Former President Donald Trump often seems proud to advertise his administration's record on speedily developing COVID-19 vaccines.
On the campaign trail to win another term in the White House, though, he also has knocked the use of those very vaccines. In October, for example, he unleashed a barrage of social media attacks on Ron DeSantis' pandemic record by reposting claims that the Florida governor — who is running against him in the Republican presidential primaries — was too active in vaccinating Sunshine State residents.
In a further twist, Trump simultaneously circulated an MSNBC article suggesting DeSantis wasn't vaccinating his constituents enough.
Trump's tap dance — touting Operation Warp Speed's success at developing vaccines while criticizing vaccine use — is emblematic of how pandemic politics are intensifying broader vaccine politics. Republican presidential candidates currently trailing the former president in polls are contorting their messaging to court the party's vaccine-skeptical voters. No one embraces, without qualification, the utility of a public health measure that has saved millions of lives.
Like Trump, even the more establishment candidates can't seem to avoid embracing the anti-vaccine leanings of the party's base. Take Nikki Haley, who formerly served as governor of South Carolina and ambassador to the United Nations and has been rising in the polls. In the waning days of the Trump administration, she was pro-vaccine. But by the end of November 2021, in an interview with the Christian Broadcasting Network, she repeated dubious anti-vaccine claims: for instance, that the vaccine could undermine a woman's fertility. (Studies consistently show no effect.)
The GOP has gained the allegiance of "a minority of people who feel very strongly about the safety of vaccines," Robert Blendon, a Harvard professor of public health, told KFF Health News. Presidential candidates are trying to use this sensibility as "a cultural issue" to signal distrust in scientists, other experts, and government authority in general, he said.
The resulting dynamic carries the risk of reaching beyond the current election cycle to affect public health policy in years to come, leading to lower rates among schoolchildren and seniors of vaccinations that protect them from measles, shingles, and HPV. Even as candidates try to weaponize this rhetoric, they've had little luck in changing the former president's front-runner status.
A recent KFF survey of adults about their plans to get vaccinated against the flu, respiratory syncytial virus, known as RSV, and COVID found that partisanship remains a key predictor of how people view vaccines. Confidence in the safety of the updated COVID vaccines split sharply along party lines, with more than 8 in 10 Democrats saying they trust the new shots, compared with 1 in 3 Republicans.
But unease about COVID or the vaccines is not Republican primary voters' top issue — Blendon said concerns around the border, crime, and inflation are — and it's not clear vaccine-focused attacks hurt Trump.
"I didn't like his response to COVID," says an Iowa business owner featured in a critical ad from a well-funded political action committee that questioned Trump's handling of the pandemic. "I thought he probably got led a little bit by the bureaucrats," he says, hitting Trump on his bragging about the development of the vaccine and contrasting Trump unfavorably with certain governors the man in the ad thought performed better against COVID. (Images of DeSantis, otherwise unnamed, flash by.)
The result? The ad "produced a backlash" and, when audience-tested with focus groups, improved the former president's support, according to a memo summarizing the political action committee's attempts to dent the front-runner.
Candidates nonetheless are trying to make hay, acknowledged Joe Grogan, who led the Domestic Policy Council during the Trump administration. But "I think people have a lot of other targets for ire about the pandemic."
"Trump is not at the top of the list for Republican primary voters," Grogan said. "He's not on Page 2. Or 3, or 4. It begins with the media, the public health bureaucracy, or Big Tech companies."
Voters have strong, yet divided and sometimes inconsistent, opinions. Some, like Joshua Sharff, 48, of Chesapeake, Virginia, are opposed to the COVID vaccines and to candidates who support the shots as safe and effective. Sharff describes himself as a conservative voter who intends to support the Republican nominee for president. Though he's vaccinated, he said, "If you're a governor or a president and you tell me that I have to take a vaccine that has not been tried, that has not been tested, and ignores the science, that's a problem for me. You're taking away my freedoms as an American citizen."
These positions have led Sharff away from Trump — and toward DeSantis, who has promoted anti-vaccine and anti-public health positions in his quest for the nomination.
Trump "pushed the vaccine very hard and recently came out, when he began to get pushback on it, that it was somebody else's fault," Sharff said. "That's not true."
Other Republican voters said the vaccine is not key to their vote.
"It will not sway my vote one way or another," said Kimberly Hunt, 59, of Melville, Tennessee.
In chasing these voters, some candidates are distancing themselves from initial, pro-vaccine positions to embrace outspoken views against the shot. Vivek Ramaswamy, a biotech entrepreneur, started out as a vaccine cheerleader. But then he flipped, coming out against vaccine mandates and saying this summer that he regretted getting vaccinated. (His wife, a doctor, said she had no regrets.)
The most vocal of all is DeSantis.
Appearing on the right-leaning "PBD Podcast" on Oct. 30, DeSantis attacked Trump and "the corrupt medical swamp in D.C." for overselling a vaccine that, despite the initial federal guidance, could not prevent infection or transmission of COVID. The Centers for Disease Control and Prevention recommends the vaccine for anyone 6 months and older to protect against serious illness.
Though he initially encouraged people to get vaccinated in early 2021, DeSantis pivoted months later, banning vaccine passports for businesses and government entities, and later approving legislation prohibiting vaccine mandates in the state. That fall, he also appointed a new Florida surgeon general, physician Joseph Ladapo, whose guidance on COVID vaccines contradicts CDC recommendations. DeSantis formed a Public Health Integrity Committee to assess, and generally dispute, federal health recommendations.
When the CDC released new vaccine guidance in September, Florida responded with its own advisory casting doubt on the safety of the boosters.
This anti-vaccine positioning hasn't helped DeSantis. He has been losing support nationally and is generally polling third behind Haley and Trump in New Hampshire, a key early primary state. He headlined a "medical freedom" town hall in Manchester on Nov. 1 with Ladapo as a special guest.
Among the candidates remaining, DeSantis may be the most famous convert to the politics of anti-vaccination, but, with this subject, Haley has more experience.
In the 2021 CBN interview, she said "mandates are not what America does." But the forceful declaration is merely the end of an ambivalent record, and, for critics, demonstrates her willingness to get in sync with the demands of the GOP base. As a state legislator, she supported 2007 legislation that included a mandate for HPV vaccines before voting against it; and later, as governor, she vetoed an effort to promote those vaccinations.
Bakari Sellers — now a commentator on CNN, but at the time a lawmaker who spearheaded that bill — told KFF Health News, "That's the biggest Nikki Haley issue that there is: She kind of has her finger in the air."
The issue of vaccines may affect the general election: Even as Trump defends his vaccine record, it's nevertheless clear he has support from the anti-vaccine crowd. An analysis by Politico, for example, found overlap among donors to independent presidential candidate Robert F. Kennedy Jr., who is staunchly opposed to vaccines, and Trump.
The willingness among politicians to assail what's traditionally looked on as a foundational achievement of public health is likely to lead to turbulence for doctors themselves. Allison Ferris, a primary care physician and an associate professor at Florida Atlantic University, said people should be listening to their doctors and not to presidential candidates about whether to take the new COVID vaccines. But that message is hard to deliver in the current climate.
"It is a tricky position to be in," said Ferris, who co-authored recently released guidance advising doctors to counsel patients that frequent COVID vaccination will likely become a necessity.
KFF Health News, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
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