Public and official compliance with public health advice, vaccination rates, and Covid deaths varied widely across the regional cultures identified in the American Nations model
By Colin Woodard
With the Trump administration canceling half a billion dollars in mRNA vaccine research and considering the dismantling of science-based immunization schedules and new restrictions on who can get Covid-19 boosters, it’s a good time to revisit nation’s experience with the COVID-19 and the health measures and vaccines that helped combat it.
Now that federal officials are a primary source of vaccine disinformation, we could well see epidemics of diseases we’d tamed long ago, like measles, mumps, and Hepatitis, and containing the next novel pandemic will be all the harder. The evidence from the last pandemic suggests that the outbreaks and suffering will be worst in certain regions of the country, where individualistic cultural norms, chronic underinvestment in public goods, and the prevalence of Biblical fundamentalism make containing infectious diseases much, much harder.
Let’s take the lessons of the Covid-19 pandemic chronologically.
In the opening days of the crisis, the pandemic struck hardest in high-density places that had intimate transportation and trade links to China and Europe, where the coronavirus had already gotten out of hand. Because President Trump refused to take the threat seriously — “we have it very much under control,” he told reporters Feb. 23 — the federal government did not mobilize to rapidly produce, distribute, and analyze Covid tests, allowing the disease to enter and spread undetected in these gateway cities for weeks prior to the first confirmed cases in March 2020. Boston, Seattle and, especially, New York City emerged as hot spots, with 20,000 New Yorkers killed by the disease in just two months, the city’s people experiencing one of the highest death rates on the planet. Meanwhile, much of the South, Southwest and Midwest remained calm.
But this disparity reversed itself in tragic and preventable ways in the months and years that followed, as political leaders and the citizenry in each of our regional cultures wildly diverged in their willingness to trust and follow public health advice. Why did this happen?
As we’ve discussed regularly, the fundamental philosophical divide between the American Nations regional cultures is over the question of how best to organize American society: via an emphasis on individual liberty and autonomy or on the common good, on building and maintaining the infrastructure that allows humans to be free. We call these individualistic or communitarian, and the regions historically broke out like this (though Tidewater, a compact region caught in the federal halos around D.C. and Hampton Roads, has transformed over the past 60 years into a communitarian region.) This map shows how the regions line up in this regard:
In May and June 2020, the communitarian regions got the virus under control through social distancing, mandated closures, and a high level of compliance with public health recommendations to wear masks, maintain six feet of distance from one another and avoid risky activities like hanging out in crowded bars. Regions with an emphasis on individual liberty reopened early, typically had leaders who downplayed the threat, and saw far less public compliance with scientific recommendations.
Compliance was regionally varied from the start. Public officials called for lockdowns and citizens across communitarian Yankeedom, the Midlands, New Netherland, Spanish Caribbean Left Coast, and most of El Norte pretty much stopped traveling during the week of March 23, according to an analysis of the geolocation data of millions of (anonymous) cell phone users conducted at the time by the New York Times. But across Deep South, Greater Appalachia, and much of the Far West, people continued traveling, in many counties at the same level they had before the pandemic.
Similarly, the initial response by state governors varied by regional culture more than by the partisan affiliation. Republican governors in Yankee Vermont, New Hampshire, Massachusetts and (Yankee-Midland-dominated) Ohio took early and firm action to reduce the spread of the disease, while their counterparts in the Deep South left decision-making at the local level (Georgia) or declined to close or mandate changes in practices in businesses (Mississippi) or simply allowed spring breakers to party on the beaches (Florida). “I don’t like government telling private business what they can and cannot do,” Mississippi Gov. Tate Reeves said at the end of March, 2020, even as Massachusetts’s Republican Gov. Charlie Baker was doing just that.
This behavior and leadership divide — which persisted throughout the crisis — resulted in a massive regional gap in Covid cases. Here, using The New York Times’ database, are all the new daily cases of the disease in each regional culture in the first four months of the pandemic plotted with a seven-day sliding curve by my colleagues at Maine’s Portland Press Herald, where I was reporting on the pandemic at the time. By the end of June, 2020, cases in Yankeedom and the Midlands fell by more than half from their peak, and in New Netherland by more than 90 percent. Meanwhile, in the last two weeks of June, the rolling average of new cases in Deep South and Greater Appalachia more than doubled.
Miraculously, scientists developed effective vaccines by the end of 2020 and industry and governments were able to ramp up production and distribution to the point that, by the summer of 2021, any adult who wanted to be vaccinated against the deadly disease could. (This, ironically, was one of the Trump administration’s most laudable accomplishments.) And, yet, huge numbers of people in the individualistic regions declined to do so. Here, as we reported earlier, are the per capita vaccination rates by region August 15, 2021.
Some of the communitarian regions had all-age vaccination rates more than 20 points higher than in Deep South or Greater Appalachia.
And this, from the New York Times, is a map of the (resultant) per capita Covid deaths by the end of that Delta-variant plagued summer.
This dynamic did not change during the rest of the public health emergency. From CDC data, my frequent academic research collaborator, Ross Arena of the University of Illinois-Chicago, calculated the regional COVID-19 primary vaccination rates as of February 23, 2023, the date the agency chose to be the end of this data collection. We reported these results — which exclude Florida, which had not reported the necessary data — in a research paper published in Current Problems in Cardiology last year. The results are depicted in the map at the top of the post.
And here are the grimmest statistics of all: the per capita Covid-19 deaths as of that same date. According to the CDC data, the Deep South lost 505 people per 100,000 to the virus. That’s almost a quarter million dead. That’s also two and a half times the proportion slain in Left Coast, 195 per 100,000, and five times the rate in Hawaii (part of Greater Polynesia), which, being an island, was able to largely seal itself off and therefore provides a control sample of what might have been possible.
The data gathered here has three clear takeaways: lockdowns and social distancing kept a lid on the spread of Covid in the early weeks and months of the pandemic; vaccinations saved millions of lives after they became available in the crisis’s second year; and the use of these tools — and, thus, per capita deaths — varied widely across our regional cultures. According to the trackers at Johns Hopkins University School of Medicine,, the U.S., representing only 4 percent of the world’s population, accounted for more than a fifth of the world’s Covid-19 cases and deaths. This is partly due to the first Trump administration’s failure to take the approaching threat seriously — especially in its ineptitude in regards to developing and deploying effective testing in the winter of 2019-2020. But a bigger problem was cultural. The predominant, aggressively individualistic values of Deep South and Greater Appalachia made the virus impossible to properly contain, and hundreds of thousands of Americans unnecessarily died as a result.
If this second Trump administration dismantles the country’s immunization regime and hollows out the CDC, the epidemics and pandemics that follow will likely have these same regional patterns. State governments controlled by communitarian regional cultures are already forming compacts to devise their own vaccination advice. They would be wise to extend these efforts to other functions once provided by the federal government, from disease tracking to the stockpiling of critical supplies.
— Colin Woodard is the director of Nationhood Lab at Salve Regina University’s Pell Center for International Relations and Public Policy. He thanks his Motivf colleague John Liberty (for the 2023 maps in this piece), Ross Arena of the University of Illinois-Chicago for the 2023 Covid data crunching. and his erstwhile Press Herald colleague, Chad Gilley, for the data and graphics we published there in 2021.