Vermont and Wyoming
Vermont has the nation’s highest vaccination rate — 72.4%
Wyoming has a rate that is well below average — 38.2%
Why such a big difference? These states rank number 49 and 50 in population. Both states are lacking in big urban areas. Both states are overwhelmingly white, with relatively few minorities. At the same time, there are obviously huge cultural differences between the two states.
It’s also worth noting that Vermont has the lowest Covid fatality rate among the lower 48 states. Wyoming’s fatality rate isn’t that bad, but is 2 1/2 times worse than Vermont, and also far worse than states like Utah, Washington and Oregon.
I’d be surprised if Vermont’s high rate of vaccination was unrelated to its low Covid fatality rate. Perhaps both facts are related to Vermont’s culture. Perhaps Vermonters are risk averse people who “trust the science”. Here are two counterarguments for my claim:
1. Vaccination rates are high throughout the Northeast, and yet many northeastern states have high Covid fatality rates.
2. Perhaps culture doesn’t explain the low vaccination rates, rather in places with higher infection rates there is less vaccination because many people already have have natural immunity from previous exposure. They don’t believe they need to be vaccinated.
Of course, the second point in is tension with the first. Lots of people in Massachusetts have been exposed to Covid (far more than in Wyoming), so why such a high vaccination rate in Massachusetts?
In the Northeast, the worst Covid wave was during the spring of 2020, before many people realized the severity of the pandemic. In addition, those areas are densely populated. (Even indoors. I find that shopping in Mission Viejo is much less crowded than back in Boston.)
My best guess is that cultural differences explain the Vermont/Wyoming discrepancy in vaccination rates. This FT story has “nudge” suggestions for encouraging vaccination from behavioral research.
PS. Biden got 66.1% of the vote in Vermont, highest of any state in the country. In 1936, Alf Landon got 56.4% of the vote in Vermont, highest of any state in the country.
Vermont is weird.
PPS. Here’s a Yahoo story on Wyoming:
Some public health officials have resigned themselves to the reality that many in their community will not budge on shots.
In Wyoming’s Sweetwater County, population 44,000, authorities are at a loss for what else they can do to achieve herd immunity.
Sweetwater carries the unfortunate distinction of being the county with the steepest increase in infections in the state with the most new infections per capita in the country. Only a quarter of its residents are fully vaccinated, and public health officials don’t see the number budging much higher.
Jean Stachon, Sweetwater County’s health officer, said officials held mass clinics, brought vaccine doses to employers and churches and accept walk-ins at the public health office. They have sacrificed extra doses in a vial to vaccinate at least one person. But demand is minimal, even as the virus still looms in the community. Two people died of covid-19 in the last week. Eight emergency room patients were diagnosed with coronavirus in one night.
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15. June 2021 at 12:36
We should remove federal and state funding of Covid-19 treatment for people who aren’t vaccinated. That will alter the cost/benefit calculus of people deciding to not be vaccinated.
On top of this, we can legislate that insurance providers don’t have to cover Covid-19 treatment.
Society shouldn’t be shouldering the burden of a pound of cure when an ounce of prevention is available.
The solution is fair in that people can still choose to not get vaccinated — they simply bear the some of the costs of that choice. They still don’t bear negative externalities such as infecting others, but it’s a significant step forward.
15. June 2021 at 13:00
Frank, I sympathize with your frustration over low rates of vaccination, but I doubt your proposal is feasible. One could make the same argument for public funds treating lung cancer victims who choose to smoke, or other examples like diabetes victims with bad eating habits.
It might be more feasible to use the “carrot” approach, lottery prizes to those who get vaccination, etc.
I use scare quotes for “carrot” because economists understand that there is no difference between carrots and sticks (taxpayers pay for the carrot). But 99% of people see a big difference between the two.
15. June 2021 at 13:14
Scott, we don’t have vaccines for smoking, diabetes, or bad eating habits. We have a vaccine for Covid-19, and it’s cost efficient in monetary and time dimensions for both the provider and receiver.
15. June 2021 at 13:16
I’m not the one you have to convince. If I had my way, I’d get the government out of healthcare entirely, or almost entirely.
15. June 2021 at 13:26
Honestly, I don’t understand how this isn’t the best nudge. We have a vaccine that is cheap on many fronts. If people aren’t willing to protect at least themselves, we shouldn’t be covering expenses from their decision.
Imagine the government paying your liability bills if you got into an auto accident because you didn’t purchase liability insurance. Similiar thing, except a vaccine is much cheaper than liability insurance.
If someone isn’t willing to pay the small cost of receiving a vaccine (insurance), society shouldn’t need to support the long-tail costs of that decision.
