Smallpox vaccination theory based on politics

By Richard Perez-Pena
The New York Times

The Bush administration's program to vaccinate 500,000 medical professionals against smallpox has been troubled, to put it kindly, with about 36,000 people inoculated so far. Many doctors and nurses questioned whether the vaccinations were needed or even safe.

But this is no general, nationwide pattern. In some states, the program has gone swimmingly. In others, it has barely gone along at all. Vaccination rates range from 96.4 per 100,000 people in South Dakota, to 0.5 per 100,000 in Nevada. In New York and New Jersey, vaccination rates are well below the national average.

Why the differences? Have Western mountain states demonstrated their mistrust of big government? No, Wyoming has the second-highest vaccination rate, and Idaho, Utah and Montana are in the middle of the pack.

Are some governors more enthusiastic than others about doing the president's bidding? Well, states with Republican governors have a somewhat higher vaccination rate than those with Democratic governors, but the difference is not large. Small states, big states — again, no pattern.

But politics does offer a rough hint of how fully health-care workers have embraced the program: In states carried by Bush in the 2000 election, the vaccination rate is almost three times as high as in states won by Al Gore.

As of May 9, according to the most recent figures compiled by the Centers for Disease Control and Prevention (CDC), the Bush states (including Florida) had a combined vaccination rate of 18.2 per 100,000 people, while the Gore states (including the District of Columbia) stood at 6.8.

The pattern is not uniform, but it is strong. Of the 15 states with the highest vaccination rates, Bush carried all but one, Minnesota. The states Bush carried by the biggest margins tend to have the highest rates; the ones that Gore won overwhelmingly have among the lowest.

"If you told me it was just New York lagging, I would say, well, it's just the healthy skepticism of New Yorkers, but I'm just floored by the idea that it's Gore states in general," said Dr. Irwin Redlener, director of the National Center for Disaster Preparedness at Columbia University.

Redlener and others have argued for months that the decision to be vaccinated was a question of national security.

But people would have to rely on the federal government's assessment of that threat. Is it possible, then, that doctors and nurses make their decisions based on how well they trust the Bush administration's assessments?

"I strongly doubt that this is a political phenomenon, rather than a demographic one," said Alan Ehrenhalt, executive editor of Governing magazine, which focuses on local government.

In the absence of a comprehensive survey of medical professionals, it is impossible to know their attitudes.

Experts say that some states have done a more aggressive job than others of persuading people to be vaccinated — but again, there is no obvious pattern, geographic, political or otherwise.