May 18, 2003 – States that avoided smallpox shots voted against Bush.
 

May 18, 2003, New York Times

Voting for Bush, Voting to Get a Smallpox Shot

By RICHARD PÉREZ-PEÑA

The Bush administration's program to vaccinate 500,000 medical
professionals against smallpox has been troubled, to put it kindly,
with about 36,000 people inoculated so far. Many doctors and nurses
questioned whether the vaccinations were needed or safe.

But this is no general, nationwide pattern. In some states, the
program has gone swimmingly. In others, it has barely gone along at
all. Vaccination rates range from 96.4 of 100,000 people in South
Dakota, to 0.5 per 100,000 in Nevada. In New York and New Jersey,
smallpox vaccination rates are well below the national average.

Why the differences? Have Western mountain states demonstrated their
traditional mistrust of big government? No, Wyoming has the second-
highest vaccination rate, and Idaho, Utah and Montana are in the
middle of the pack.

Are some governors more enthusiastic than others about doing the
president's bidding? Well, states with Republican governors have a
somewhat higher vaccination rate than those with Democratic governors,
but the difference is not large. Small states, big states — again, no
pattern.

But politics does offer a rough hint of how fully health care workers
have embraced the program: In states carried by Mr. Bush in the 2000
election, the vaccination rate is almost three times as high as in
states won by Al Gore.

As of May 9, according to the most recent figures compiled by the
Centers for Disease Control and Prevention, the Bush states (including
Florida) had a combined vaccination rate of 18.2 per 100,000 people,
while the Gore states (including the District of Columbia) stood at
6.8.

The pattern is not uniform, but it is strong. Of the 15 states with
the highest vaccination rates, Mr. Bush carried all but one,
Minnesota. The states Mr. Bush carried by the biggest margins tend to
have the highest rates; the ones Mr. Gore won overwhelmingly have
among the lowest.

"If you told me it was just New York lagging, I would say, well, it's
just the healthy skepticism of New Yorkers, but I'm just floored by
the idea that it's Gore states in general," said Dr. Irwin Redlener,
director of the National Center for Disaster Preparedness at Columbia
University's school of public health.

Mr. Redlener and others have argued for months that the decision to be
vaccinated was a question of national security. If there was a real
threat of a smallpox attack, they said, then of course large numbers
of people should be vaccinated. But people would have to rely on the
federal government's assessment of that threat. Is it possible, then,
that doctors and nurses make their decisions based on how well they
trust the Bush administration's assessments?

"I strongly doubt that this is a political phenomenon, rather than a
demographic one," said Alan Ehrenhalt, executive editor of Governing
magazine, which focuses on state and local government. The plains
states, he said, have "a culture of high civic participation," as
measured by things like voter turnout, so there might be "certain
places where people just do things that they're told are in their
interest."

Sure enough, three of the four highest vaccination rates are in South
Dakota, Nebraska and North Dakota. But also near the top are Wyoming,
a mountain state, and many states in the South — a region swept by Mr.
Bush — including Tennessee, West Virginia, Arkansas and Louisiana.

"Now, that would be hard to understand," Mr. Ehrenhalt said.

Of course, in the absence of a comprehensive, state-by-state survey of
medical professionals, it is impossible to know their attitudes toward
the vaccination program. Experts say that some states have done a much
more aggressive job than others of persuading people to be vaccinated
— but again, there is no obvious pattern, geographic, political or
otherwise.

And it may turn out, Mr. Ehrenhalt cautioned, that if the program
picks up steam, the apparent parallel to the 2000 election results
will evaporate.

Could be.