People who identify with the political right are less likely to be vaccinated and more likely to believe misinformation about vaccines.

Ted S.Warren/AP

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Ted S.Warren/AP

People who identify with the political right are less likely to be vaccinated and more likely to believe misinformation about vaccines.

Ted S.Warren/AP

Even with widely available vaccines and new effective treatments, residents of counties that voted heavily for Donald Trump in the last presidential election are more than twice as likely to die from COVID-19 than those living in areas that voted for President Biden to have. That’s according to a newly updated analysis by NPR, which examines how partisanship and misinformation are shaping the pandemic.

NPR looked at COVID deaths per 100,000 people in roughly 3,000 counties across the US as of May 2021, when most Americans could find a vaccine if they wanted one. Those living in counties that voted for Trump by 60% or more in November 2020 had a 2.26 times higher death rate than those who went for Biden by the same margin. Counties with a higher proportion of Trump votes had even higher death rates.

The level of avoidable loss of life is staggering. According to a recent analysis by Brown University, Nearly 320,000 lives could have been saved nationwide if more people had chosen to get vaccinated. The Brown analysis also reveals a partial split in how these preventable deaths are distributed. States that voted most strongly for Trump — including Wyoming and West Virginia — have some of the highest rates of preventable deaths, while states that voted heavily for Biden — like Massachusetts and Vermont — were among the lowest.

“How you vote shouldn’t predict whether you will die from COVID,” says Jennifer Nuzzo, an epidemiologist at Brown University School of Public Health. The social causes of the split are complex, but the immediate reason is quite simple: Trump-leaning counties have far lower vaccination rates than those that have voted for President Biden. NPR’s analysis showed the gap was 21 points, with 81% of adults in strong Biden counties vaccinated, compared to 60% of adults in pro-Trump counties.

According to the CDC, vaccinated people are 10 times less likely to die from COVID-19 infection than unvaccinated people.

Nuzzo says she sees the partisan divide over COVID deaths as one of the biggest public health messaging failures of this pandemic. “Public health advice on vaccines often says, ‘Talk to your doctor,'” says Nuzzo. But many people don’t have one.

Meanwhile, pro-vaccination advocates have found new audiences on social media, often by fueling conspiracy theories from the political right. Trusted conservative sources of information tend to have far higher misinformation about vaccines than liberal sources. “It’s difficult for people to find the facts, especially when they belong to a certain political persuasion,” she says.

Political affiliation remains the biggest predictor of vaccination status, says Liz Hamel, director of public opinion and survey research at the Kaiser Family Foundation, a nonpartisan think tank. About 90% of Democrats say they are vaccinated, compared to just 55% of Republicans. Additionally, Hamel says 37% of Republicans now say they definitely won’t get vaccinated. “It seems that the attitude of those who have chosen not to get vaccinated is hardening,” she says.

Hamel says previous polls have shown that belief in misinformation is highly correlated with not being vaccinated. Kaiser examined several common misinformation such as the idea that the government is exaggerating the severity of the pandemic or that the vaccines contain a microchip. Kaiser’s poll found that 94% of Republicans believed one or more false statements about the vaccines.

“There was some evidence that people who trusted conservative news media for COVID information were more likely to believe misinformation than those who trusted more mainstream news sources,” Hamel says.

Despite these factors, the death gap between pro-Trump and pro-Biden districts narrowed slightly from 2.73 to 2.26 over the winter.

According to William Hanage, an epidemiologist at Harvard University, this was probably mainly due to the Omicron variant. Hanage says Omicron is much more effective at evading masks and other measures to prevent infection. “Before Omicron, actions people took, like wearing masks in schools, had a really significant impact,” he says. “After Omicron, they have far less.”

The variant’s high portability likely allowed Omicron to reach communities in more democratic parts of the country that were previously able to protect themselves. Nuzzo also suspects that the narrowing gap is partly due to older Americans of all political persuasions not getting a booster shot, even when eligible. According to Kaiser’s most recent data, 30% of Americans age 65 and older remain unboosted. “It’s a huge factor,” she says.

Nuzzo and Hanage both say they expect the gap in deaths by political affiliation to narrow over time. The more Americans who survive COVID infections, the less likely they are to die from subsequent bouts of COVID. But Nuzzo says new people are being born every day and others are aging into different risk categories. Vaccination is likely to remain an important tool to combat COVID in the future. “The fact that we didn’t get to the bottom of this hesitation,” she warns, “presents us with bigger problems.”

And Hanage foresees even deeper problems if a subset of far-right politicians are willing to “take vaccines and make them a wedge issue for political gain.” He fears that deeply Republican parts of the country will soon begin rejecting essential childhood vaccines like measles, mumps and rubella, which prevent outbreaks of other infectious diseases. “It’s part of the long-term damage that comes when politicians try relentlessly to denigrate it and turn it into political football,” he says.


COVID-19 deaths per 100,000 population are calculated by dividing the total cumulative deaths from COVID-19 by county or county population. The population data of the county come from the The 2020 US Census Bureau decennial census.

The line chart is a calculation of the cumulative COVID-19 deaths per 100,000 population since March 1, 2020 in the three analyzed groups: counties that voted heavily for Donald Trump in 2020, counties that voted heavily for Joe Biden in 2020, and the overall average. Dates of death are collected by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University and are current as of May 18, 2022.

The scatter plot shows the COVID-19 deaths per 100,000 population by county since May 1, 2021. May 1, 2021 was chosen as the start date of our analysis as this is approximately when vaccines for adults 18 and older will be widely available became. Death data is also from Johns Hopkins University, except for Utah, Ohio, and Missouri data, which is from the CDC Community Profile Reportproduced by the White House COVID-19 team.

The immunization rate data is the rate of complete vaccination for all persons 18 years and older as of May 18, 2022. It is from the Centers for Disease Control and Prevention.

The 2020 election results data is from MIT election data and science lab.

Nebraska, Hawaii, and Alaska were excluded from all analyzes due to insufficient data.

All averages are weighted by district population. A total of 3014 counties are used in this analysis.

Thanks to Beth Blauer of the Centers for Civic Impact at Johns Hopkins University for discussions on our methodology.

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