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Monday, January 31, 2022

Informal Removals

 In The Politics of Autism, I write about special education and the Individuals with Disabilities Education Act

 The National Disability Rights Network (NDRN) has a report titled "Out from the Shadows: Informal Removal of Children with Disabilities from Public Schools."  The report lists several ways in which such informal removals take place:

An informal poll of P&As [protection and advocacy agenices] in August 2021 found the following issues to be the most common in their discipline work:
  • Repeated or long-term use of a shortened school day, as a result of behaviors related to the child’s disability.  Sending children home frequently in the middle of the school day, as a result of behaviors related to the child’s disability. These removals tend to be at irregular times and may not occur daily, but occur often enough to cause harm to the child.
  • Placing children on homebound instruction almost always with fewer than ten hours (often only 1-5 hours) of in-person tutoring per week due to behaviors related to the child’s disability. A typical public-school calendar requires about 30 hours of in school time per week.
  • Placing children on virtual or remote education due to behavior related to the child’s disability (rather than contagion prevention), even after other students have returned to in-person schooling (following COVID-19 pandemic building closures or restrictions.)
  • “Transfers to nowhere:” the involuntary transfer by the Local Education Agency (LEA)7 to a program that does not exist, has entrance requirements that the child cannot meet, or has no openings.
  • Entering into “Agreements in Lieu of Suspension” or related contracts

Some case studies from the report:

  •  Three students with diagnoses of autism, from the same small town, were repeatedly sent home because the LEA didn’t have sufficient paraprofessional (teacher’s aide) coverage and they were considered “too hard to handle.” One child was not in school for almost a year.  The other two students were repeatedly sent home for shorter lengths of time. All three children experienced significant disruption and delay in their education because they simply weren’t receiving an education. 
  • AA is a 10-year-old child who has a diagnosis of autism. He was placed in over 100 restraints at school during his kindergarten and 1st grade years. In the beginning of his 2nd grade year, he was placed on homebound services due to disability related behaviors.  He was not allowed to attend school events or to participate in extracurricular activities.  He did not have a seat in a classroom or a locker for at least 3 school years (2nd, 3rd, and 4th grade.) When asked, he cannot describe a typical school day.
  • CC was 15 years old and in the 9th grade at the time the P&A represented her. She was diagnosed with a seizure disorder at 6 months and then with autism in her teens. Except for a few words, CC is mostly non- verbal. The LEA contacted her mother many times per month to pick her up from school: whenever her behavior began to escalate or when the teacher or her assigned aide would be absent. This resulted in the equivalent of weeks of missed school

Sunday, January 30, 2022

Communicating Science

 In The Politics of Autism, I analyze the discredited notion that vaccines cause autism. This bogus idea can hurt people by allowing diseases to spread  And among those diseases could be COVID-19.

Antivaxxers are sometimes violent, often abusive, and always wrong.  

At Trends in Molecular Medicine, Dr. Peter Hotez has an article titled "Communicating science and protecting scientists in a time of political instability."

In its modern form, the antivaccine movement began during the late 1990s and early 2000s following claims that the measles–mumps–rubella (MMR) vaccine caused pervasive developmental disorder, now known as autism spectrum disorder [6]. Ultimately, the lead publication making this claim was retracted by The Lancet (in which the paper was published in 1998), but this did not stop a succession of alternative claims that thimerosal preservative, aluminum, or closely spaced vaccines were responsible [6]. The discovery of dozens of new autism genes involved in early fetal brain development [7] helped to provide a powerful alternative narrative to vaccines; however, claims that vaccines cause autism persist.

As a vaccine scientist with an autistic daughter, I thought my advocacy in countering false vaccine links would be very powerful and began publicly defending vaccines [6]. However, my public stance invited a wave of aggression from antivaccine groups, most notably those identified by the Center for Countering Digital Hate as the ‘disinformation dozen’iv. However, this paled in the face of what followed.

After the retraction of The Lancet article in 2010, the antivaccine movement in the USA re-energized by becoming a political movement and aligning itself with far-right groups or the Republican Tea Party, especially in Texas [8]. Doing so increased the number of people willing to become antivaccine adherents, while affording new opportunities for funding and organization. The rallying cry was ‘health freedom’ and it gained a strong following, even forming political action committees (PACs) to promote vaccine exemptions with state legislatures [8]. With the COVID-19 pandemic, ‘health freedom’ expanded to protest COVID-19 prevention measures, including masks and alternative treatments, such as hydroxychloroquine or ivermectin, both drugs shown in most studies to offer no benefit in COVID-19 cases or that could even be harmful.


