President Trump promised a COVID vaccine by Election Day: that politicized vaccination intentions

In the weeks leading up to the presidential election, President Trump promised Americans on several occasions that a vaccine for the novel coronavirus would be ready for public use by Election Day. The Trump campaign saw accelerated vaccine development as an important campaign talking point – featured in battleground state campaign ads, and touted on several occasions at the first presidential debate. Vaccine experts – including the administration’s CDC director Robert Redfield – cautioned that this timeline was unrealistic. Although Operation Warp Speed enabled the manufacture of vaccines prior to the conclusion of clinical trials, with the hope of beginning the distribution process within one day of approval, experts projected widespread availability months after Election Day.

Nevertheless, the President’s decision to link vaccine development to the election fueled concerns the administration might pressure regulators to cut corners in the approval process. Some scientists worried that the administration might attempt to ease emergency use authorization (EUA) guidelines, which allow vaccines in development to be administered to vulnerable populations before approval for widespread use, in order to facilitate distribution in October. The administration exacerbated these concerns by placing substantial pressure on the FDA to permit doctors to treat sick people with the plasma of recovered coronavirus patients; a promising, yet presently unproven way to fight off the virus more quickly. Likewise, HHS spokesperson Michael Caputo, who formerly served on the President’s 2016 election campaign, was met with scorn after he accused government scientists of prolonging the pandemic in order to advance their personal and political ambitions.

The administration’s decision to tie vaccine development to the election politicized elites discussion of vaccines on the campaign trail. In an interview with CNN in early September, Vice Presidential candidate Kamala Harris stated that she “would not take [President Trump’s] word” that a vaccine developed before election day would be safe and effective. Worryingly, elite partisan disagreements about vaccine-related issues are also reflected in Americans’ intentions to receive a coronavirus vaccine, once it becomes widely available.

In demographically representative surveys of mass level politicization in vaccination intentions (see the red and blue lines Figure 1). For reference (in gray), I include an indicator of monthly media attention to vaccine politicization — i.e., the total count of newspaper and television stories coverage of President Trump’s Election Day vaccine promise.

Figure 1. COVID-19 vaccination intentions by partisanship (April – October 2020)

Note. Combined N = 4,002.. Mean levels of vaccine refusal across survey waves. Respondents were asked to report whether they are “very likely,” “somewhat likely,” “not too likely,” or “not likely at all” to “request to be vaccinated” against COVID-19 “when a vaccine for the novel coronavirus becomes widely available.” Respondents were also asked a standard (branched) partisan identification question (with those “leaning” toward the Democratic or Republican parties coded as Independents). Responses were collected via Lucid Theorem’s online opt-in internet service, which used quota sampling to target demographic representativeness on respondents’ age, race, gender, educational attainment, income, partisan identification, and residential region. I apply post-stratification weights to account for any remaining differences between the sample and U.S. population on the basis of age, income, educational attainment, gender, and race. Media volume data reflect all U.S. newspaper articles and television closed caption data where the terms “Trump,” “vaccine,” and (“before Election Day” or “by Election Day”) co-occur in the same piece. Media data were obtained via ESCO-host.

I find that, at the onset of the pandemic in April 2020, over 70% of both Republicans and Democrats indicated that they would be willing to receive a vaccine. However, as the pandemic progressed, Republicans’ intentions declined gradually, potentially a result of waning concern about the severity of the pandemic – before reverting back to early-pandemic levels (75%) on the eve of Election Day. One could argue Republicans’ fall resurgence could be due in part to an uptick in concern about the pandemic, amid a “Fall Wave” of new infections. Polling averages, however, suggest very little change in public pandemic concern from mid-August to mid-October.

Alternatively, and consistent with the possibility that vaccination intentions became highly politicized, this shift coincides with President Trump doubling down on his promise of a vaccine within “a few weeks” (i.e., in the first Presidential Debate), as well as Vice President Pence’s assertion, in the Vice Presidential Debate, that Senator Harris’ skepticism about the safety of a vaccine approved by the Trump administration might “undermine public vaccine confidence.” The shift also follows a major spike in media attention to President Trump’s Election Day vaccine promise (see: gray shaded line).

Democrats, on the other hand, remained enthusiastic in their vaccination intentions throughout the summer; with over 80% reporting that they planned to vaccinate by June. However, Democrats’ intentions began to drop off in the last week of August; just days after President Trump referred to the FDA as “deep state” actors seeking to prevent Americans from receiving a coronavirus vaccine, and put pressure on the agency to authorize unproven therapeutics.

Democrats’ enthusiasm for the vaccine dropped off sharply in the coming months, amid increasing elite polarization about vaccine-related issues and media attention to President Trump’s Election Day promise. By October, just 67%. This means that the partisan subgroup once most likely to vaccinate experienced the steepest decline in vaccine intentions, from late summer into early Fall.

These results, while correlational, nevertheless caution that playing politics with vaccine development can have important and negative public health consequences.

While Democrats’ substantial dropoff in vaccination intentions may have been offset, to some degree, by Republican enthusiasm, Americans’ intentions to vaccinate remained concerningly low; decreasing from 74% in April to 67% in October. Because current epidemiological estimates suggest that as many as 70% of Americans must develop immunity to COVID-19 in order to put the virus’ spread into decline, either by getting vaccinated, or by contracting and recovering from the virus, politicization may extend the amount of time it takes to achieve herd immunity against the disease. Ironically, then, it may be that the President’s decision to guarantee a vaccine before Election Day, aimed at promising a speedy return to “life as usual”, has actually prolonged the time it may take to recover from the pandemic.