Oct. 19, 2021 -- Puerto Rico tops the list for fully vaccinated population rates in America at 81%. Not Vermont. Not Massachusetts. But the United States territory of Puerto Rico.

And at least one global public health expert suggests that may be because its political climate is different from that of the mainland.

A tweet by Ashish Jha, MD, called attention to Puerto Rico’s top performance and pointed out that it’s not just the “wealthy New England states” where rates are highest.

Jha said the territory has gotten too little credit for its progress and it’s "worth reflecting on how they did it.” Overall, 66% in the United States are fully vaccinated, according to vaccination tracker Covid Act Now.

“Best I can tell, they’ve done this largely by not tying vaccines to politics,” Jha tweeted. “They pay less attention to mainland politics. All their political parties actively support vaccinations. And generally, political identify & vaccinations are not intermixed.”

He also pointed out that people may think Puerto Rico is much smaller than Vermont, but its population is about five times larger than Vermont and that Puerto Rico is “quite poor compared to much of the U.S.”

Focus on the Science

Dhruv Khullar, MD, assistant professor of health policy and economics at Weill Cornell Medical College in New York City, says, “I agree with Ashish. I think there are real dangers when something like vaccination gets linked to politics and identity because that makes it harder to have open-minded, data-informed conversations about the issue.”

Labeling groups, regions, or political parties as being more likely not to get the vaccine may strengthen people’s resolve to defend their ideals as they see it as a statement of who they are, he says.

“To the extent that leaders and communities are able to keep these discussions out of politics — and focused instead on the science showing how safe and effective COVID vaccines are — they're likely to be more successful in getting people vaccinated and savings lives,” Khullar said.

Tweets were posted in support of Jha’s comments, but also suggesting other reasons Puerto Rico is in the lead such as strict testing policies on entry and perhaps a stronger culture of helping people.

Coral Olazagasti, MD, who lists her location as New York and says she is “#PRproud” pointed out that virtually everyone in Puerto Rico over 65 has been fully vaccinated.

“Time to look at this tiny yet mighty island as an example,” she wrote.

Another person tweeted: “It may be a U.S. territory but culturally it is a nation.”

José Lazada, MD, a hematologist-oncologist currently practicing in Puerto Rico, says he agrees political views are not tied to vaccine status in Puerto Rico.

“Also, people here are a bit more conservative and tend to have more faith in doctor's advice as a general rule,” he said.

More Unity?

Marina Del Rios, MD, an emergency physician at University of Iowa, who was raised in Puerto Rico, says Jha is on target and that she thinks politics play a big role in the difference.

She also noted that the three main political factions in Puerto Rico were all pro-COVID-19 vaccine.

Del Rios gave an example of unity from when she visited her family in Puerto Rico this summer: “Everyone wore masks indoors and this is even after (CDC Director) Rochelle Walensky had made the statement that if you’re vaccinated you don’t have to wear a mask anymore.”

She said the sense of collective responsibility is more pronounced in Puerto Rico.

“There’s a sense that we’re not all OK until we’re all protected,” she said.

Del Rios speculated that may be because there have been so many natural disasters on the island over the past few years.

“There may be some sense that we have to protect ourselves, because nobody else will,” she said.

Del Rios also noted that all children 12 years of age and older had to be vaccinated against COVID-19 before returning to school this fall, per government order.

Medscape Medical News

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