Vaccine interest higher among Whites and Hispanics, wealthier households, and Democrats

This is the latest product from the Tufts Research Group on Equity in Health, Wealth, and Civic Engagement, which I co-lead; and I did some of this analysis.

MEDFORD/SOMERVILLE, Mass. (July 9, 2020)—Despite widespread agreement among experts that having a prophylactic COVID-19 vaccine will be critical to the nation’s ability to safely return to some form of normalcy, only 57% of Americans say they would get a COVID-19 vaccine if it were available today, according to a national survey designed and analyzed by Tufts University’s Research Group on Equity in Health, Wealth and Civic Engagement.

The nationally representative survey also uncovered significant variations in vaccination acceptance by race/ethnicity, household income, educational background and party affiliation. Whites and Hispanics, Democrats, those with more formal education, and those with higher incomes reported being more likely to get vaccinated than Blacks, Republicans, those with less education, and those with lower incomes. Fully one-quarter of respondents said they didn’t know if they would get the vaccine, possibly indicating the need for more public health education and information.

 “It’s really concerning that only 57% of our respondents said they would get vaccinated. It’s evident that we need to begin working on a national vaccine strategy and education campaign right now– even before we have the vaccine in hand,” said Jennifer Allen, professor of community health in Tufts University’s School of Arts and Sciences and co-leader of the study. “There is still some uncertainty, but some studies show that we need between 60 and 70% of the population to be vaccinated in order to confer herd immunity.”

There has been growing resistance to all vaccines in the U.S. over the past decade, which has led to reduced compliance with vaccine recommendations and the re-emergence of diseases like measles and mumps, which were previously well-controlled. Growing anti-vaccination sentiment has been fueled by misinformation about vaccines, including the widely de-bunked theory that vaccines could cause autism.

Whites and Hispanics more likely to vaccinate

The study also revealed marked differences of opinion toward vaccination across racial groups, with 58% of non-Hispanic whites and Hispanics reporting they would get the vaccine as compared with 48% of non-Hispanic Blacks.

“The pandemic has disproportionately affected Black individuals,” said Allen. “The lower level of vaccine acceptance within this population is worrisome, as it suggests the vaccine could further exacerbate COVID-19 racial/ethnic disparities. Given the legacy of medical experimentation on African Americans, there is understandable mistrust in medical science and in government.

“The accelerated time-frame for vaccine development and testing could further raise concerns about the safety and efficacy of an eventual vaccine,” Allen continued. “Targeted efforts will be needed to make sure that a vaccine doesn’t further widen the gap in health outcomes.”

Income and education plays factor

Surprisingly, those with higher levels of income and education were more likely to report that they would get the COVID-19 vaccine. “Historically, those most likely to refuse vaccines have been those with higher levels of income and education,” said Allen.

Among those with incomes less than $20,000, only 41% said they would get the vaccine, compared with 72% among those with incomes of $150,000 or more. Less than half of those with a high school education or below said they would get the vaccine, compared with 74% among those who had a college education.

Differences across political parties

Sharp polarization by political party affiliation also emerged in the responses. Willingness to be vaccinated was highest among Democrats (71%) compared with Independents (61%) and Republicans (47%).

“Differences between political parties are striking. As with many aspects of the pandemic, vaccination is a highly partisan issue,” said Peter Levine, an associate dean at Tufts’ Tisch College of Civic Life. “The partisan gap may pose an obstacle to widespread vaccination.”

While public health officials, clinicians and pharmaceutical companies race to develop a COVID-19 vaccine, it is evident that, should a successful vaccine become available, distribution and administration will need to be accompanied by health communication, promotion and education campaigns,” said Tom Stopka, an infectious disease epidemiologist and associate professor with the Tufts University School of Medicine, and a co-leader of the study. “Such campaigns can help to increase understanding of how the vaccine will work, decrease doubts and mistrust of local, state, and federal officials, and potentially demonstrate that the benefits of the vaccine far outweigh the risks.

“The U.S. population has been overwhelmed with COVID-19 information and stress, as well as massive changes to their day-to-day lives,” added Stopka. “When and if a vaccine becomes available, and has been thoroughly tested in human populations, it will be necessary to also develop a massive public health communication campaign to provide community members with the information they need to make an informed decision to protect themselves, and to protect their families and local communities.”

