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. 2022 Aug 9;51(2):139–146. doi: 10.1177/1532673X221118888

Political Partisanship and Trust in Government Predict Popular Support for COVID-19 Vaccine Mandates for Various Professions and Demographic Groups: A Research Note

Filip Viskupič 1, David L Wiltse 1,✉
PMCID: PMC9364069  PMID: 38603210

Abstract

Due to the slow rate of COVID-19 vaccine uptake and the spread of the highly contagious Omicron variant, governments are considering mandating COVID-19 vaccination for specific professions and demographic groups. This study evaluates popular attitudes toward such policies. We fielded a survey of 535 registered voters in South Dakota to examine popular attitudes towards vaccine mandates for five groups—children 12 and older, K-12 teachers, medical staff, nursing homes staff, and police personnel. We estimated a series of logistic regression models and presented predicted probabilities to find the primary determinants of these attitudes. Results revealed that political partisanship and trust in government are strong predictors of support for vaccine mandates across all models. Should government and public health officials wish to increase the proportion of people vaccinated for COVID-19, they must recognize the limitations of current public health campaigns, and reshape their efforts in congruence with scientific findings.

Keywords: COVID-19, vaccine mandate, public opinion

Introduction

Scientists agree that vaccinating a critical portion of the society is the most effective way to bring the COVID-19 pandemic under control. While the number of vaccinated people grew rapidly when vaccines were first made available, there has been little movement in the recent months despite the presence of encouragements and incentives. Due to low uptake and the rapid transmission of the highly infectious Omicron variant and its several mutations, governments have started considering more intrusive ways to increase vaccination rates, such as vaccine passports and vaccine mandates. So far, over 60 countries have mandated COVID-19 vaccinations for some occupations or demographic groups, and Turkmenistan and Indonesia require vaccination for all adults.

In the United States, about 67% of the eligible population are fully vaccinated as of June 2022, despite a wide availability of multiple brands of vaccines at no cost and the presence of encouragements and incentives. At the same time, the country has the greatest number of COVID-19 deaths globally. For this reason, the federal government has been considering a variety of mandates on specific classes of individuals, such as healthcare workers, public employees, military personnel, and employees of large private companies. Simultaneously, some states and localities across the United States imposed vaccine mandates for their public employees.

COVID-19 vaccine mandates have been a contested topic among experts as well as the public. While a consensus exists among scientists that vaccination is the most effective protection against the virus and that it is imperative to get as many people vaccinated as possible, there is less agreement on whether vaccination should be compulsory. Undoubtedly, a mandate is more intrusive than existing approaches to boost vaccination rates. Scientists continue to debate the various legal, logistical, and ethical contours of COVID-19 vaccine mandates for specific professions and demographic groups. On the one hand, some experts made a strong case for vaccine mandates for health care workers (Gostin et al., 2021; Klompas et al., 2021; Sokol, 2021). Others see a vaccine mandate for health care personnel as a last resort policy that comes with troubling ethical concerns (Gur-Arie et al., 2021); while some legal experts condemn vaccine mandates for nursing home staff (Hayes & Pollock, 2021).

Disagreements also exist regarding a COVID-19 vaccine mandate for children. For proponents, a vaccine mandate for children is the key to bringing the pandemic under control (Mendenhall, 2021; Schleiss et al., 2021). One study concluded that for both adults and children, “COVID-19 vaccine mandates are legally and ethically permissible” (Largent & Miller, 2021). Other scholars remain cautious and call for more clinical research before such a decision could be reached (Opel et al., 2021; Pegden et al., 2021; Savulescu et al., 2021; Zimmerman et al., 2021). Some argued that COVID-19 vaccine mandates for children in the United States would be illegal (Younes, 2021). Overall, experts are deeply divided on COVID-19 vaccine mandates for specific professions and demographic groups.

It is not completely clear what the degree of popular support is for various COVID-19 vaccine mandates. Scholarship is only emerging given that scholars focused predominantly on the legal and ethical aspects of such mandates. The few empirical studies conducted examined popular support for mandates for general population (Gagneux-Brunon et al., 2022; Graeber et al., 2021). This project contributes to the existing scholarship by examining the drivers of public attitudes towards COVID-19 mandates for specific demographic and occupational groups, which has been understudied. Understanding public opinion about such vaccine mandates is important as political and health leaders across the United States, and in other countries, weigh the imposition of such mandates in their communities.

