New Haven Register (New Haven, CT)
The North saved lives. The South resisted
Some political voices reached a fever pitch as President Joe Biden announced a national vaccine mandate for large employers, even though there have been 650,000 deaths in the United States from the pandemic and it continues to devastate with 1,500 new deaths each day. In South Carolina, the state currently with the highest COVID-19 case incidence and with more than 2,500 of its citizens hospitalized with COVID-19, Gov. Henry McMaster vowed to fight Biden and his party “to the gates of hell.” The outrage against the mandate from 20 GOP governors, including those from the Southern states of Texas, Florida, Georgia, Mississippi and Alabama, is particularly appalling because these states have experienced disproportionately greater morbidity and mortality since the launch of the vaccines.
In December 2020 and early 2021, COVID-19 became the leading cause of death in the United States, surpassing heart disease and cancer. The rapid deployment of COVID-19 vaccines in the early months sharply curtailed mortality, but as the vaccine uptake began to stall and the more infectious delta variant spread throughout the country, COVID-19 re-emerged as the third leading cause of death in August 2021.
This is troubling enough, but it is shockingly more troubling to see the extent to which COVID-19-related health outcomes have diverged across states since March, when vaccines became widely available. Based on data we obtained from the COVID
Data Tracker site of the U.S. Centers for Disease Control and Prevention, the highest seven-day case incidence (South Carolina, as of Sept. 9) exceeded the lowest case incidence (Connecticut) by a factor of 6.2. The state with the largest total number of per capita hospitalizations since March 1 (Kentucky) exceeds the state with the lowest hospitalizations (Vermont) by a factor of 8.9. And Florida, the state with the highest per capita number of COVID-19 deaths since March 1, has a COVID mortality rate 8.4 times greater than Vermont’s.
These are staggering differences, and they dwarf the disparities that health experts have long worried about. According to data from 1999 to 2019 compiled by Kaiser Family Foundation, cancer deaths per 100,000 people varied by a factor of 1.5 from the highest (Mississippi) to the lowest (Utah). Similarly, deaths due to heart disease per 100,000 people varied
by a factor of 1.9 from the highest (Oklahoma) to the lowest (Hawaii).
COVID-19’s death toll did not have to be so tragic. If Florida and Texas had COVID-19 mortality rates on par with Vermont’s, they would have saved, respectively, almost 14,000 and 9,000 lives since March 1. If the rest of the nation had the mortality rate of New England’s, we would have saved almost 90,000 lives since March 1.
The single, salient explanatory factor for these wide variances in COVID-19 morbidity and mortality across the states is vaccination. Politically motivated opposition to vaccines by several state governors and/or legislatures has caused vaccination rates to diverge substantially across states. An accompanying chart shows the gap between two regions,
New England and the South, but the disparity between individual states, like Vermont (68 percent fully vaccinated) and Mississippi (40 percent), is even wider.
Our observation — that the vaccination rate is the principal determinant of differences in health outcomes between states — is also plainly visible in our other charts.
Vaccination, cases, hospitalizations and deaths
The scatterplot shows the correlation between vaccination rate and the total number of hospitalizations per 100,000 people since March 1, 2021.
The most devastating consequence of politically motivated opposition to vaccines emerges is the chart that shows states with low vaccination have mortality rates six to eight times higher than states with high vaccination.
This is an unplanned and deplorable experiment, which has turned vast populations into human subjects.
Politicians opposed to the vaccine will continue to ignore these facts. The question is whether their constituents will pay attention. Recent surveys are not encouraging.
In a global survey of 15 countries, Morning Consult found their U.S. sample to be the second most resistant (after Russia) to COVID-19 vaccines, with 27 percent of the population being “uncertain” (10 percent) or “unwilling” (17 percent) to accept a vaccine.
The response of higher education and business leaders
This stark divide is also reflected in the adoption of vaccine mandates at colleges and universities in each state. Higher education institutions in New England states such as Connecticut (80 percent), Rhode Island (79 percent) and Massachusetts (51 percent) have gone considerably further in adopting mandates than those in Southern states such as Georgia (5 percent), South Carolina (3 percent), Texas (2 percent) and Florida (less than 1 percent), as shown in a separate chart. In several of these states, the absence of mask mandates in public universities is the result of prohibitions imposed by the state.
Against this backdrop of deep political rift, it is impressive that many business leaders have adopted vaccine mandates for their organizations. Even before President Biden’s new national mandate plan for large employers, more than 50 of the nation’s largest firms, including Disney, Microsoft, Norwegian Cruise Lines, Johnson & Johnson, Moderna, United Airlines, Goldman Sachs and Walmart, had adopted vaccine requirements last month.
The Business Roundtable, representing 200 major employers, announced that it “welcomes the Biden administration’s continued vigilance in the fight against COVID-19. America’s business leaders know how critical vaccination
and testing are in defeating the pandemic.”
In contrast to state politicians, there appear to be no regional divides in how the business community sees the pandemic. Business leaders around the nation do not want unsafe workplaces, absenteeism or sick, angry communities. Nor do they wish to see the pandemic continue to thwart economic growth.
It is tragic that many political leaders have hitched their ambitions to the wagon of vaccine resistance, imposing enormous and harmful externalities on the entire nation.
Political leaders who oppose vaccines bear moral responsibility for the tens of thousands of deaths that could have been prevented with vaccines. It remains to be seen if their constituents will repudiate the politicians who oppose both science and overwhelming evidence, but in the meantime it is necessary and urgent for institutions across the country to embrace vaccine mandates. Perhaps, in contrast to the accusation in the film “A Few Good Men,” Americans can handle the truth.
Anjani Jain is deputy dean for academic programs and professor in the practice of management at the Yale School of Management, specializing in operations management. Albert Ko is the Raj and Indra Nooyi Professor of Public Health and professor of epidemiology and medicine at the Yale Schools of Public Health and Medicine. Jeffrey Sonnenfeld is a senior associate dean, Lester Crown Professor of Management Practice at the Yale School of Management and president of the Yale Chief Executive Leadership Institute. A longer version of this article originally appeared in Fortune.com.