Key considerations for communicating science for COVID-19 vaccines and other interventions
  • Antivaccine aggression kills: 200 000 unvaccinated Americans needlessly lost their lives to COVID-19 during the second half of 2021.
  • Those refusing COVID-19 vaccinations are victims to disinformation.
  • While social media is widely touted as the culprit, Facebook and other platforms are not generating the disinformation content.
  • Instead, the disinformation arises from three major sources: (i) The ‘disinformation dozen nongovernmental organizations identified by CCDH; (ii) State actors including the Russian Government; (iii) and political extremism from the far right.
  • In America, the far right has the greatest influence, and originates from the US Congress and other elected officials, conservative news outlets, and think tanks.
  • There are about a dozen major talking points why people refuse to get vaccinated, but these can be easily refuted. The real culprit are political groups and others generating antivaccine content.

Saturday, January 29, 2022

Lit Review on Autism and Criminal Justice

In The Politics of Autism, I discuss interactions between police and autistic people.  Police officers need training to respond appropriately.  When they do not, things get out of hand

At Autism, Dylan S. Cooper and colleagues have an article titled "Policy gaps and opportunities: A systematic review of autism spectrum disorder and criminal justice intersections." Lay abstract: 

The number of people with autism spectrum disorder has increased, and as this population ages, research is showing high rates of contact with the criminal justice system among this group. Social and communication differences that autistic individuals experience can act as a risk factor during these interactions, as shown by public reports of negative and violent encounters between autistic individuals and the law enforcement. There is a clear need for evidence-based strategies to reduce high rates of contact and to improve outcomes when an interaction occurs. This article provides a systematic review of research on autism spectrum disorder and criminal justice system to compile this evidence base. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis structure was used to identify 89 articles after searching six databases. The Sequential Intercept Model describes the criminal justice system as different stages, or intercepts, that are connected, and the Sequential Intercept Model serves as an overall framework to organize the included articles. Articles were analyzed to identify research themes at each intercept, which offer guidance for policy and program changes that support equitable justice for autistic individuals.

From the article:

Given that this analysis found that police encounters are causing high rates of trauma among autistic individuals, policy and practice changes should focus on reducing contact with the police as much and as safely as possible. The broader social movement has created significant momentum and is informing the design and implementation of alternative responder models. One such example, which can be replicated for autistic individuals, is to have mental health professional teams respond to behavioral and mental health crises and noncriminal acts, and only if necessary coordinate with police to determine if and why a police presence is needed. More research is needed to identify optimal first responder models, and this should include an emphasis on scaling and replicating to local contexts. Emerging alternative first responder models are showing promise. One example is CAHOOTS (Crisis Assistance Helping Out On TheStreets), a program in Oregon, USA, that has been in place for more than 30years and demonstrates efficacy, cost savings, and can be safely deployed in other cities eager to replicate it (Pollack & Watson, 2020; Westervelt, 2020). Adaptation and replication of models like CAHOOTS could dramatically reduce the risk of police violence, while improving equitable justice and public safety
Pollack, H. A., Watson, A. C. (2020). From crisis to care: Improved second response to mental health crises. Google Scholar | Crossref

Westervelt, E. (2020). Removing cops from behavioral crisis calls: “We need to change the model.” Google Scholar

Friday, January 28, 2022

Bizarre Rants on Autism and Demons

 In The Politics of Autism, I discuss various ideas about what causes the conditionMany posts have discussed the potential correlatesrisk factors, and possible causes that have been the subject of serious studies.  Genetics tops the list.  One thing that is NOT on the list is demonic possession.  

Checked Bible Gateway for mentions of "cancer" in the New International Version. There aren't any. Pretty sure it exists.

This bizarre rant underscores the need for more religious outreach to autistic people and others with neurological differences.

Thursday, January 27, 2022

Autism Museum

In The Politics of Autism, I discuss autism history.

Bryce Airgood at The Lansing State Journal:

When he was younger Xavier DeGroat wanted to work at the Henry Ford Museum of American Innovation, but now the Delta Township man is opening his own museum in Meridian Mall.

DeGroat, founder and CEO of nonprofit Xavier DeGroat Autism Foundation, will host a ribbon-cutting event at 6:30 p.m. Feb. 4 for the foundation’s museum near Schuler Books.