Attitudes Towards COVID-19 Vaccine Mandates for Various Groups

We believe that attitudes towards COVID-19 vaccine mandates for specific groups are likely driven by the same factors that have been found to explain attitudes towards COVID-19 mitigation measures. Below, we explore how political identification and trust in government might affect attitudes towards COVID-19 vaccine mandates for various groups.

Support for COVID-19 vaccine mandates is likely based largely on partisan self-identification. While management of the COVID-19 pandemic is at its core a medical and public health issue, scholars have noted the high degree of politicization (Gollust et al., 2020), which is similar to the politicization of other scientific issues in our society (Joslyn & Sylvester, 2019; Rabinowitz et al., 2016). We observed difference of attitudes between liberals and conservatives as well as Democrats and Republicans prior to the pandemic towards vaccination. Scholars found that conservatives are more opposed to vaccination against preventable diseases (Baumgaertner et al., 2018). Baum (2011) reported that Republicans were less likely to vaccinate against the N1H1 virus. Partisan differences in vaccination compliance are greatest when the other party is in power. During the George W. Bush administration, Democrats were more skeptical of vaccination than Republicans, and the situation reversed when Obama became president (Krupenkin, 2021).

Recent studies confirmed that both political ideology and political partisanship are linked to COVID-19 attitudes and mitigation measures. In particular, Republicans show higher resistance to various Center for Disease Control and Prevention (CDC) guidelines on COVID-19 mitigation than their counterparts. Evidence exists that Republican-leaning counties had lower compliance with stay-at-home orders during the COVID-19 pandemic (Goldstein & Wiedemann, 2021; Grossman et al., 2020). Kerr et al. (2021) reported that liberals are more likely to adhere to COVID-19 mitigation behaviors, such as wearing face masks. On the other hand, Republicans are less likely to receive a COVID-19 vaccination than Democrats (Callaghan et al., 2021; Cao et al., 2022; Fridman et al., 2021; Viskupič & Wiltse, 2022).

It should follow that political partisanship shapes people’s attitudes towards COVID-19 vaccine mandates. A study found that political conservatism was negatively correlated with support for a general vaccine mandate (Clarkson & Jasper, 2022). When it comes to narrower mandates, a study conducted in the United States found that political partisanship drove support for both student and teacher mandates across different educational settings (Haeder, 2021). People who lean toward political liberalism are more likely to support COVID-19 vaccine mandates for health care workers as well as for air and train travelers (Harris et al., 2022). The politicization of the pandemic is not confined to the US; a study conducted in Australia found that support for mandatory COVID-19 vaccination was based on political party identification (Smith et al., 2021). We expect to find a similar impact of political partisanship on the vaccine mandates that we examine in our study. We hypothesize that,

H1: Democrats are more likely to support COVID-19 vaccine mandates than Republicans.

Scholars also identified trust in government as a central element in the COVID-19 pandemic, which predicts a variety of mitigation behaviors. Information about the coronavirus is often technical and the general population lacking the required expertise relies on government for guidance (Bargain & Aminjonov, 2020; Siegrist & Cvetkovich, 2000). Even before the coronavirus pandemic, scholars reported that parents in the United States who distrust the government are less likely to trust vaccine information from health care providers (Lee et al., 2016). On the other hand, those with high trust in medical experts have more positive attitudes towards pertussis, influenza, and measles vaccinations (Justwan et al., 2019) and MMR vaccination (Stecula et al., 2022).

Specific to COVID-19, individuals who trust the government are more likely to follow the advice regarding various mitigation practices, including vaccination. On the other hand, those who do not trust the government are less likely to receive a COVID-19 vaccination (Cao et al., 2022; Daly et al., 2021; Jennings et al., 2021; Viskupic et al., 2022). These findings were bolstered by studies in multiple countries around the world that reached similar conclusions (Schernhammer et al., 2021; Trent et al., 2021).

