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Most studies of policy entrepreneurship seek to understand how entrepreneurs influence the behavior of policy‐makers in the agenda‐setting or decision‐making phases of the policy process. Recent scholarship has sought to understand what role entrepreneurs might play in policy implementation by focusing on their ability to influence bureaucrats' discretion and behavior. However, these studies overlook the potentially critical influence of policy entrepreneurs during the implementation of “opt‐in” policies that require voluntary compliance by individuals to be successful. Here, we consider whether and how a visible policy entrepreneur can impact opt‐in policy implementation, focusing on their credibility—or ability to gain public trust—as a potential driving factor of their influence. Using the empirical context of COVID‐19 vaccination recommendations, we identify Dr. Anthony Fauci as a highly visible policy entrepreneur and assess his influence on individual vaccine intention and uptake. Drawing on data from a novel panel survey of the American public on attitudes about the virus, risk, politics, and vaccination during the first several months of the COVID‐19 vaccine rollout in the United States, we test the relationship between respondent trust in Dr. Fauci and changes in reported intention to vaccinate and vaccination uptake across time. We find that trust in Dr. Fauci is an important predictor for influencing individuals' intention to vaccinate and actual vaccination behavior.

 

Abstract How does the state of American federalism explain responses to COVID-19? State-by-state variations to the COVID-19 pandemic illustrate the political dynamics of “kaleidoscopic federalism,” under which there is no single prevailing principle of federalism. In the COVID-19 pandemic, features of kaleidoscopic federalism combined with shortcomings in the public health system under the Trump administration, leading to fragmented responses to the pandemic among the states. Federalism alone does not explain the shortcomings of the United States’ response to the pandemic. Rather, the fragmented response was driven by state partisanship, which shaped state public health interventions and resulted in differences in public health outcomes. This has sobering implications for American federalism because state-level partisan differences yield different and unequal responses to the pandemic. 

In Spring/Summer 2020, most individuals living in the United States experienced several months of social distancing and stay-at-home orders because of the coronavirus (COVID-19) pandemic. Clinicians, restaurant cooks, cashiers, transit operators, and other essential workers (EWs), however, continued to work outside the home during this time in order to keep others alive and maintain a functioning society. In the United States, EWs are often low-income persons of color who are more likely to face socioeconomic vulnerabilities, systemic racism, and health inequities. To assess the various impacts of COVID-19 on EWs, an online survey was distributed to a representative sample of individuals residing in six states during May/June 2020. The sample included 990 individuals who identified as EWs and 736 nonessential workers (NWs). We assessed differences between EW and NW respondents according to three categories related to health equity and social determinants of health: (1) demographics (e.g. race/ethnicity); (2) COVID-19 exposure risk pathways (e.g. ability to social distance); and (3) COVID-19 risk perceptions (e.g. perceived risk of contracting COVID-19). EWs were more likely to be Black or Hispanic than NWs and also had lower incomes and education levels on average. Unsurprisingly, EWs were substantially more likely to report working outside the home and less likely to report social distancing and wearing masks indoors as compared to NWs. EWs also perceived a slightly greater risk of contracting COVID-19. These findings, which we discuss in the context of persistent structural inequalities, systemic racism, and health inequities within the United States, highlight ways in which COVID-19 exacerbates existing socioeconomic vulnerabilities faced by EWs. 

Inland freshwater salinity is rising worldwide, a phenomenon called the freshwater salinization syndrome (FSS). We investigate a potential conflict between managing the FSS and indirect potable reuse, the practice of augmenting water supplies through the addition of highly treated wastewater (reclaimed water) to surface waters and groundwaters. From time-series data collected over 25 years, we quantify the contributions of three salinity sources—a water reclamation facility and two rapidly urbanizing watersheds—to the rising concentration of sodium (a major ion associated with the FSS) in a regionally important drinking-water reservoir in the Mid-Atlantic United States. Sodium mass loading to the reservoir is primarily from watershed runoff during wet weather and reclaimed water during dry weather. Across all timescales evaluated, sodium concentration in the reclaimed water is higher than in outflow from the two watersheds. Sodium in reclaimed water originates from chemicals added during wastewater treatment, industrial and commercial discharges, human excretion and down-drain disposal of drinking water and sodium-rich household products. Thus, numerous opportunities exist to reduce the contribution of indirect potable reuse to sodium pollution at this site, and the FSS more generally. These efforts will require deliberative engagement with a diverse community of watershed stakeholders and careful consideration of the local political, social and environmental context.