Body Politic: The Political Divide in Vaccine Uptake. A County-Level Analysis of COVID-19 and Flu Vaccination Rates Across the United States

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Abstract
Purpose: To examine the relationship between political county-level partisanship and COVID-19 and flu vaccination uptake in the United States following the 2020 and 2024 presidential elections. Design: Ecological, cross-sectional analysis utilizing public datasets. Setting: All 3224 US counties and county equivalents. Sample: Data includes 3224 counties; 3192 had complete COVID-19 vaccination data, and 3125 had complete flu vaccination data. Measures: Dependent variables were county-level flu and full COVID-19 vaccination rates. Independent variables included 2020 and 2024 GOP vote share, median household income, education, healthcare access, and county-level health indicators. Analysis: Spearman correlation, independent t-tests, and multivariate linear regressions. Results: GOP vote share is strongly negatively correlated with COVID-19 vaccination ( r = −.699, P < .001) and moderately with flu vaccination ( r = −.427, P < .001). Counties in the highest GOP quartile had significantly lower vaccination rates than Democratic quartile counties (COVID-19: 45% vs 60%, t = −39.64, P < .001; flu: 35% vs 46%, t = −23.10, P < .001). Each percentage-point increase in GOP vote share is associated with a 0.45% decrease in COVID-19 uptake in 2024 ( β = −.449, P < .001) and a 0.13% decrease in flu uptake ( β = −.128, P < .001), independent of socioeconomic controls. Conclusions: Partisan alignment has become a significant determinant of vaccination, with the divide persisting between 2020 and 2024. Findings underscore the need for localized, depoliticized public health strategies.

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