We believe that trust in government is going to play a central role in shaping people’s attitudes towards COVID-19 vaccine mandates. A vaccine mandate is a more intrusive measure to control the pandemic, and therefore trust in government is going to be crucial. Because people with low trust in government are skeptical of any COVID-19 related restrictions imposed by the government, they are more likely to oppose a vaccine mandate. Those with high trust in government are more likely to believe that the government is doing what is right to bring the pandemic under control, and accept more intrusive measures, including vaccine mandates. A study from France provided evidence that those with no trust in government were less likely to support a COVID-19 vaccine mandate for the general population (Gagneux-Brunon et al., 2022). Therefore we propose that,

H2: People with high levels of trust in government are more likely to support COVID-19 vaccine mandates than those with low levels of trust in government.

Methods

Design and Participants

To analyze popular support for COVID-19 vaccine mandates for specific groups, we used data from a survey fielded from July 31 to August 13, 2021 on a sample of 535 registered voters in South Dakota. The goal of the survey was to understand the impact of the COVID-19 pandemic on the lives of South Dakotans; it also included questions on attitudes towards vaccine mandates for specific professions and demographic groups.

In the United States, the population subgroups that have shown high resistance to adhering to COVID-19 mitigation guidelines are rural residents, born again Christians, and Republicans, all of which are well represented in South Dakota. Thus, South Dakota provided a good “least likely” population for evaluating attitudes on vaccine mandates since the state’s overall population is fairly evenly divided on all but one of these policy questions (required vaccination for children).

We used registration-based sampling and randomly selected 12,000 registered voters in the state, who received a mailed invitation to complete an online survey. The response rate of this survey was 4.8%, which is comparable to other statewide surveys using registration-based sampling (Barber et al., 2014). While the survey sample was broadly representative of the state population, we used entropy balancing to weight the sample by gender, age, region within the state, vaccination status, and political party affiliation towards population parameters (Hainmueller, 2012).

Measures

Dependent variables in the analysis were support for vaccine mandates for children older than 12 years (the minimum age of CDC authorization at the time), K-12 teachers, medical staff, nursing home staff, and police personnel. We focused on medical personnel, nursing home personnel, and police personnel as these professions are part of critical infrastructure. In many countries, vaccine mandates for these groups are already in place, and other countries considering mandates are first looking at these occupations. We also focused on K-12 teachers and children 12 years older as vaccine mandates for these groups generated the greatest controversy among scientists, politicians, and the public. Participants were asked to indicate whether they supported a mandate for each of the groups. In line with best practices for survey research, the order in which these items were presented was randomized. The order of the question block within the survey containing these measures was randomized as well.

Trust in government and partisan self-identification are the independent variables of primary interest. Several control variables that have been found to shape attitudes on COVID-19 mitigation were also included: evangelical identity, partisan self-identification, age, gender, education, and COVID-19 vaccination status (Adams et al., 2021; Corcoran et al., 2021; DeMora et al., 2021; Myerson et al., 2021; Viskupic et al., 2022). The survey also included an attention check question, which 98.3% participants answered correctly. Full text of survey questions and descriptive statistics of all variables are included in the Appendix.

Analysis

We first report overall support of vaccine mandates for all groups. We then analyze the predictors of support for vaccine mandates for the groups examined. Given that the five dependent variables in this study are categorical, we estimate a series of logistic regressions with variables discussed above as control variables. We also present predicted probabilities of support for vaccine mandates for specific groups to aid in interpretation. All analyses were conducted in Stata 17 using the SPost13 software package (Long & Freese, 2014).

Results

We find that overall support for vaccine mandates for the various groups varies significantly. A mandate for medical staff and nursing homes staff had the greatest support (51.2% and 51.3%, respectively). Support for K-12 teachers and police personnel mandates was somewhat lower (43.6% and 40.3%, respectively). Support for a mandate for children that were 12 years and older was rather unpopular at 32.4%.

The full results of our logistic regression analysis are presented in Table 1. Five separate models for each type of mandate were estimated. The results show that trust in government and partisan self-identification are statistically significant predictors of support for all vaccine mandates examined, and explain the bulk of variation in the dependent variables. Age is statistically significant in all of the models, with the exception of a vaccine mandate for medical staff. Trust in physicians and evangelical identification are significant only in the model of mandated vaccinations for medical staff. The control variable of vaccination status is also significant in all models. The other variables included fail to reach the standard threshold for statistical significance.