15. June 2021 at 16:34
At least in MA, the fall COVID wave was worse that the spring in terms of infections, but not in terms of hospitalizations and deaths.
15. June 2021 at 16:52
Frank, I’m not saying it’s necessarily a bad idea, I just don’t see it happening.
Maybe others can respond, if my political instincts are off base here.
David, Yeah, that’s because cases were massively undercounted in the spring of 2020. Fatality rates are a more accurate indicator.
16. June 2021 at 03:35
There appears to be a fair amount of correlation between Trump voters and not getting vaccinated. For example, https://www.nytimes.com/interactive/2021/04/17/us/vaccine-hesitancy-politics.html
There may of course be confounding factors.
16. June 2021 at 05:31
As foosion noted, there’s really no mystery. To suggest that vaccine hesitancy is anything other than a result of party affiliation is ignoring Occam’s Razor. Don’t forget Trump himself secretly got the vaccine and didn’t let anyone know for months, presumably because it would look bad for political reasons.
https://today.yougov.com/topics/politics/articles-reports/2021/05/06/one-five-americans-continue-refuse-covid-19-vaccin
16. June 2021 at 07:48
Frank –
1) Vaccine hesitancy does not correlate strongly to party affiliation: https://www.kff.org/coronavirus-covid-19/issue-brief/latest-data-on-covid-19-vaccinations-race-ethnicity/
2) The Orange Man has been pushing the effectiveness of vaccines for well over a year at this point (even trying to take credit for the development and distribution). So your point makes absolutely no sense at all. In fact, please look to every single party leader in the democratic party leading up to the election (Joe Biden, Kamala Harris, Nancy Pelosi, Chuck Schumer) who all claimed they would be hesitant or would NOT get a vaccine that was developed under the Trump Administration.
The data consistently show that the gaps in vaccination are predominantly found in the African American and Hispanic demographic which overwhelmingly vote democrat.
I imagine there is a FAR higher correlation between wealth & vaccine hesitancy (higher wealth–> higher likelihood of getting the vaccine) as well as education level and vaccine hesitancy. I think this would be a far more interesting area to research rather than sticking w/ the typical tribal lines.
16. June 2021 at 08:06
“1. Vaccination rates are high throughout the Northeast, and yet many northeastern states have high Covid fatality rates.”
You need to normalize for death rates early in the pandemic vs later in the pandemic. Death rates dropped by 30%-50% for hospitalized patients. Adjust the death rates in the NE down to what they became by June last year and then the death rates for the NE are in the middle of the pack. (We (my institution) had death rates cut significantly by April/May but I would use June because by then I think protocols were pretty widely spread. People largely gave up treats,ents that didnt work or were harmful and did the few things that helped.)
Steve
16. June 2021 at 09:05
Tom, It’s true that blacks and Hispanics are less likely to be vaccinated, but that also seems to be true of Republicans. Both statements can be true.
Steve, Good point.
16. June 2021 at 10:14
I prefer Government to be almost completely out of healthcare too. I do not understand the thought process of Frank T. Let’s punish states who do not obey by force. Is it much different than requiring states to have a perfect BMI score—simply because there is no vaccine? This all would resolve itself to Frank’s liking if we let markets determine healthcare—-and people would pay for their own behavior. That will never happen of course. But we do not need more “force”.
16. June 2021 at 11:27
Perhaps you need to watch more Longmire, it’s weird you find Vermont the weird one and not Wyoming.If you mapped the world and offered vaccines everywhere I’m pretty sure the SE states and places like Wyoming would stand far apart.
I’m shocked by the degrees – Alberta a province that is proximate to Wyoming geographically and also with similar mindsets has a 69% first dose vaccination rate. Canada’s rate is quite consistent across all the provinces. I haven’t seen demography data, I doubt that would be available.
As an outsider and without having studied the data, it appears to be associated mainly with education levels and party affiliation.
Where I’m from the hesitance is often with people that read something scary on some blog or what not. Again the degree of hesitancy in these states is just staggering.
16. June 2021 at 17:22
Could population density be a factor on vaccination rate? Wyoming = 6 people/sq mile. Vermont = 68 people/sq mile.
Or maybe the number of Walgreen’s + CVS matters? Wyoming = 12, Vermont = 41.
What seems to be the common denominator is the extent to which people distrust government. Left, right and minorities tend to be the groups that fall into that category and tend to be the pockets with lowest vaccination rates. Every time I go in the grocery store, they are announcing that they have vaccine available in pharmacy and are giving away free gift cards with vaccination. That sounds like a good incentive.
