COVID-19 Revealed Record-High Political Divides in Public Health

Political divisions during the COVID-19 pandemic were significantly more divided than those seen in previous disease outbreaks, creating major gaps between Democrats and Republicans in concerns about infection and attitudes toward vaccines, according to a recent study published in the American Journal of Public Health.

While partisanship or these political divides have long influenced public health responses in the United States, the study shows that COVID-19 represented a turning point. Political identity became closely tied to attitudes toward masking, social distancing and vaccination, making it more difficult for public health officials to set effective measures.

Trust in government, a critical factor for vaccine uptake and adherence to health guidelines, was particularly affected, highlighting the overall consequences of extreme polarization.

Although political divides aren’t new—trends have been observed since the mid-1970s—previous disease outbreaks did not generate the same extreme disparities.

In this study, 170 public opinion polls spanning 13 major outbreaks over nearly 70 years were analyzed, including the HIV/AIDS epidemic, the anthrax attacks following September 11, 2001 and the Ebola crisis. While earlier outbreaks showed only slight party-based differences, COVID-19 produced partisan divides five to twelve times larger, especially regarding vaccine hesitancy.

The findings suggest that traditional strategies for bridging political divides may no longer be sufficient and that new approaches will be crucial for strengthening future pandemic preparedness.

To examine how political polarization shaped public opinion during outbreaks, researchers analyzed polls archived in the Roper Center’s iPoll database, the largest storage of public opinion data in the nation. They searched for disease-related terms, such as “virus,” “outbreak” and “pandemic,” paired with outcome-related terms tied to concern about infection or intention to vaccinate.

Eligible polls asked questions using consistent response scales, included party affiliation, and surveyed adults nationwide within five years of an outbreak’s emergence. Polls with biased wording, limited samples or outdated contexts were excluded.

For each poll, responses were grouped by political affiliation to estimate the proportion of Democrats and Republicans who were highly concerned about infection or unlikely to receive a vaccine. Survey weights were applied when available, and adjustments were made for traditional sampling methods.

The team then conducted meta-analyses and meta-regressions to compare partisan differences across outbreaks and to determine whether COVID-19 represented a significant departure from historical trends.

Out of more than 6,000 surveys reviewed, the researchers found 170 that measured concern about infection or vaccine hesitancy across nine major disease outbreaks since the 1950s. These surveys received responses from over 158,000 partisans, with slightly more Democrats than Republicans represented.

About 42% of infection concern polls focused on COVID-19, while the remainder covered outbreaks including HIV/AIDS, Ebola and anthrax. Most surveys were conducted by telephone and often during Republican presidential administrations. For vaccine hesitancy, 71% of polls examined COVID-19, while other outbreaks, including polio, accounted for the rest.

Ipsos conducted over half of these surveys.

The results revealed eye-catching differences.

Prior to the pandemic, Democrats were only about 5% more likely than Republicans to report being “very concerned” about infection. During COVID-19, this gap widened to nearly 25%. In addition, partisan divides over vaccine hesitancy increased from less than 2% before COVID-19 to nearly 24% during the pandemic. These findings highlight the magnitude of political polarization in public health during COVID-19.

There are strengths to support this study. For example, it demonstrates the value of using multiple polls and adjusting for survey methods, timing and political context to examine polarization.

However, limitations include the focus on only two prevention behaviors, reliance on Roper Center data that may miss smaller outbreaks, true diversity among polls and an inability to control for outbreak magnitude.

Authors call for urgent research on strategies to reduce societal polarization, as COVID-19 shows that extreme partisan divides can disrupt effective public health responses and may not be negatively affected by approaches that were sufficient in past outbreaks.