Table 1.

Logistic Regression on Support for COVID-19 Vaccine Mandates.

K-12 Teachers Medical Staff Nursing Home Staff Police Personnel Children 12+
Trust in government 0.838*** 0.629** 0.525* 0.874*** 0.482**
(0.181) (0.195) (0.210) (0.190) (0.170)
Trust in Doctors 0.330 0.511* 0.437 0.117 0.452
(0.268) (0.221) (0.226) (0.257) (0.274)
Partisan self-identification (1 = Dem 2 = Ind 3 = Rep) −1.293*** −1.076*** −1.090*** −1.015*** −0.809***
(0.229) (0.231) (0.236) (0.205) (0.184)
Age 0.025** 0.016 0.022* 0.019* 0.029**
(0.009) (0.011) (0.009) (0.009) (0.010)
Education 0.034 −0.239 −0.024 −0.142 0.101
(0.113) (0.148) (0.120) (0.114) (0.111)
Male 0.340 0.282 0.353 0.494 0.071
(0.311) (0.293) (0.306) (0.302) (0.305)
Income −0.098 −0.056 −0.148 −0.147 −0.120
(0.091) (0.082) (0.083) (0.076) (0.085)
Evangelical −0.654 −0.927* −0.703 −0.527 −0.601
(0.387) (0.387) (0.368) (0.357) (0.367)
COVID-19 vaccinated 3.488*** 2.497*** 3.025*** 2.856*** 2.576***
(0.595) (0.409) (0.435) (0.518) (0.728)
Constant −4.201* −1.971 −2.507* −2.716* −5.400**
(1.727) (1.328) (1.274) (1.378) (1.663)
Pseudo R-Square 0.543 0.454 0.495 0.459 0.394
Number of cases 403 403 403 403 403
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* p|t| < .05 **p|t| < .01 *** p|t| < .001, two-tailed tests of statistical significance.

To help with the interpretation of the non-linear logistic coefficients, Table 2 reports predicted probabilities of support for vaccine mandates for specific groups across trust in government and partisan self-identification (both ordinal variables), with other variables held at their means. We observe stark differences in the probability of supporting all vaccine mandates examined. The effects of trust in government are most profound on the support for on mandates with the smallest overall support: K-12 teachers, police, and children 12 and older. For example, with respondents that trust the government to do what is right “most of the time,” the probability of supporting a mandate for police personnel is .710, as opposed to .151 for those who “never” trust the government. The effect of trust in government is weakest, yet still quite strong, on the support for mandate for children: .426 for high trust individuals and .148 for low trust individuals.

Table 2.

Predicted Probabilities of Support for Vaccine Mandates for Various Groups.

K-12 Teachers Medical Staff Nursing Home Staff Police Personnel Children 12+
Trust in government
 “Most of the Time” .767 .820 .805 .710 .426
 “Never” .210 .408 .460 .151 .148
Party identification
 Democrats .828 .873 .881 .707 .500
 Independents .570 .702 .713 .467 .308
 Republicans .266 .446 .456 .241 .166
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We also found that partisan identification shapes vaccine mandate attitudes, though with varying effects for any given mandate. For example, the effect of partisanship is most profound for a teacher mandate, with a probability of support for Democrats at .828 and Republicans at .266. To display the effect of age (a continuous variable coded in years), Figure 1 plots the predicted probability of age on supporting a mandate for children 12 and over. While the effects are not nearly as profound as they were for trust in government and political partisanship variables, there is still a substantial increase associated with age. For example, for a 20 year-old and 80 year-old respondent, the probabilities of support are .113 and .419, respectively.

Figure 1.

Figure 1.

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Relationship between age and the probability of support for a COVID-19 vaccine mandate for children 12 and older.

We conducted additional regression analysis to check for the robustness of our results. We estimated the same logistic regressions with unweighted data, and the results are very similar in terms of significance and substantive effects (Table S3).

Discussion and Conclusion

The findings of this study build upon and extend the existing scholarship, as well as provide implications for public health officials and political leaders. This study is amongst the first to look at support for mandates for specific occupations and demographic groups (Attwell et al., 2021; Harris et al., 2022). Support for vaccine mandates across occupations has been understudied, particularly mandates for nursing home and police personnel. We found that support for mandatory vaccination for different groups varied. There was majority support for mandatory vaccination for medical and nursing home staff, but support of a mandate for teachers, police, and children quickly eroded.