Not sure on the fatality rates, but people in northwest tend to have healthy hobbies like biking, running, hiking, and mountain climbing. Not sure how popular those activities are in the northeast.
16. June 2021 at 20:39
Tom M: You need to explain why Trump didn’t advertise he got the vaccine and kept it a secret. Your link also doesn’t describe vaccine hesitancy, only who has gotten vaccine. There’s a difference. And if you dig into the data, party affiliation had the strongest predictive component to “I will not get vaccinated.” Trump supporters agree 30% with that statement. Minorities only agree 14%.
https://docs.cdn.yougov.com/lftymxzxfl/econTabReport.pdf
Michael R: we have an infection disease with high negative externalities (contagion). Society is allowed to make the rules on who gets social insurance. If you want insurance (coverage), you pay the premium (get the vaccine). Do you expect your insurance company to pay out if you don’t pay premiums? Also, the vaccine is widely available — there is no shortage in the US. I’m not using force — people can still get to choose to not get the vaccine — they just don’t get social coverage if they choose so.
17. June 2021 at 10:06
milljas, I agree that Wyoming is weird on vaccines. I meant that it’s weird to go from being the most GOP state to the most Democratic state.
17. June 2021 at 15:54
I guess another way to put the pharmacy thing is that there is one CVS/Walgreens per 250 sq miles in Vermont vs one every 10,000 miles for Wyoming.
I think travel does matter with getting the vaccine. I also think travel can be an issue with inner city neighborhoods.
Vaccination is easy in nursing homes, where travel is measured in feet. It’s also easier when people are retired and can fit it into their schedule.
17. June 2021 at 16:54
Ken P – I should have read the comments before I just spent 20 minutes researching the number of CVS/Walgreens per square mile in Wyoming and Vermont. Great minds think alike I guess.
But to add some more context. Your current risk of getting Covid and dying in Wyoming if you’re under 65 and healthy is about 0.000075%.
Your risk of dying in an automobile accident in Wyoming if you drive 25 miles to a CVS and back is about..
0.000075%
17. June 2021 at 21:23
This is Vermonth
Chittenden 58% fully vaxxed – 1/4 of VT population lives here with a population density of 305/km2, home to UVM.
What does the rest of the State look like (vaccination rates and population density)
Franklin 28% 80/km2
Essex 31% 9/km2
Caledonia 29% 45/km2
Bennington 34% 52/km2
So basically, Vermont has an atypically high percentage of its population living in one lilly white, prosperous and picturesque city with a vax rate similar to other comparable cities throughout the country, and the rest of it’s population living in sparsely populated areas with vax rates similar to other sparsely populated areas throughout the country.
17. June 2021 at 21:24
BTW – For anyone wondering. Vermonth is our new 51st state.
19. June 2021 at 14:19
Ken, Sorry, but any American who wants a vaccine can get one.
dtoh, Chittenden has 1258 people:
https://en.wikipedia.org/wiki/Chittenden,_Vermont
That’s not even 1% of Vermont’s population.
“BTW – For anyone wondering. Vermonth is our new 51st state.”
Are you sure you don’t mean Vermouth?
19. June 2021 at 19:45
Scott,
You’re looking at the town of Chittenden not the county.
I definitely support statehood for Vermouth.
20. June 2021 at 10:00
My mistake. But the statewide 72% vs. 38% difference in vaccination rates is pretty huge. One county with 25% of the population can’t come close to fully explaining that difference.
(BTW, my data was for first doses.)
I wonder if vaccination rates are higher in Wyoming’s cities (which are a bit larger than Vermont’s cities).
20. June 2021 at 14:05
@Scott
Unfortunately there is no vaccination data at the city level… only at the County level. Also the Burlington Metro area has about twice the population and twice the population density of Cheyenne (Wyoming’s largest city.) Laramie the county in which Cheyenne is located has a vaccination rate comparable or slightly higher than Vermont counties with comparable population densities.
There are some anomalies, but as far as I can tell the aggregate vaccination rate for any state appears to be largely dependent on the demographic mix of big cities, suburbia, and rural areas in that state.
21. June 2021 at 19:13
dtoh, Check out a map of vaccination rates by county across the US.
There are definitely some weird things going on beyond urban/rural (and also beyond Dem/GOP.) Such as Iowa/Missouri.
https://www.bloomberg.com/news/articles/2021-06-21/delta-variant-seen-spreading-in-undervaccinated-u-s-counties?srnd=premium&sref=XgZBm7li
22. June 2021 at 06:59
lol ever been to rural Wyoming?
“population density” doesn’t quite capture the fact it is entirely possible to live there for years and hardly ever meet more than the same 5-6 people
22. June 2021 at 08:06
Dave, Is that why their Covid rates are so high compared to Vermont?
