Document Type

Article

Publication Date

2025

DOI

10.3389/ijph.2025.1608162

Publication Title

International Journal of Public Health

Volume

70

Pages

1608162

Abstract

Objectives: To investigate whether the 2021 U.S. presidential inauguration contributed to a widening of partisan divides in COVID-19 vaccine attitudes and uptake. Methods: We leverage the presidential inauguration as a natural experiment and analyze data from the Household Pulse Survey and CDC vaccination records. Using a difference-in-differences framework with continuous treatment, we examine how the transition differentially affected state-level vaccine refusal rates and county-level vaccination rates, based on varying levels of partisanship as measured by the Trump-Biden vote gap. Results: Following Biden's inauguration, vaccine refusal declined more in pro-Biden states. Distrust in government and vaccines accounted for approximately 80% of the interstate variation. County-level analysis revealed that for every 1 percentage point increase in Trump's vote share over Biden's, counties experienced an additional 0.515%-2.674% decline in vaccination rates among adults aged 65+. These effects were more pronounced in politically loyal and high-turnout counties. Conclusion: The presidential transition appears to have widened partisan divides regrading COVID-19 vaccines. These findings highlight the need for depoliticized health messaging and bipartisan strategies to mitigate the influence of partisanship on public health.

Rights

© 2025 Fan, Zhou, Liu, Shen, and Zhang

This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

Original Publication Citation

Fan, H. B., Zhou, Z. L., Liu, G. P., Shen, C., & Zhang, Q. (2025). Politics in public health: Growing partisan divides in COVID-19 vaccine attitudes and uptake post-2021 presidential inauguration. International Journal of Public Health, 70, 1-10, Article 1608162. https://doi.org/10.3389/ijph.2025.1608162

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