The survey was fielded online by Ipsos using its KnowledgePanel. The sample was nationally representative, and the number of complete responses was 1,267. More technical information about the survey is at https://equityresearch.tufts.edu/the-survey/.

Tufts University’s Research Group on Equity in Health, Wealth and Civic Engagement was established in 2019 as part of a strategic effort to use resources and expertise of Tufts campuses and schools to address major global issues. It brings together researchers from across the university to discuss and investigate aspects of equity and inequity in the United States and the world. The research has been funded by Tufts University’s Office of the Vice Provost for Research as one of several such initiatives. 

The group’s principal investigators are Allen, Levine and Stopka. Other members of the group can be found here. 

By September 2020, the Research Group will launch a website at https://equityresearch.tufts.edu that will allow anyone to explore numerous dimensions of equity and inequity with an interactive data-visualization tool. Tufts’ Jonathan M. Tisch College of Civic Life is funding the data-visualization tool.

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About Tufts University

Tufts University, located on campuses in Boston, Medford/Somerville and Grafton, Massachusetts, and in Talloires, France, is recognized among the premier research universities in the United States. Tufts enjoys a global reputation for academic excellence and for the preparation of students as leaders in a wide range of professions. A growing number of innovative teaching and research initiatives span all Tufts campuses, and collaboration among the faculty and students in the undergraduate, graduate and professional programs across the university’s schools is widely encouraged.

I’m one of those who already knew the music and lyrics of Hamilton extremely well but watched a performance of it for the first time this weekend on video.

I hadn’t realized how consistently Aaron Burr (Leslie Odom Jr.) appears on stage or even dominates it. I understood the plot but didn’t appreciate the strength of Burr’s presence. Specifically, I had missed scenes that emphasize his parallels with Hamilton, such as when the two men split the stage to sing love songs to their infants.

The musical as a whole is about who gets to tell the story. At the end, George Washington and the company sing, “Who lives / Who dies / Who tells your story?” Burr asks, “But when you’re gone, who remembers your name? / Who keeps your flame?” Angelica and the women of the company echo his question: “Who tells your story?” The women say, “Eliza,” and she begins, “I put myself back in the narrative.”

Washington has skillfully controlled his own story by exiting voluntarily and leaving a farewell address (written by Hamilton). Burr is the one who narrates Hamilton’s story for us, but he plays his cards so badly that he makes himself into the villain. Hamilton is obsessed with his own reputation; his efforts to safeguard it are one source of his own destruction. Eliza takes herself out of the narrative and then puts herself back in, using her 50 remaining years after Hamilton’s death to become a public historian. And Lin-Manuel Miranda turns Hamilton’s life into the material for his own art, thus becoming the one who really tells the story.

One general implication is that politics generates the noblest stories. We should want to be in the Room Where it Happens because then we can engage with other people, not as friends but as equals, and make something public and lasting together. This is high drama. It is possible only in a republic or in a revolutionary struggle to make a republic. Of course, Burr’s tragedy is that he can’t get in.

I think that Hamilton is the best fictional evocation of the intrinsic value of politics–politics not as a necessary means to some end but as a venue for drama and excellence. It also rescues the American story by treating our republic as an ongoing project to which anyone can contribute.

[HAMILTON]

Legacy. What is a legacy?
It’s planting seeds in a garden you never get to see
I wrote some notes at the beginning of a song someone will sing for me
America, you great unfinished symphony, you sent for me
You let me make a difference

Another general point is that Miranda has appropriated the founding history. He has taken it as his material and turned it into something original that exemplifies his own culture. To be sure, any culture is layered, internally diverse, and vaguely bounded. Lin-Manuel Miranda and the original Alexander Hamilton actually share some aspects of culture as their common birthright. But the musical (lyrics, plot, music and cast) surely reflect a racially diverse 21st century New York City and a base in hip hop that are distant from Hamilton.

In this case, cultural appropriation is great. It is an impressive power move and a creative act. That reinforces my view that cultural appropriation is not an intrinsic problem at all. It simply depends on who appropriates whom for what. Appropriation is a political act, and politics can be noble.