23. June 2021 at 04:22
Scott,
Looks to me what is happening is a spike in the Delta variant centered in Greene County (Springfield) MO, which is spreading into the surrounding counties and now down into Arkansas.
My hypothesis on vaccination rates is that people are making rationale cost/benefit analyses on getting vaccinated. The transmission rate factors into that calculus so if the delta variant increases the risk of getting infected and dying (or killing family and friends), you will soon see the vaccination rate go up because people are in fact very rationale. (Keeping in mind of course that different people have different internal rates of return.)
Also BTW, I never said urban/rural. I said it was the mix of big cities, suburbia, and rural areas, which also partially explains the lower vaccination numbers and higher case numbers in Missouri.
23. June 2021 at 07:57
dtoh, Hundreds of unvaccinated Americans are dying of Covid every single day. I wonder if their loved ones view their decisions as “rational”?
I suspect that delta is spreading in areas where people didn’t get vaccinated.
23. June 2021 at 13:28
Scott, a hundred Americans are dying in car accidents every single day, I wonder if their loved ones view their decisions to use automobiles as “rational”?
You said, “I suspect that delta is spreading in areas where people didn’t get vaccinated.”
Yes, but also spreading in areas where more people did get vaccinations…. as are all the variants but at lower rates, (i.e. with an R0 below 1.) I think you’re talking about the rate at which it is spreading.
Delta will of course spread faster than less transmissible variants, and it will spread faster in areas where immunity (natural or from vaccines is lower.)
IMHO with the higher underlying transmissibillity of the Delta variant, more people will need to (and will) get vaccinated to keep R0 below 1 (i.e. keep the number of new cases from increasing.)
23. June 2021 at 19:48
Scott,
And just to add further evidence to hypothesis that people are rationale, I’ve just looked at WaPo data for vaccination trends. Missouri is up 27% for weekly vaccine doses administered while virtually every other State is down.
24. June 2021 at 11:19
dtoh, I fail to see how the auto accident analogy has any bearing on this. I drive a car and I got vaccinated. Am I a hypocrite? What’s your point?
And I’m not saying people who don’t get vaccinated are irrational, I said I don’t see how one would view the decision not to get vaccinated as “rational”, meaning “sensible” in the context of your statement. Words have multiple meanings. Rational can mean “a good idea” or it can mean “not insane”.
24. June 2021 at 12:29
Scott,
There are costs and benefits to any decision. If the odds of contracting Covid are very small, you live an hour away from a CVS, and you need a friend or relative to drive you because of potential fever/fatigue from the shot, it probably is perfectly sensible not to get the vaccine or wait until your next trip planned trip into town. If you’re a block away from a CVS, the calculus is very different.
Also what you and I regard as sensible, depends on our individual internal discount rates and circumstances. There are lots of experiments in behavioral economics where people will choose one cookie now over waiting an hour for two cookies. Similarly and at the opposite end of the spectrum, I know lots of people who because they can’t get the vaccine in Japan are spending $10k to fly to the U.S., spend 3 weeks in the U.S. to get two doses of vaccine, and then spend 2 weeks in strict quarantine after returning to Japan.
My guess is that for the bulk of the people who aren’t getting or who haven’t yet gotten the vaccination, you and I would make a similar decision if we were in the same circumstances.
I think it’s mistake to attribute different decisions to a difference culture, i.e. Vermonters and smart and urbane while Wyomingites are dumb hicks.
26. June 2021 at 09:11
dtoh, You said:
“I think it’s mistake to attribute different decisions to a difference culture, i.e. Vermonters and smart and urbane while Wyomingites are dumb hicks.”
I agree, and of course I didn’t do that. I said the difference was due to culture, and it clearly is. People in Cheyenne and Laramie are no further from a drug store than people in Burlington. I did not say that Wyoming people are dumb. And I certainly don’t think Vermonters are smart. Most people in both states have an IQ of somewhere around 100, plus or minus 15.
26. June 2021 at 14:25
Scott,
There are no data for vaccination rates for either Cheyenne or Burlington….only for Chittenden and Laramie counties. The population density in Chittenden is 10 times higher than the population density in Laramie. There is 1 CVS in Laramie. There are 5 in Chittenden.
27. June 2021 at 07:57
dtoh, This is getting silly. CVS is a company that started on the East Coast. If they don’t have CVS then they have Walgreens or something else. It’s absurd to suggest that people in Wyoming are not getting vaccinated because they don’t have access to drug stores.
And yes, I’ve been to Wyoming.
