many Republican voters has taken a concerted campaign.
Mr Trump is chiefly responsible for it. Analysis by Shana Ga
darian, a political scientist, suggests scepticism about covid19
vaccines is largely a consequence of his efforts to play down the vi
rus and mitigation measures such as maskwearing. As so often
with Mr Trump, it was an approach that mingled conservative ide
ology with demagoguery and personal strangeness. Conservatives
prize freedom of choice over the common good; demagogues rub
bish expert advice in order to propagate their own reality; and Mr
Trump, a conservative demogogue but also a lifelong conspiracy
theorist, probably believed some of his own misinformation.Just a small prick
He was once a noted antivaxxer—which may explain why he did
not publicise his own covid jab until weeks after it took place. By
thus minimising his role in the vaccinations he made it easier for
likeminded entrepreneurs, such as Tucker Carlson, to denigrate
and blame the jabs —one of the biggest successes of Republican
government in years—on Joe Biden. Fox News’s biggest star calls a
Biden administration effort to step up local vaccination cam
paigns “the greatest scandal in my lifetime.”
This extreme politicisation has encouraged vaccinehesitant
Republicans to dig in. To be conservative is now to a great degree
to be against covid19 vaccination. And interviews with senior of
ficials in Ohio and Tennessee (including Mr DeWine, who recently
completed a statewide tour of vaccine centres) suggested there is
little confidence that this can be reversed.
Some publichealth experts wondered whether the accelerat
ing Delta variant might tip the balance. But it seems unlikely. Ten
nessee, like other states, has already seen so much death. “It is a
mystery to me why watching your loved ones die of an infectious
disease that we can easily preventdoesn’t move more people to re
consider,” said Dr Fiscus, revealing,yet again, the insidious pro
life sentiment that got her fired.nLexington
America’s vaccination programme is stalling. Populist conservatives are to blame