July 4 Didn’t Have To Be Like This

It’s July 4, and it looks like the U.S. has narrowly missed President Joe Biden’s goal of making sure 70% of adults have at least one dose of vaccine by now. But the main problem isn’t availability. It’s public interest.

Many people who could get the vaccine aren’t, in a distinctly political pattern that says a lot about why COVID-19 has been so deadly in the U.S. ― and why it didn’t have to be.

The 20 states that have hit Biden’s threshold are mostly on the coasts, and all voted for Biden in the 2020 election. At the very top are Massachusetts and Vermont, two of the most reliably liberal and Democratic states in the country. Also among the high-vaccination states is California, which is notable given its well-publicized distribution problems earlier this year.

On the other end of the spectrum, among the 20 states with the lowest vaccination rates overall, all but two are states that voted for former President Donald Trump in 2020. They are heavily concentrated in the Deep South, with Alabama and Mississippi at the very bottom of the list.

Political affiliation isn’t the only factor that correlates with vaccination rates. Education, income, urban versus rural residency and race all seem to play roles too. Plus, there are still people not getting shots because access is difficult for one reason or another.

But the political breakdown is so stark that the same pattern shows up at the county level, too. Worse still, polling has shown for months that Republicans are more likely than other Americans to say they will never get the vaccine, no matter what they learn about it. 

This is very different from, say, Black Americans, who have expressed skepticism about the vaccine but have generally described themselves as “waiting and seeing” to see more safety data. 

Based on the numbers from a recent Yahoo News poll, it looks like “there’s around 2.44 million Biden voters who are apparently unreachable… but 23.75 million Trump voters who fall into that category,” according to Charles Gaba, the health care numbers guru who publishes at ACASignups.net.

This situation was entirely predictable. But that doesn’t mean it was inevitable. 

There’s nothing inherently political about a virus or the way society responds to it. And it’s not hard to imagine a very different history of COVID-19 here ― one with a different Republican president, like a Mitt Romney or even a Chris Christie, who were more likely to pay attention to science and recognize that the crisis required a muscular government response.

But instead of that hypothetical, the U.S. had Trump in charge. And that had a huge impact, as several new books on the pandemic make clear.

One of them is ”Preventable,” by Andy Slavitt, the former health care industry executive who last month finished up a temporary assignment working on COVID-19 response for Biden. 

“Preventable” is mostly a chronicle of Slavitt’s activities and observations in 2020, before he joined the administration, when he was working behind the scenes with private and public sector officials. The title captures its main point ― that, although the pandemic was destined to be a catastrophe, it didn’t have to be nearly as awful and deadly as it has been.

Slavitt’s first stint in government began in 2013, when the Obama administration recruited him to help rescue HealthCare.gov, the Affordable Care Act’s website that crashed upon launch. Slavitt is as much technocrat as Democrat, and that attitude comes through in the book. 

He actually has some nice things to say about Jared Kushner, Trump’s son-in-law and a former White House official, whom Slavitt found receptive to advice on issues like reopenings. He also praises Republican governors like Mike DeWine of Ohio, whose aggressive pandemic measures provoked statehouse protests.

At the same time, Slavitt is critical of New York City Mayor Bill de Blasio, a Democrat, who in Slavitt’s view could have acted more quickly to shut down the city when the virus first struck. Slavitt contrasts de Blasio’s performance with that of San Francisco Mayor London Breed, another Democrat, who acted more swiftly and whose city fared better according to most metrics.

But in criticizing de Blasio, Slavitt allowed for the fact that pretty much every public servant was bound to make some mistakes, because this was such a novel crisis with so many scientific unknowns. 

“I don’t hold a Bill de Blasio … or any other elected leader responsible for not being able to predict an unpredictable future, for getting every one of these very difficult decisions right, as long as they’re operating in good faith, and making an effort, and have enough empathy for everyone,” Slavitt told HuffPost.

But Trump, Slavitt said, showed none of those traits. “The fact that Trump couldn’t even pretend to be empathetic and working on these problems seriously is pretty extraordinary,” he said.

Trump’s inability to look beyond his own political fortunes is also a theme of ”Nightmare Scenario,” by Yasmeen Abutaleb and Damian Paletta. The Washington Post reporters interviewed nearly 200 people, and their journalistic account provides story after story of Trump seeing the crisis almost exclusively through the lens of politics rather than public health. 

Early in the pandemic, they report, Trump was agitating to slow down or halt testing because he was concerned about his job performance numbers. “Testing is killing me,” they describe him telling one adviser. “I’m going to lose the election because of testing! What idiot had the federal government do testing?” And following an outbreak on the cruise ship Diamond Princess, the authors say, Trump floated the idea of quarantining passengers in Guantanamo Bay because he hoped it would keep down case numbers in the U.S.

In the summer, with caseloads at a low, Trump ignored experts warning that a return to normalcy would mean more outbreaks ― because, Abutaleb and Paletta report, it wasn’t good for his reelection prospects. ”He couldn’t equivocate anymore,” they write. “He couldn’t be held back by the doctors and have people chirping about masks and social distancing on television. He needed to lean in hard to the idea that the pandemic was in the rearview mirror.”

Scholars will spend decades studying and debating precisely what role Trump’s leadership played in the pandemic’s toll. But it doesn’t take a dissertation to see the straight line from Trump’s downplaying of the pandemic’s severity, and his disdain for public health experts like Dr. Anthony Fauci, to the low vaccination rates in Republican-leaning parts of the country.

The irony is that vaccination could have been a Trump success story. Operation Warp Speed neglected distribution of the shots once they were manufactured. By nearly all accounts, though, the decision to purchase so much vaccine up front and coordinate the efforts of scientific agencies helped the U.S. to get the enormous supply that, eventually, would make it a world leader in vaccination.

But vaccines don’t do any good when people don’t take them. America’s fatality rate from COVID-19 is already one of the highest in the developed world. Now that rate will get higher. Already hospitalizations are rising in low-vaccination areas. The deaths that follow will be tragic, all the more so because they truly did not need to happen.