Excess Death Rates for Republican and Democratic Registered Voters in Florida and Ohio During the COVID-19 Pandemic

Wallace J, Goldsmith-Pinkham P, Schwartz JL. 

JAMA Intern Med. 

Published online July 24, 2023.

doi:10.1001/jamainternmed.2023.1154

Key Points

Question

Was political party affiliation a risk factor associated with excess mortality during the COVID-19 pandemic in Florida and Ohio?

Findings

In this cohort study evaluating 538 159 deaths in individuals aged 25 years and older in Florida and Ohio between March 2020 and December 2021, excess mortality was significantly higher for Republican voters than Democratic voters after COVID-19 vaccines were available to all adults, but not before. These differences were concentrated in counties with lower vaccination rates, and primarily noted in voters residing in Ohio.

Meaning

The differences in excess mortality by political party affiliation after COVID-19 vaccines were available to all adults suggest that differences in vaccination attitudes and reported uptake between Republican and Democratic voters may have been a factor in the severity and trajectory of the pandemic in the US.

The research is here.

My Take

Beliefs are a powerful force that can influence our health behaviors. Our beliefs about health, illness, and the causes of disease can shape our decisions about what we eat, how much we exercise, and whether or not we see a doctor when we're sick.

There is a growing body of research that suggests that beliefs can have a significant impact on health outcomes. For example, one study found that people who believe that they have a strong sense of purpose in life tend to live longer than those who do not. Another study found that people who believe in a higher power tend to be more optimistic and have a more positive outlook on life, which can lead to better mental health, which can in turn have a positive impact on physical health.  However, certain beliefs may be harmful to health and longevity.

The study suggest that beliefs may play a role in the relationship between political party affiliation and excess death rates. For example, Republicans are more likely to hold beliefs that are associated with vaccine hesitancy, such as distrust of government and the medical establishment. These beliefs may have contributed to the lower vaccination rates among Republican-registered voters, which in turn may have led to higher excess death rates.

Vaccination as a social contract

L. Korn, et al.

PNASJun 2020, 117 (26) 

14890-14899; 

DOI: 10.1073/pnas.1919666117

Abstract

Most vaccines protect both the vaccinated individual and the society by reducing the transmission of infectious diseases. In order to eliminate infectious diseases, individuals need to consider social welfare beyond mere self-interest—regardless of ethnic, religious, or national group borders. It has therefore been proposed that vaccination poses a social contract in which individuals are morally obliged to get vaccinated. However, little is known about whether individuals indeed act upon this social contract. If so, vaccinated individuals should reciprocate by being more generous to a vaccinated other. On the contrary, if the other doesn’t vaccinate and violates the social contract, generosity should decline. Three preregistered experiments investigated how a person’s own vaccination behavior, others’ vaccination behavior, and others’ group membership influenced a person’s generosity toward respective others. The experiments consistently showed that especially compliant (i.e., vaccinated) individuals showed less generosity toward nonvaccinated individuals. This effect was independent of the others’ group membership, suggesting an unconditional moral principle. An internal metaanalysis (n = 1,032) confirmed the overall social contract effect. In a fourth experiment (n = 1,212), this pattern was especially pronounced among vaccinated individuals who perceived vaccination as a moral obligation. It is concluded that vaccination is a social contract in which cooperation is the morally right choice. Individuals act upon the social contract, and more so the stronger they perceive it as a moral obligation. Emphasizing the social contract could be a promising intervention to increase vaccine uptake, prevent free riding, and, eventually, support the elimination of infectious diseases.

Significance

Vaccines support controlling and eliminating infectious diseases. As most vaccines protect both vaccinated individuals and the society, vaccination is a prosocial act. Its success relies on a large number of contributing individuals. We study whether vaccination is a social contract where individuals reciprocate and reward others who comply with the contract and punish those who don’t. Four preregistered experiments demonstrate that vaccinated individuals indeed show less generosity toward nonvaccinated individuals who violate the social contract. This effect is independent of whether the individuals are members of the same or different social groups. Thus, individuals’ behavior follows the rules of a social contract, which provides a valuable basis for future interventions aiming at increasing vaccine uptake by emphasizing this social contract.

The research is here.