Pandemics and Compliance: The Long-Term Effect of the 1918 Influenza on COVID-19 Vaccination

The paper investigates the long-term effect of the 1918 influenza on COVID-19 vaccination compliance and explores the potential mechanisms of this effect. Employing ordinary least squares (OLS) and instrumental variable (IV) methods, the paper finds a long-term positive effect and that both institutional and cognitive mechanisms play a role in the generation and persistence of this effect: exposure to the flu pandemic increases COVID-19 policy compliance by increasing the capacity of local health care systems, the availability of health care resources, and citizens’ belief in the value of health care access and the willingness to comply with public health policies. Heterogeneity analysis shows that local partisan orientation and social trust level account for the regional heterogeneity of the 1918 pandemic’s positive effect. The paper also preliminarily explores the impact of the 1918 influenza on public compliance in other policy areas, finding that it led to a decrease in census policy compliance in the long term, suggesting that the 1918 influenza had differentiated effects on policy compliance in different areas. The paper is the first to document a positive legacy of the 1918 influenza pandemic and to identify a historical determinant of COVID-19 policy compliance.