See also Hannah Arendt and Lin-Manuel Miranda; ambition: pro or con?; Arendt, freedom, Trump; taking satisfaction from politics in the face of injustice; a welcome talk for college interns newly arrived in Washington; what is cultural appropriation?; and diversity, humility, curiosity

Here is Michel Foucault’s definition of “spirituality”:

… I think we could call “spirituality” the search, practice, and experience through which the subject carries out the necessary transformations on himself in order to have access to the truth. We will call “spirituality” then the set of these researches, practices, and experiences, which may be purifications, ascetic exercises, renunciations, conversions of looking, modifications of existence, etc., which are, not for knowledge but for the subject, for the subject’s very being, the price to be paid for access to the truth. Let’s say that spirituality, as it appears in the West at least, has three characteristics.

[1] Spirituality postulates that the truth is never given to the subject by right. … It postulates that for the subject to have right of access to the truth he must be changed, transformed, shifted, and become, to some extent and up to a certain point, other than himself. … It follows that from this point of view there can be no truth without a conversion or a transformation of the subject.

[2] Eros [the subject’s attraction to the truth, or the truth’s movement to the subject] and askesis [labor] are, I think, the two major forms in Western spirituality for conceptualizing the modalities by which the subject must be transformed in order finally to become capable of truth.

[3] The truth enlightens the subject; the truth gives beatitude to the subject; the truth gives the subject tranquility of the soul. In short, in the truth and in access to the truth, there is something that fulfills the subject himself, which fulfills or transfigures his very being.

Foucault, The Hermeneutics of the Subject, Lectures at the College de France 1981-2, translated by Graham Burchell (Palgrave, 2005), pp. 15-16

Foucault distinguishes spirituality from philosophy: “the form of thought that asks what it is that enables the subject to have access to the truth and which attempts to determine the conditions and limits of the subject’s access to the truth” (p. 15).

Although philosophy and spirituality are different, all the Greek and Roman philosophers–except (Foucault thinks) Aristotle–believed that a person could not have access to the truth without first being transformed into a better self. Therefore, all the classical philosophers argued for spirituality, as defined above. More than that, they combined their philosophical arguments with spiritual instruction, because they saw the two as inseparable.

One of the main topics that a self was supposed to understand was justice. To understand justice required improving oneself. In turn, learning about justice made a person better. “Consequently, taking care of oneself and being concerned with justice amount to the same thing” (p. 72, here interpreting Plato).

These presuppositions of ancient philosophy and spirituality contrast with two prevalent modern traditions. First:

• Science is that set of methods and institutions (such as labs, PhD programs, and peer-review) that allow us to know nature without having to improve the self first. A scientist “can recognize the truth and have access to it in himself and solely through his activity of knowing, without anything else being demanded of him and without him having to change or alter his being as subject” (p. 17). In turn, science generates knowledge that may not improve anyone spiritually. Nature is precisely the realm that is independent of our spiritual condition. If some scientists prepare themselves mentally to do their jobs or gain tranquility from what they discover about nature, those are incidental facts about them as people. Spiritual preparation may not be necessary, and it certainly isn’t sufficient. Science is about methods, techniques, instruments, rules, and norms that prevent the self from influencing knowledge. And science pursues truth without flinching even when the results are morally problematic.

I would add another tradition as a contrast with ancient spirituality, although I am not sure Foucault would agree:

• Liberalism is the political tradition that seeks to base good government on well-designed institutions (rights, checks-and-balances, elections and other mechanisms of accountability) so that good government need not depend on the moral excellence of either leaders or the people. Good institutional design is a more secure basis for justice than human excellence. Further, in a well-designed polity, we can leave people alone in their private lives instead of badgering them to transform themselves. Thus liberalism is compatible with freedom as autonomy and with diverse understandings of the good life.

According to Foucault, classical spiritual traditions lived on in Christianity. Spirituality ran into trouble with the rise of scholasticism, which made the study of God into a kind of science. Drawing on Aristotle, medieval scholastics provided methods for understanding God and nature that did not depend upon spiritual self-improvement. They left methods of self-improvement to non-scholars, a division that continues today.

I struggle to decide where Foucault stands himself. Does he give detailed lectures about Greco-Roman spiritual traditions because he believes that modern science and governance are bad and he wants us to return to a better way? Does he describe these Hellenistic traditions dispassionately, as a contribution to truth that may not improve us or himself? (In other words, is he a scientist of the past?) Or does he seek to liberate us from spirituality and science by demonstrating the historical contingency of both? If we shed spirituality and science, what are we left with?

