Race, partisanship, and the distinctiveness of vaccine hesitancy in health care attitudes

ABSTRACT

Partisanship has served a dominant role in influencing public opinion on health reform in the United States in the past decade. Republicans are significantly less supportive than Democrats of expanding the Affordable Care Act and implementing broader government insurance provisions. With the onset of the pandemic, partisan divisions have also spilled over into polarized attitudes on public health measures to curb the spread of COVID-19 and vaccine uptake. The influence of partisanship should not be overstated, however, particularly when examining public opinion across racial groups. Black Americans were among the strongest proponents of health reform during the passage of the Affordable Care Act, and they remained strong supporters of Democratic-led proposals to expand health insurance access and of many public health measures to curb the spread of COVID-19. But high levels of Democratic partisanship alone cannot explain the dynamics of Black public opinion on vaccination, an issue for which Black Democrats consistently show more skepticism than white Democrats. Using multiple sources of nationally representative survey data from 2016 to 2022, this study illustrates how self-interest and racialized experiences with the government and the health care system help explain the distinctive racial divide in vaccination attitudes.

KEYWORDS:

• Health care
• race
• vaccine hesitancy
• public opinion
• COVID-19

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 Prior to COVID-19, public health scholarship has documented vaccine hesitancy among Black Americans (Martin, Stanton, and Johnson 2023; Roat et al. 2023), including in cases of the flu and H1N1 vaccines (Callaghan et al. 2021; Burger et al. 2021).

2 The KFF and CMPS questions used in this table are available in the online appendix.

3 The KFF interaction analysis is somewhat constrained by Black Republican sample size, with only 32 Black Republicans in the 2021 KFF data. The CMPS has a larger sample, with 298 Black Republicans.

4 Personal experience with unfair treatment or racial discrimination in health care has more mixed results. It is associated with less support for mask mandates and Medicare for All in the CMPS data.

5 In supplemental analyses in Appendix Tables A7 using the 2021 CMPS, which included some measures of general media consumption, we do find that the racial gap in vaccine hesitancy persists after controlling for self-reported viewership of Fox News, which is positively related to vaccine hesitancy, consumption of MSNBC, The New York Times, and whether individuals report their friends and family as their primary sources of news and information.

6 Supplemental analyses in Appendix Tables A4–A5 show regression results where the outcome is vaccine uptake instead of vaccine hesitancy. We find that white respondents are more likely to have reported receiving at least one dose of the vaccine in the 2021 survey samples, but this difference is significant only in the 2021 CMPS.