The museum will have a timeline of the history of autism from early in the 20th century to present day and will highlight prominent figures on the spectrum like Elon Musk, he said.

The museum will have a sensory friendly educational program and DeGroat will take inspiration from "Mister Rogers’ Neighborhood" as Mister Rogers was a role model growing up, he said.

The Xavier DeGroat Autism Foundation will also host a dinner and gala with VIP pre-reception starting at 6 p.m. at LAUNCH Trampoline Park. Tickets for the dinner/gala are $50 and VIP tickets are $100. People can contact and visit Xavier DeGroat Autism Foundation’s website for more information.

Wednesday, January 26, 2022

Autism and the Antivax DC Rally

 In The Politics of Autism, I analyze the discredited notion that vaccines cause autism. This bogus idea can hurt people by allowing diseases to spread  And among those diseases could be COVID-19.

Antivaxxers are sometimes violent, often abusive, and always wrong.  

A leading anti-vaxxer is Robert F. Kennedy, Jr.  Yesterday, he appeared at an "anti-mandate" rally in DC.  In recent years, he has invoked the Holocaust, and he did it again this time.  (His remarks were inaccurate as well as abhorrent. The Nazis did find Anne Frank, in Amsterdam.)  

Kennedy apologized for the Anne Frank reference -- but not for his long history of spreading the lie that vaccines cause autism.  That lie pervades the antivax movement.

Tim Marchman at VICE News:
The first person I met at Defeat the Mandates—a rally held in Washington, D.C. this past weekend in opposition, organizers and attendees unconvincingly claimed, not to vaccines but to vaccine mandates—was a well-composed woman named Maya, who had travelled from Michigan. A speech-language pathologist who works with autistic children, Maya was sitting with a small group of friends in front of a barricade at the Lincoln Memorial, wearing a yellow band bearing black text on her right arm.

Maya, who falsely believes that vaccines are the leading cause of autism, would not say whether or not she thought it was appropriate to compare herself to Jews living in Nazi Germany or Black people living under segregation and Jim Crow, though she did acknowledge that the unvaccinated are not being rounded up and murdered. “But we need to acknowledge the steps that get to that,” she said.


This was, nonetheless, deeply an anti-vaccine rally, complete with ubiquitous use of euphemisms like “medical freedom” (for an anti-vaccine stance) and “repurposed drugs” (for snake oil) to go alongside the preference for “anti-mandate” to take the place of “anti-vaccine,” which has taken on some of the stigma of a racial slur among people who are vigorously opposed to vaccines. Robert Malone, after invoking King, claimed that one in 3,000 vaccinated children will be hospitalized due to vaccine damage; Christina Parks, whose recently viral claims about vaccines have been thoroughly debunked, made the particularly repulsive claim that the CDC had covered up evidence that vaccines caused Black boys to be hundreds of times more likely to become autistic. (This particular false claim was a cornerstone of the anti-vaccine film Vaxxed, made by anti-vax luminary and disgraced ex-physician Andrew Wakefield, which gave extensive airtime to the claims of a “CDC whistleblower” named William Thompson, though Thompson himself never appeared in the film. While the history of Thompson’s statements is too tangled to unwind here, the claim that MMR vaccines led to an increase in autism for Black boys or anyone else has, at this point, been extensively debunked, yet it continues to live on, unchanged, at anti-vaccine rallies and conferences.)

Tuesday, January 25, 2022

RFK Jr. and Anne Frank

 In The Politics of Autism, I analyze the discredited notion that vaccines cause autism. This bogus idea can hurt people by allowing diseases to spread  And among those diseases could be COVID-19.

Antivaxxers are sometimes violent, often abusive, and always wrong.  

A leading anti-vaxxer is Robert F. Kennedy, Jr.  Yesterday, he appeared at an "anti-mandate" rally in DC.  In recent years, he has invoked the Holocaust, and he did it again this time.  (His remarks were inaccurate as well as abhorrent. The Nazis did find Anne Frank, in Amsterdam.)  UPDATE:

Andrew Jeong at WP:
Robert F. Kennedy Jr. drew quick public criticism, including from his wife, on Monday after he compared the U.S. government’s vaccine mandates to the Holocaust actions of the Nazis, invoking Anne Frank to imply Jews then had more freedoms than unvaccinated Americans today.

... [H]is latest remarks drew especially strong condemnation for invoking Frank, a child who died in a Nazi concentration camp. “Even in Hitler’s Germany, you could cross the Alps to Switzerland. You could hide in an attic like Anne Frank did,” Kennedy said at a anti-vaccine rally in the District of Columbia on Sunday, speaking in front of the Lincoln Memorial.


