Prof. Dr. Annika Frahsa, Prof. Dr. med. Nicola Low and Team
Institute of Social and Preventive Medicine
This paper systematically reviews research on how political and affective polarisation influenced COVID-19 health behaviours and outcomes. It shows that political beliefs and partisan identities shaped trust in authorities, interpretation of public health messages, and behaviours such as vaccination and mask-wearing—factors that help explain disparities in infection and mortality beyond well-known social and demographic determinants.
The authors find consistent evidence that higher political polarisation is associated with lower COVID-19 vaccine uptake and intent, while evidence for affective polarisation is more variable. Importantly, the effects of polarisation are not uniform: associations often depend on political group membership, meaning health behaviours differ by in-group affiliation. Vaccination emerged as a central point of political conflict and was easier to measure consistently than other preventive behaviours.
Strengths of the study include its multidisciplinary team and pre-registered protocol. The authors conclude that while there is evidence linking polarisation to COVID-19 health behaviours, more international, interdisciplinary, and longitudinal research is needed to clarify direction of effects, understand impacts on health outcomes such as infection and mortality, and inform more effective public health and pandemic preparedness policies.
Ipekci, A.M., Filsinger, M., Buitrago-Garcia, D., Kobler Betancourt, C.I., Liwanag, H.J., Frahsa, A. and Low, N. Polarization and health-related behaviors and outcomes during the COVID-19 pandemic: a systematic review. SSM–Population Health 33¸101891 (2026).
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