We found that partisan identification, trust in government, age, and COVID-19 vaccination status are correlated with, and have a substantial effect on support for mandatory vaccination for all groups we examined. Writ large, the determinants of other COVID-19 related attitudes are also associated with support of vaccine mandates for professions and demographic groups.

The results of our study underscore the deeply political nature of the coronavirus pandemic. We show that Republican voters show strongest resistance to vaccine mandates, which is consistent with recently published studies (Cao et al., 2022; Daly et al., 2021; Haeder, 2021; Kerr et al., 2021). It is likely that Republican voters taking cues from Republican leaders, such as former President Trump and several governors across the nation, many of whom have repeatedly downplayed the seriousness of the pandemic and opposed mandates of most mitigation efforts, particularly vaccination (Grossman et al., 2020).

Our results also show the importance of trust in government as a predictor of attitudes towards COVID-19 vaccine mandates. Scholars showed that trust in government is a strong predictor of vaccination attitudes and vaccination status (Jennings et al., 2021; Viskupic et al., 2022). It is unsurprising that those individuals with high trust in the government are more likely to support a vaccine mandate, which they consider appropriate and necessary in bringing the pandemic under control.

While the overall effect of age is not as strong as trust in government or partisan identification, it is still quite important. We suspect that many respondents of the “baby boom” generation have memories of vaccinations at schools from their youth, and are thus less concerned about most of these proposed mandates. Additionally, the risks of COVID-19 are demonstrably higher for the aged. Given those additional risks, older respondents are broadly more accepting of COVID-19 mitigation efforts in general, and vaccination mandates specifically.

The findings of this study should be of interest not only to scientists, but also to health and policy leaders. COVID-19 vaccine mandates are a more intrusive form of intervention by the government than the use of incentives. Health and policy leaders should consider imposing vaccine mandates for those groups where there is least resistance—medical personnel and nursing homes personnel. If possible, other approaches should be used. For example, it has been argued that partnerships with leaders trusted in their political communities can help increase adherence to COVID-19 mitigation approaches (Meyer et al., 2022). Health and political leaders should also strive to increase people’s trust in the government in order to boost vaccination rates in the society.

Despite the multiple contributions, this study is not without limitations. The survey sample is from South Dakota, which is more rural, and socially and politically conservative than the rest of the United States. The governor of South Dakota has been strongly opposed to vaccine mandates so it is unlikely that they will be implemented in the state at least in the near future. Another limitation of the survey is that we only reached registered voters in the state. The wording our of survey questions on support for COVID-19 vaccine mandates allowed for religious and medical exemptions, which might have affected the results.

In the future, scholars should continue to investigate the drivers of mass level attitudes towards various COVID-19 vaccine mandates, such as senior citizens 65 years and older, and amongst children of eligible vaccination age. It might also be fruitful to investigate if endorsements from medical, religious, or political leaders could increase support for such mandates. For example, Dr. Oz’s endorsement of the MMR vaccine on his show made his viewers more likely to view the vaccine as less risky (Stecula et al., 2022). More recently, scholars found that messaging from religious leaders is an effective tool at motivating the unvaccinated population to receive a COVID-19 vaccination (Viskupič & Wiltse, 2022). A similar mechanism might be at play when it comes to support for COVID-19 vaccine mandates.

Supplemental Material

Supplemental Material - Political Partisanship and Trust in Government Predict Popular Support for COVID-19 Vaccine Mandates for Various Professions and Demographic Groups: A Research Note
Click here for additional data file. (137.1KB, pdf)

Supplemental Material for Political Partisanship and Trust in Government Predict Popular Support for COVID-19 Vaccine Mandates for Various Professions and Demographic Groups: A Research Note by Filip Viskupic and David Wiltse in American Politics Research

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by South Dakota State University.

Supplemental Material: Supplemental material for this article is available online.

ORCID iDs

Filip Viskupic https://orcid.org/0000-0003-1096-325X

David L. Wiltse https://orcid.org/0000-0002-6928-4246

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