In a statement a Kennedy spokeswoman sent to the Associated Press on Monday, he said he “compared no one to the Nazis or Adolf Hitler.” 
“I referred to Anne Frank’s terrible two year ordeal only by way of showing that modern surveillance capacity would make her courageous feat virtually impossible today,” Kennedy said.

It was not the first time Kennedy invoked the Holocaust in reference to vaccines. In 2015, he said of vaccinations: “They get the shot, that night they have a fever of a hundred and three, they go to sleep, and three months ater their brain is gone. This is a holocaust, what this is doing to our country.”

For years, Kennedy, an environmental lawyer and author, has publicly supported the conspiracy theory that vaccines cause autism. They do not.

In 2005, Kennedy incorrectly wrote in an article published in Rolling Stone and Salon that an ingredient in some new vaccines, thimerosal, was dangerous and that the government was hiding its links to autism. Rolling Stone issued several corrections. Salon retracted the story from its website. Kennedy expanded the article into a book published in 2014.


Monday, January 24, 2022

The Antivax Rally in DC

 In The Politics of Autism, I analyze the discredited notion that vaccines cause autism. This bogus idea can hurt people by allowing diseases to spread  And among those diseases could be COVID-19.

Antivaxxers are sometimes violent, often abusive, and always wrong.  

A leading antivaxxer is Robert F. Kennedy, Jr.  Yesterday, he appeared at an "anti-mandate" rally in DC.  In recent years, he has invoked the Holocaust, and he did it again this time.  (His remarks were inaccurate as well as abhorrent. The Nazis did find Anne Frank, in Amsterdam.)

Sunday, January 23, 2022

Antivax Rally

In The Politics of Autism, I analyze the discredited notion that vaccines cause autism. This bogus idea can hurt people by allowing diseases to spread  And among those diseases could be COVID-19.

Antivaxxers are sometimes violent, often abusive, and always wrong.  

Peter Jamison and Ellie Silverman at WP:
As anti-vaccine activists from across the country prepare to gather on the steps of the Lincoln Memorial on Sunday, they are hoping their rally will mark a once-fringe movement’s arrival as a lasting force in American society.

That hope, some public health experts fear, is justified. 
Almost two years into the coronavirus pandemic, the movement to challenge vaccines’ safety — and reject vaccine mandates — has never been stronger. An ideology whose most notable adherents were once religious fundamentalists and minor celebrities is now firmly entrenched among tens of millions of Americans.

Baseless fears of vaccines have been a driving force among the approximately 20 percent of U.S. adults who have refused some of the most effective medicines in human history: the mRNA vaccines developed against the coronavirus by Pfizer, with German partner BioNTech, and Moderna. The nation that produced Jonas Salk has exported anti-vaccine propaganda around the globe, wreaking havoc on public health campaigns from Germany to Kenya.

The scientific case for the full range of vaccines recommended by public health authorities in the United States remains as solid as ever. Research has shown that those vaccines — which have all but eliminated diseases that once sickened, debilitated or killed millions every year — to be safe for the vast majority of those who receive them. The 1998 study by Andrew Wakefield that claimed a link between a common childhood vaccine and autism, launching the modern anti-vaccination movement, was exposed as fraudulent.

Jamieson and Silverman also report:

Organizers estimate that 20,000 people will attend the rally, marching from the Washington Monument to the Lincoln Memorial, according to a permit issued by the National Park Service. D.C. police were fully activated from Friday Jan. 21, during the annual March for Life, through today for the anti-vaccine mandate rally, spokesman Dustin Sternbeck said.

The march is billed as a protest of mandates, rather than the medicines themselves. But similar rhetoric — emphasizing individual autonomy rather than untenable scientific ideas — has long characterized the broader anti-vaccine movement, and the march’s speakers include movement veterans such as Robert F. Kennedy Jr. and Del Bigtree, founder of the anti-vaccine group Informed Consent Action Network.

Other speakers include physician Robert Malone, a prominent critic of the coronavirus mRNA vaccines, and former CBS News correspondent Lara Logan, who in a November appearance on Fox News compared White House chief medical adviser Anthony S. Fauci to the Nazi doctor Josef Mengele. Public employee associations that have formed to protest their employers’ vaccine mandates, such as Feds for Medical Freedom and D.C. Firefighters Bodily Autonomy Affirmation Group, are also participating.