I don’t know, but I enjoy the moments in the lectures when Foucault interacts with his audience. For instance, here he demonstrates concern:

[Is there] another room you can use? Yes? And are those people there because they cannot get into the other room or because they prefer to be there? I am sorry that the conditions are so bad, I can do nothing about it and as far as possible I would like to avoid you suffering too much. Okay, earlier, while talking about these techniques of the self and their existence prior to Platonic reflection on the epimeleia heautou [care of oneself], it came to mind, and I forgot to mention it to you, that there is a text … (p. 65)

And here he is playing with his audience:

I was saying that it seemed to me that at a certain moment … the link was broken, definitively I think, between access to the truth, which becomes the autonomous development of knowledge (connaissance), and the requirement of the subject’s trans- formation of himself and of his being. When I say “I think it was definitively broken,” I don’t need to tell you that I don’t believe any such thing, and that what is interesting is precisely that the links were not broken abruptly as if by the slice of a knife (pp. 25-6).

Foucault respected and learned from his colleague Pierre Hadot, a great scholar of Hellenistic thought. Hadot emphasized that the Hellenistic thinkers did not write systematic treatises. They were teachers who worked with students or other audiences in concrete circumstances.

Philosophy in antiquity was a spiritual exercise. … Whether we have to do with dialogues as in the case of Plato, class notes as in the case of Aristotle, treatises like those of Plotinus, or commentaries like those of Proclus, a philosopher’s works cannot be interpreted without taking into consideration the concrete situation which gave birth to them. They are the products of a philosophical school, in the most concrete sense of the term, in which a master forms his disciples, trying to guide them to self-transformation and -realization. Thus, the written work is a reflection of pedagogical, pyschagogic, and methodological preoccupations.

Although every written work is a monologue, the philosophical work is always implicitly a dialogue. The dimension of the possible interlocutor is always present within it. This explains the incoherencies and contradictions which modern historians discover with astonishment in the works of ancient philosophers.

Hadot, Philosophy as a Way of Life, translated by Michael Chase (Blackwell 1995), pp. 104-5

Foucault’s concrete situation was rather unusual. As a holder of a chair in the College de France, he was required only to conduct his own research and report the results annually in a series of lectures–free, public, and uncredited. Because he was an academic superstar, he gave these lectures to a packed lecture hall and overflow areas, with ranks of tape-recorders piled on the desk before him. The audience could not literally discuss with him, but he could address them in a dialogic way.

Here is Foucault’s description of Epictetus:

unlike Seneca, [Epictetus] is a teacher by profession [and] he really does have a school. He opens a school which is called “school” and in which he has students. And, of course, among his students there are a number, no doubt a considerable number, of young people who come to be trained. … It should not be thought that the care of the self, as principal axis of the art of life, was reserved for adults. But alongside this, intertwined with this training of young people, we can say that in Epictetus’s school there is also what could be called, employing an unjust metaphor no doubt, an open shop: an open shop for adults. And in fact adults come to his school to hear his teaching for one day, for a few days or for some time. Here also, in the social world evoked in the Discourses, you see, for example, a town inspector passing through, a sort of tax procurer if you like. He is an Epicurean who comes to consult Epictetus and ask him questions. There is a man sent to Rome by his town who, passing through Asia Minor to Rome, stops to ask Epictetus questions and get advice on how he can best accomplish his mission. Moreover, Epictetus by no means disregards this clientele, or these adult interlocutors, since he advises his own students, young people therefore, to find prominent people in their town and to shake them up a bit by saying: Tell me then, how do you live? Do you really take proper care of yourselves? (p. 90)

I think Foucault’s own role is similar. And that makes him–not a scientist of history–but a practitioner and provider of spiritual exercises.

See also Philosophy as a Way of Life (on Pierre Hadot); does focusing philosophy on how to live broaden or narrow it?;  Hannah Arendt and philosophy as a way of life; Kieran Setiya on midlife: reviving philosophy as a way of life; science, UFOs, and the diminishment of humankind; notes on the social role of science: 1. the example of fetal ultrasounds.