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Republicans may be more likely to perceive and report side effects after COVID shots, including serious adverse events (AEs), findings from a cross-sectional study suggested.

Based on data from the Vaccine Adverse Event Reporting System (VAERS) and 2020 voting patterns, researchers showed that a 10% increase in voting for former President Donald Trump at the state level was associated with a higher likelihood of AE reports after vaccination (P<0.001 for all):

• Any AEs: OR 1.05 (95% CI 1.05-1.05)
• Severe AEs: OR 1.25 (95% CI 1.24-1.26)
• Proportion of AEs being severe: OR 1.21 (95% CI 1.20-1.22)

Yet the same voting patterns showed none of these associations when it came to AE reports following flu vaccination, according to David Asch, MD, MBA, of the University of Pennsylvania in Philadelphia, and colleagues in .

Prior reports have demonstrated that counties that voted for Trump in 2020 had rates and , they noted, but no study has looked at the connection between voting patterns and AE reporting.

While the voluntary nature of patient and clinician reports to VAERS creates a large risk for bias, this weakness actually becomes a strength when attempting to study the perception of AEs and motivation to report them, the authors said.

"Without a plausible reason to believe that vaccine recipients and their clinicians in Republican-inclined states will objectively encounter different rates of vaccine AEs than those in Democrat-inclined states, or have different abilities to report them, differences in reporting of those AEs will reflect the product of how those AEs are perceived and the inclination to report them," wrote Asch and colleagues.

Anti-vaccine sentiment has become with conservative politics in recent years, often taking on the form of questioning the effectiveness or safety of vaccines, they said, and the current findings suggest that Republicans are more likely to perceive or report those safety concerns. On the flipside, Democrats may be less likely to.

"The association between observation and belief runs both ways," the researchers wrote. "The adage 'seeing is believing' recognizes that our individual experiences inform our sense of truth, and 'believing is seeing' recognizes that our preconceptions modulate what we experience in the first place."

Asch's group assessed VAERS data for reports related to COVID-19 (2020-2022) or flu (2019-2022) vaccines for adults across all 50 states and the District of Columbia. AEs related to administration or storage errors were excluded from the analysis. Severe AEs were those described as life-threatening or which involved deaths or resulted in an emergency department visit, hospitalization, or disability.

For the COVID vaccines, 68,519 of the total 620,456 AEs were reported as severe (of note, people can report multiple times to VAERS). Indiana had the highest AE reporting rate (about 25 per 10,000 vaccinated), while Michigan, Montana, Kentucky, and Minnesota had the highest severe AE reporting rates (ranging from about 4 to 5 per 10,000 vaccinated). Those latter four states also had the highest proportions of severe AE reporting for the COVID vaccines.

For the 12,620 flu vaccine AE reports, 709 were considered severe. VAERS reports for the COVID and flu vaccines, respectively, involved individuals with a mean age of 52 and 56 years, while 70% and 75% involved women.

One limitation is that voting and AE reporting are both performed by individuals, while the current study had to rely on state-level data for both. But a strength, said Asch and co-authors, was that the findings held up on multiple sensitivity analyses that took into account population heterogeneity.

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