Saturday, January 22, 2022

Texas Is a Tough State

In The Politics of Autism, I write about special education and the Individuals with Disabilities Education ActSome states do a reasonably good job with education and social services, but Texas has not been one of them. A 2016 Houston Chronicle investigation revealed that tens of thousands of disabled students  were refused access to services because of a de-facto enrollment cap.

Lauren Castle at The Fort Worth Star-Telegram:

Forty-six percent of Texas children ages 9 months to 35 months received a developmental screening, according to 2018-2019 data from the Annie E. Casey Foundation. The Centers for Disease Control and Prevention recommend that all children should have a developmental screening and formal test even if there are no concerns.
While pediatricians are able to help families with concerns on child development, continuous health care can be a challenge for some families. Dr. Christina Robinson, medical director at the University of North Texas Health Science Center’s pediatric mobile clinic, has noticed patients facing multiple barriers to care.
“We have noticed that there is usually not just one barrier, but layers of barriers our families are struggling with,” Robinson said. “When one barrier may not exist one time, the next time you see them another barrier might be there when the other one hasn’t resolved.”

 The state’s Early Childhood Intervention program underwent a federal investigation that concluded in 2020. The US Department of Education determined that not all of the young children eligible for the agency’s programs were provided services, according to an Oct. 2020 letter sent to the Texas Health and Human Services Commission.

Texans Care for Children, a policy organization, stated in a 2020 report that the state program overall was under-enrolling infants and toddlers across the state, and disparities were seen among children of color. “In 2018, Texas [Early Childhood Intervention] served 2.34 percent of children under age three, compared to the national average of 3.74 percent, ranking the state 46th in the nation,” the Texans Care for Children report stated. “While Texas [Early Childhood Intervention] enrollment is low for children of all backgrounds, it is disproportionately low for Black children.”

Friday, January 21, 2022

Asian Americans with Disabilities

In The Politics of Autism, I write about the experiences of different economicethnic and racial groups.  

At NBC, Victoria Namkung reports on Princeton University undergraduate Jennifer Lee:
These experiences led Lee to found the Asian Americans with Disabilities Initiative, or AADI, in July of 2021 with a goal of amplifying disabled Asian American voices and creating space to explore the intersectional identities of being both disabled and Asian American. The youth-led nonprofit group wants to provide the next generation of disabled Asian American leaders with accessible resources to help combat anti-Asian racism and ableism.

Last week, the advocacy organization published the Asian Americans with Disabilities Resource Guide featuring first-person testimonials, comprehensive peer-reviewed research and sections such as access to disability services, mental illness and intersectionality. The nearly 80-page online guide is designed for Asian Americans with disabilities, as well as their caretakers, family members, allies, businesses and organizations.

Thursday, January 20, 2022

The Antivax Toll

In The Politics of Autism, I analyze the discredited notion that vaccines cause autism. This bogus idea can hurt people by allowing diseases to spread  And among those diseases could be COVID-19.

Antivaxxers are sometimes violent, often abusive, and always wrong.  

At LAT, Dr. Venktesh Ramnath, medical director of critical care and telemedicine outreach at UC San Diego Health:
Incredulous families summarily deny that COVID-19 (and absence of vaccination) could be responsible for the critical illnesses I see every day. Patients and their relatives vehemently claim that healthcare workers and hospitals are “poisoning” and “punishing,” as if part of an Orwellian plot, leading to belligerent, abusive behaviors against staff.

Many providers have become inured to uninformed rebuffs of medical recommendations, including vaccination. Educational efforts have devolved into counterproductive debates.

Far from “heroes” or even compassionate advocates for health, providers are viewed as biased technicians with dubious motives locking loved ones behind hospital doors.

One response to this emotional onslaught is, understandably, attrition. Most veteran ICU nursing staff where I work have left, replaced by temporary assignment nurses from across the country. Some physicians who have become ostracized by the very communities they serve now contemplate nonclinical work or early retirement.

Among those of us still in the trenches, some medical professionals are now breaking traditional practice norms. Providers are resorting to less evidence-based practices, desperate to help and also to avoid another conflict. By opening the door to “try everything,” they have become unwitting supporters of anti-science movements, placing additional stress on others who promote well-established, proven practices.

A 2021 release from USC:

Between 37,000 and 43,000 children in the United States have lost at least one parent to COVID-19, a “staggering” 20% increase in parental loss over a typical year, USC research shows.

