ARKANSAS, LIKE many other American states, is in the middle of another wave of the covid-19 pandemic. Its only health-sciences university hospital, the University of Arkansas for Medical Sciences (UAMS), is near capacity as it battles severe covid-19 infections, mostly among the unvaccinated. Across the state, covid-19 infections are worryingly high: the positivity rate, the percentage of all tests that are positive for covid-19, is five times the national average, according to a UAMS report. And vaccination rates are low: only 41% among people aged 12 and older, compared with the nationwide average of 58%, the Arkansas Department of Health said on July 27th. UAMS researchers describe the situation as “a raging forest fire”.
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Yet restaurants in Little Rock, the state capital, are packed with diners, most of them unmasked. (The state’s Republican governor, Asa Hutchinson, signed a law in April banning public institutions, but not private businesses, from requiring masks.) Customers chatter away inside air-conditioned restaurants, ignoring the patios outside. Some establishments post signs encouraging face coverings: “Consistent with CDC guidelines, unvaccinated guests and customers should wear masks,” says one sign in a hotel lobby. But that same lobby was filled with unmasked visitors.
The contrast between the situation inside hospitals and life elsewhere in Little Rock is striking. “The truth is, walking around here, you should be seeing people who are masked up,” says Cam Patterson, the chancellor of UAMS. “What you’re seeing is actually part of what is causing this forest fire to rage.”
Throughout the United States covid-19 is spreading rapidly, mostly owing to the highly contagious Delta variant. According to the Centres for Disease Control and Prevention (CDC), the seven-day moving average of daily new cases on July 23rd (40,246) was 47% higher than the average a week earlier—and 251% higher than the lowest average in the past 12 months, recorded on June 19th.
Areas with the lowest vaccination rates are being hit the hardest. Arkansas has had 359 new cases per 100,000 residents over the past week. About 45% of its adults are fully vaccinated. Louisiana has 441 new cases per 100,000 people and a 47% vaccination rate among adults. By contrast, Vermont, with a vaccination rate of 78%, has only 26 new cases per 100,000 residents, and New Hampshire, where 68% of adults are vaccinated, has 24.
Many Democrats have been quick to blame Republican politics for the soaring infections. Republicans are less likely than Democrats to get vaccinated. Prominent Republican leaders have long politicised the jab and other covid-19 prevention methods, such as masks and social distancing. In Texas, where new cases are running at 121 per 100,000 residents, the governor has decreed that people cannot be obliged to wear masks in public spaces. Several Republican-run states, including Arkansas and Florida, have imposed some form of ban on vaccine passports. Republican legislators in Tennessee have pressed their state health department to stop outreach to teens for any vaccinations, covid or otherwise.
Fox News, America’s most-watched cable news outlet, has been a forum for vaccine scepticism for months, though it recently began encouraging the jab during prime time. Former President Donald Trump hid his vaccination status for weeks before touting inoculation.
But the problem goes beyond disinformation and poor leadership. The roots of vaccine hesitancy run deep. And the barrage of scepticism would have been much less effective had people been equipped with a better understanding of health. “We have really struggled with health literacy over the years—this is not new,” explains Jennifer Dillaha of the Arkansas Department of Health. “People struggle with how to get good health information and apply it to their lives. And this existed as a problem in our state, long before the previous administration.”
Covid-19 is not the only health epidemic raging across America. The states struggling the most with covid-19 infections also have the least healthy populations. About two out of five American adults are obese, according to the CDC. America is the fattest country in the OECD, a club of mostly rich countries. Heart disease accounts for one in four deaths. Almost half of Americans have high blood pressure, and 12% have high cholesterol. About one in ten has type 2 diabetes. For all these diseases, states with the highest prevalence also tend to have the lowest vaccination rates.
Many Americans have trouble staying healthy because they lack access to resources. Only 23% of people get enough exercise and only one in ten eats enough fruit and vegetables, says the CDC. But more than half of Americans do not live within one mile of a park, and 40% of all households do not live within a mile of shops where they can buy fresh produce.
For many, illiteracy is also part of the trouble. Less than half of Americans are proficient readers, and only 12% are considered by the country’s health department to be “health-literate”. Over one-third struggle with basic health tasks, such as following prescription-drug directions. Couple this with a lack of access to consistent health care (one in eight adults reports not going to a doctor in the past year because of the cost), and America was bound to have a vaccination problem.
In the short term, policymakers are implementing pandemic-mitigation measures. California and New York City are requiring public employees to be vaccinated, or tested regularly. The Department of Veterans Affairs announced vaccination requirements for its medical employees on July 26th. The next day President Joe Biden said the federal government was considering similar rules for its employees.
Masks are also returning for the vaccinated. Los Angeles county reimposed its mask-wearing requirement on July 22nd, and the CDC advised on July 27th that everyone (jabbed or not) should wear masks indoors in areas with high covid-19 transmission. In Arkansas the mayor of Little Rock is prepared to defy the state’s ban on mask mandates. “I took an oath to serve and protect the public health, safety, and welfare of every resident of Little Rock,” says Frank Scott junior, a Democrat. “And so if it gets to the point that we need to do something, we will. Even if it means we go against the state.”
In the longer term, education—along with access to better health care—will be vital in overcoming disinformation, raising vaccination rates and improving America’s overall health. “I’m not finding that blame is very useful,” says Dr Dillaha. “No one is choosing to not get vaccinated because they’re wanting to make a bad decision for themselves.” ■
This article appeared in the United States section of the print edition under the headline “Beyond the pandemic blame game”