The Vaccine Class Gap

It is common to hear about two different demographic groups that are hesitant to receive a Covid-19 vaccination: Republican voters and racial minorities, especially Black and Latino Americans.

The two groups seem to have different motivations. For Republicans, the attitude is connected to a general skepticism of government and science. For Black and Hispanic Americans, it appears to stem from the country’s legacy of providing substandard medical treatment, and sometimes doing outright harm, to minorities.

These ideas all have some truth to them. But they also can obscure the fact that many unvaccinated Republicans and minorities have something in common: They are working class. And there is a huge class gap in vaccination behavior.

Here is a look at vaccination behavior by racial groups and political identification, based on polling by the Kaiser Family Foundation:

Here are those same groups subdivided by class, using a four-year college degree as the dividing line between working class and professional:

As you can see, working-class members of every group are less likely to have received a vaccine and more likely to be skeptical. “No matter which of these groups we looked at, we see an education divide,” Mollyann Brodie, who oversees the Kaiser surveys, told me. In some cases, different racial groups with the same education levels — like Black and white college graduates — look remarkably similar.

This poll did not break out Asian-Americans, but other Kaiser surveys have, and it’s consistent: Asian-Americans have a higher median income than Black, Hispanic or white Americans and also a higher vaccination rate.

All of which points to the fact that the class divide is bigger than the racial divide.

There are still differences by ethnicity, because racial inequities are a reality of U.S. life. Many Hispanic Americans, across social classes, say either that they want a shot but have not yet received one or that they are waiting to see how the vaccines affect other people. And there are even bigger differences by partisanship, with many Republicans, including professionals, skeptical of the vaccines.

But you can’t understand the country’s struggle to vaccinate everyone — and save thousands of lives — without understanding the class gap.

The ‘coming apart’

The story here is bigger than Covid-19. Last year, the economists Anne Case and Angus Deaton published a book called “Deaths of Despair and the Future of Capitalism” that documented a growing class divide in one area of American life after another.

Income and wealth have grown much more quickly over recent decades for people with a bachelor’s degree than people without one. Marriage, church attendance and self-reported happiness have declined more for the working class than the professional class; chronic pain, obesity and alcohol consumption have increased more. As the title of the book indicates, life expectancy has also diverged, partly because of deaths from alcoholism, drug overdoses and suicide.

“This B.A./non-B.A. divide,” says Deaton, a Nobel laureate, “just comes up again and again and again.”

Case and Deaton, who are Princeton professors, argue that behind these trends is a “coming apart” of the working-class experience. For many people, life lacks the structure, status and meaning that it once had.

Frequently, people are not officially employed by the company where they work, which robs them of the pride that comes from being part of a shared enterprise. They don’t belong to a labor union, either. The timing of their work shifts can change unexpectedly. Many parents are trying to raise children without a partner.

These challenges can interfere with Covid vaccination in multiple ways. Carving out the time — to do the logistical research, get the shot, cope with side effects and schedule a second shot — can be hard. Working-class Americans also have less reason to trust public health officials; if you had suffered the damaging “coming apart” of the past few decades, would you trust people in positions of authority?

After I described the vaccination trends to Case and Deaton, they sent me some broader data on life expectancy, by both race and class. It shows a significant Black-white gap. But that gap has not grown over the past decade. What has grown is the life expectancy gap between college graduates and non-graduates, among both Black and white Americans.

“Though race divisions continue,” Case said, “education is becoming more important relative to race, and perhaps that might be true for vaccinations, too.”

What to do?

The growing class divide in living standards is one of the country’s greatest problems, and it obviously will not be solved before the pandemic ends. But public health experts believe that there are specific strategies that can narrow the vaccination divide.

One is information. About 25 percent of unvaccinated people remain unsure whether somebody who previously had Covid should still get the vaccine, according to Kaiser. The answer is yes: Almost everybody 12 and older should.

Another promising strategy is making shots even more convenient. Employers can help by hosting on-site vaccinations and giving workers paid time off — including the day after the shot for people who experience side effects. Drugstores and supermarkets can accept walk-ins, as some already do. Government officials can send mobile, walk-in clinics into more communities. (Text your ZIP code to 438829 — or text “VACUNA” for Spanish — and you’ll find your local options.)

“We’ve just got to remove all the barriers,” Brodie said.

Finally, friends and relatives can turn a vaccination into something more than just a shot. “Say, ‘Let’s do this together. Let’s do something, so if you get vaccinated, let’s grab dinner after. Let’s celebrate together,’” Dr. Edith Bracho-Sanchez, a New York pediatrician, told CNN.

The U.S. is on the verge of victory over Covid. But the disease remains a threat to millions of Americans. The illness and death that occurs in coming months is likely to aggravate the country’s already extreme inequality.


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Thanks for spending part of your morning with The Times. See you tomorrow. — David

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Lalena Fisher, Claire Moses, Ian Prasad Philbrick, Tom Wright-Piersanti and Sanam Yar contributed to The Morning. You can reach the team at [email protected].

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