Race, partisanship, and the distinctiveness of vaccine hesitancy in health care attitudes

Partisanship has served a dominant role in influencing public opinion on health reform in the United States in the past decade. Republicans are significantly less supportive than Democrats of expanding the Affordable Care Act and implementing broader government insurance provisions. With the onset of the pandemic, partisan divisions have also spilled over into polarized attitudes on public health measures to curb the spread of COVID-19 and vaccine uptake. The influence of partisanship should not be overstated, however, particularly when examining public opinion across racial groups. Black Americans were among the strongest proponents of health reform during the passage of the Affordable Care Act, and they remained strong supporters of Democratic-led proposals to expand health insurance access and of many public health measures to curb the spread of COVID-19. But high levels of Democratic partisanship alone cannot explain the dynamics of Black public opinion on vaccination, an issue for which Black Democrats consistently show more skepticism than white Democrats. Using multiple sources of nationally representative survey data from 2016 to 2022, this study illustrates how self-interest and racialized experiences with the government and the health care system help explain the distinctive racial divide in vaccination attitudes.