Political Ideology and Childhood Vaccination in Cross-National Perspective, 1995 to 2018

Abstract

Although the Covid-19 pandemic has renewed attention to the problem of vaccine hesitancy, vaccination rates for common childhood vaccines such as measles and pertussis have declined in many countries around the world for over a decade. To investigate the potential role of politicization in this decline, I analyze the relationship between the ideological composition of societies and childhood vaccination rates for measles, diphtheria, pertussis, and tetanus in 88 countries between 1995 and 2018, using pooled cross-national data from the World Values Survey, World Bank, and other sources. Controlling for other key determinants of vaccine uptake, coverage is highest in ideologically moderate societies and lowest in countries that skew to the Right of the political spectrum, while vaccination rates increase when countervailing ideological views are sufficiently well represented in a society. I relate these findings to theories of identity construction and maintenance, focusing especially on the “plausibility structures” approach in the phenomenological tradition and the “subcultural identity” perspective developed in religious contexts.

Keywords:

• Vaccines
• vaccine hesitancy
• polarization
• plausibility structures
• political ideology

Notes

1 Vaccination rates for achieving herd immunity against measles, pertussis, and diphtheria range between 79% and 99% (Plans-Rubió 2012).

2 Under-vaccination has been documented at Waldorf schools in California as well (Brennan et al. 2017; Sobo 2015).

3 Black individuals are also less likely than Whites or Hispanics to support experimental drugs. “One possible reason,” Anderson (2015) surmises, “may be tied to the legacy of mistreatment of blacks by the medical establishment over generations, most infamously in the Tuskegee syphilis experiment.”

4 According to Attwell and Freeman (2015:6239), the community they studied shares “apparent similarities” with Portland, Oregon, “in terms of lifestyle and values.”

5 That is, 4([2018-1995]/100)^2/9 = 2.91. I estimate these models in Stata 17 with the user-written ivreg2 command (Baum, Schaffer, and Stillman 2022; StataCorp 2021). The models take the following general form: ivreg2 y L.x, cluster(id year) bw(3) kernel(bar), where y is the dependent variable (i.e., logit-transformed vaccination rates); L.x is a vector of independent and control variables, lagged one year; id is a set of unique country identifiers; year is a variable for calendar year; bw(3) specifies the bandwidth selection; and kernel(bar) requests the Bartlett kernel.

6 I estimate these models using the xtpcse command in Stata 17.

7 The inflection point is calculated as the negative linear coefficient divided by two times the quadratic coefficient.

8 There were 96,623,148 births and 2,761,900 infant deaths among sampled countries in 2018 (World Bank 2020), yielding an estimated 93,861,248 one-year-old children in 2019. A vaccination rate of 93% percent implies that 87,321,700 of these children were fully vaccinated by their second birthday, whereas a rate of 89.2% translates into 83,734,700—a difference of 3,587,000 children.

9 Taking the inverse logit of a coefficient ($e^{\beta }/[1+e^{\beta }]$) gives its substantive effect on a country’s vaccination rate in terms of percentage-point changes.

10 No sampled country entirely lacks people who identify as Right or Left (see Appendix B).

11 In March 2012, the World Health Organization’s Strategic Advisory Group of Experts on Immunization established a Working Group on Vaccine Hesitancy, and in January 2019 the WHO declared vaccine hesitancy a top-ten threat to global health.