The scope of deaths “is forever imprinting the lives of tens of thousands of young Americans,” said study co-author Emily Smith-Greenaway, associate professor of sociology and spatial sciences at the USC Dornsife College of Letters, Arts and Sciences. “It’s a social crisis that merits far greater attention, as well as a collective response to slow the tide of loss that’s washing over children.”

The research appeared this week in JAMA Pediatrics.

Three-fourths of children who lost a parent were adolescents, and 1 in 4 were children younger than 10. Black children have also suffered disproportionately from parental bereavement: Although they comprise only 14% of children in the U.S., they make up 20% of those who’ve lost a parent to COVID-19.


Wednesday, January 19, 2022

Vaccination, Politics and COVID-19

 In The Politics of Autism, I analyze the discredited notion that vaccines cause autism. This bogus idea can hurt people by allowing diseases to spread  And among those diseases could be COVID-19.

Antivaxxers are sometimes violent, often abusive, and always wrong.  

UnfortunatelyRepublican politicians and conservative media figures are increasingly joining up with the anti-vaxxers.  There is a great deal of overlap between MAGA World and the antivax movement.

At BMC Public Health, Don Albrecht has an article titled "Vaccination, politics and COVID-19 impacts."  The abstract:

The development of safe and effective COVID-19 vaccines provides a clear path to bring the pandemic to an end. Vaccination rates, however, have been insufficient to prevent disease spread. A critical factor in so many people choosing not to be vaccinated is their political views. In this study, a path model is developed and tested to explore the impacts of political views on vaccination rates and COVID-19 cases and deaths per 100,000 residents in U.S. counties. The data strongly supported the model. In counties with a high percentage of Republican voters, vaccination rates were significantly lower and COVID-19 cases and deaths per 100,000 residents were much higher. Moving forward, it is critical to find ways to overcome political division and rebuild trust in science and health professionals.

From the article:

Despite the obvious fact that vaccines save lives and reduce human suffering [34], there has been opposition to vaccination since the time of Jenner [35]. This opposition has become more organized and vibrant in recent years, with help from the Internet and social media [30, 36]. A critical event was an article published in 1998 that purported a link between the MMR (measles, mumps, and rubella) vaccine and autism. Later it was found that the research was faulty and the article was retracted in 2010. The damage, however, had been done and a strong “anti-vax” movement was growing throughout the world. The movement was greatly enhanced by tweets from Donald Trump both before his election and after he became president [31]. The consequences are profound, and vaccination rates have been declining around the world [37].


Conservative opposition to vaccines was enhanced by the support of Donald Trump. Over the years, Trump has sent many tweets with anti-vax and pro-conspiracy theory themes. For example, in 2014 he tweeted, “Healthy young child goes to doctor, gets pumped with massive shot of many vaccines, doesn’t feel good and changes – AUTISM. Many such cases.” On September 2, 2015 he tweeted, “I am being proven right about massive vaccinations – the doctors lied. Save our children and their futures!” A study by Hornsey et al. [31] found that these statements had an effect and that Trump voters were more likely to express vaccine hesitancy, distrust medical authorities, and believe conspiracy theories about COVID-19 vaccines.

Beyond the president, other political leaders and media outlets sent divergent messages on COVID-19. Again, Republicans and the right-wing media tended to downplay the threat of the disease and express opposition to steps intended to prevent spread [93]. Fridman et al. [94] found a critical factor in vaccine resistance was exposure to right-wing media. With support from Republican leaders and the right-wing media, protests were held throughout the country in opposition to mask mandates, business and school closures, and vaccination mandates. In many communities, wearing a mask or getting a vaccine became a political statement, with many Republicans arguing that these actions violated their individual freedoms and were unnecessary anyway. The consequence was increased levels of virus spread in Republican-dominated counties. A study from early in the pandemic found that counties where Trump received a higher proportion of the vote were initially safer from the virus, but this changed as the pandemic progressed, and these counties then experienced severe impacts [95]. Research shows that a likely reason for the initial safety of Trump-leaning counties from the disease is that they tend to be more rural where people are naturally social distanced and less likely to be reliant on mass transit, conditions which enhance virus spread [61]. This same study found a positive relationship between the percent voting for Trump in a county and the severity of the pandemic in that county. In this study, we expect an inverse relationship between the percent voting for Trump and vaccination rates. Lower vaccination rates are expected to lead to higher rates of COVID-19 cases and deaths.