Rural vaccine resistance goes beyond politics and media, to class, access and distrust of system that has let them down

The resistance of many rural Americans to coronavirus vaccines is often attributed to their politics (support of Donald Trump) or their media habits (skepticism of science), but it has deeper, wider roots, Timothy DeLizza writes for Undark, which defines itself as a foundation-funded "non-profit, editorially independent digital magazine exploring the intersection of science and society."

"Many poor, rural whites have legitimate reasons to distrust the health care system — and real barriers to access," Undark says in its subhead on DeLizza's story, which says, "Vaccine hesitant conservatives are also disproportionately rural. This creates unique access problems, including shortages of health-care workers to administer the vaccines and long driving distances to vaccination sites."

Also, "Class is far more predictive of vaccine hesitancy than either politics or race, with working-class white people being twice as likely to be hesitant as White college graduates," DeLizza reports, citing polling by the Kaiser Family Foundation. 

"Poor White people expressing hesitancy typically have strong religious beliefs, face disproportionate economic and access barriers to vaccination, and have legitimate reasons to mistrust the medical system," DeLizza writes. "Historically, the same sterilization programs that the Nation of Islam members evoke also purposefully targeted poor white people. When Justice Oliver Wendell Holmes Jr. wrote “Three generations of imbeciles are enough” in a [1927] Supreme Court ruling upholding Virginia’s involuntary sterilization law, he was describing a poor White woman with no mental impairment."

Screenshot of top part of NYT graph; click to enlarge. For interactive version, click here.

DeLizza also notes the opioid epidemic, which was disproportionately rural and caused by elements of the health-care system "pushing painkillers like OxyContin," and has left a legacy of distrust. The health-care analytics firm Surgo Ventures found that "Arkansas, the state with the most 'Covid skeptics' . . . "is second in the nation in dispensing opioids. Other states such as Alabama and Louisiana also significantly exceed the national average on both lists," DeLizza reports. (Surgo's research and the Kaiser polling were reported in May in The New York Times.)

DeLizza concludes, "The suspicions felt in Black and brown communities likely aren’t all that different from the suspicions felt by white people. In each case, focusing on outlandish vaccine conspiracy theories glosses over genuine underlying concerns. In each case, vaccine hesitant Americans are being asked to take a drug developed at unprecedented speed under unfathomable pressure using novel techniques based on short-term studies. Taking such a vaccine requires trust in the medical system and in society more broadly. Most unvaccinated groups have been let down by both."