27. June 2021 at 13:12
Scott,
I was actually counting both CVS and Walgreen. If you count all pharmacies, you get the same result.
I’ve never said Wyomingites don’t have access to drug stores. I said that many people lived a long way from drug stores, which makes it more costly (time and effort) to get a vaccine. And of course it is not absurd that people are less likely to engage in an activity that is more costly. In fact, it is a principle tenet of economics especially when there is also lower utility for people living in a rural area who have fewer social contacts and are therefore less likely to get the disease and who therefore receive less benefit from the vaccine.
Again, you’ve offered no data or logical explanation for why culture would impact vaccination rates, whereas differences in population density offers an explanation that adheres to basic economic principles and assumes that humans behave rationally.
28. June 2021 at 19:10
dtoh, The cultural difference explanation is plausible because there are also huge differences in vaccination rates even within large metro areas. Some ethnic groups get vaccinated at different rates than others. And some areas with low vaccination rates in the southern US are not particularly remote areas.
That doesn’t mean cultural differences explain Wyoming, but in my opinion that’s the most likely explanation. I suspect that most people in Wyoming do not live far from a vaccination site–say less than a 40 minute drive.
29. June 2021 at 01:48
Scott,
It does not require that most people live more than a 40 minute drive from a vaccination site for there be a significant impact on the aggregate vaccination rate for a state. A mere 15 or 20% of the population living in remote areas could easily explain the divergence in vaccination rates in Wyoming compared to other states.
Nor would I would assume that ethnicity has any causal relation with vaccination rates. Income levels could certainly impact vaccination rates (a theory more consistent with normal economic analysis) and therefore disparate incomes levels between ethnic groups could fully explain the difference in vaccination rates between ethnic groups.
Also note again, that I have consistently acknowledged that population density does not fully explain differential vaccination rates and that I have suggested several times that the differences in vaccination rates for States depend not just on city versus rural but rather on the mix of big cites, suburbia, and rural areas. The data where available confirm that vaccination rates in poor densely populated urban areas are normally lower than national or state averages. Those same areas also have a higher percentage of certain ethnic groups, but again I would not attribute ethnicity as a causal factor to differences in vaccination rates when other more mainstream economic factors can explain the differences.
2. July 2021 at 15:37
You said:
“A mere 15 or 20% of the population living in remote areas could easily explain the divergence in vaccination rates in Wyoming compared to other states.”
Not even close. That might explain a 5% or 10% difference (although I doubt it), but we are talking 72% vs. 38%.
Differential vaccination rates are determined by one factor and one factor alone. Do people want the vaccine, or don’t they? Nothing else really matters.
3. July 2021 at 21:32
Scott,
Sure it does. The fully vaccinated percentage of the US population is 47%. Wyoming is 13 points lower at 34% and Vermont is 18 points higher at 65%, and I did say “compared to other states” not compared to Vermont. So a mere 13% of the population who chose not to get a vaccination because of the lower risk of infection or higher cost (travel and time) of getting a vaccination can fully explain the difference.
Similarly the high percentage of the population in Vermont living conveniently in suburban areas with easy access to vaccinations can fully explain the higher rate of vaccinations in Vermont relative to the rest of the country.
And to ask again, if it were culture that explained the high rate of vaccinations in Vermont, how do you explain the very low rates of vaccinations in rural areas of Vermont.
5. July 2021 at 09:00
dtoh, I don’t agree that vaccination rates in rural Vermont are very low. Most of Vermont is rural, and the overall state has the highest rate in the US.
https://www.healthvermont.gov/covid-19/vaccine/covid-19-vaccine-dashboard
You might be interested in this article:
A new Washington Post-ABC News poll showed 74 percent of people who haven’t been vaccinated say they probably or definitely won’t get vaccinated – and that the divide fell sharply along party lines. According to the survey, 86 percent of Democrats have received at least one vaccine shot compared with 45 percent of Republicans. Only 6 percent of Democrats said they are not likely to get vaccinated, compared with 47 percent of Republicans, including 38 percent of Republicans overall who said they definitely will not get the vaccine.
https://www.yahoo.com/news/gop-governors-implore-residents-overcome-194440369.html
5. July 2021 at 14:15
Scott,
Comparing apples to apples (% of the population fully vaccinated,) here are the CDC data for various Vermont counties versus 47% national average.
Franklin County 29%
Essex County 32%
Caledonia County 30%
Washington County 38%
Bennington County 35%
Orange County 44%
Windsor County 44%
And on the poll, you are still confusing correlation with causality.
9. July 2021 at 09:02
dtoh, I’m going with the data I provided (with link) which shows a radically different result. Virtually the entire state is highly vaccinated.