Op-Ed: How to Protect Our Health and Democracy

When election day arrived on Nov. 5, 1918, the Los Angeles Times proclaimed, “Every Loyal Californian Will Cast a Vote Today,” with the state medical board reassuring voters “that if masks are worn, there is no danger.” Yet with the country caught in the throes of an influenza pandemic which had already claimed nearly 200,000 lives, Americans abandoned the ballot box, and turnout dropped by 10.1%.

A century later, the U.S. is caught on a similar curve with COVID-19 — eerily, with more than 200,000 deaths as the November election approaches. This has heightened concerns that in-person voting during the upcoming presidential election could spread or cause a resurgence of COVID-19.

However, history is not doomed to repeat itself. State and local officials can take a number of steps, such as rethinking poll site operations and staffing, that would both ensure the safety of voters and poll workers and the integrity of the democratic process. In this article, we outline the political and public health challenges of voting during a pandemic and draw from the experience of previous elections to offer evidence-based recommendations for the upcoming national elections.

Public Health Challenges for In-Person Voting

The epidemiology of COVID-19 and the design of American democracy render the ongoing 2020 presidential elections uniquely susceptible to disruption. First, 58% of poll workers are over 60 years old; the same age group which is at the highest risk for COVID-19 infection and serious illness. Fear of infection may deter traditional volunteers from assisting on election day. This in turn may increase the risk that polling stations, of which two-thirds already report worker recruitment to be “very difficult,” may experience delays or closures.

Second, long lines and close contact between voters and poll workers on election day may increase the risk of viral transmission. Although the impact on disease dynamics is still unclear, there is some apprehension that the overlap with flu season might create a “double threat” or exacerbate the health risks from in-person voting in November. Third, while there has been an uptick in mail-in voting thus far this election cycle, it should be safe to assume that most Americans will still vote in-person on election day due to legal and practical barriers to mail-in voting in many states.

Insights from the Primaries

Dozens of states postponed their 2020 primary elections due to COVID-19. When elections eventually took place, the logistical challenges for officials and voters illustrate the need for multi-level, coordinated action.

Consider the case of Wisconsin, where the majority of election jurisdictions experienced a shortage of poll workers and a number of voting sites shut down, including 96% of polling locations in Milwaukee. Researchers estimate that site closures and the invalidation of mail-in ballots led to an 8.5% decline in turnout in Milwaukee alone. Additionally, long lines at limited polling sites can increase the risk of infection for voters and poll workers. For example, preliminary research has attributed 7.7% of new COVID-19 cases in Wisconsin between April and May to in-person voting from the state’s primary election.

Electoral disruptions have also uniquely disadvantaged people of color, who have been disproportionately affected by COVID-19. For example, Kentucky’s Jefferson County — which includes Louisville, with more than 600,000 registered voters and nearly half of the state’s Black population — had only a single polling place for the June primary. The resulting long lines not only increased the risk of infection but also functioned to suppress turnout from historically disenfranchised communities.

Recommended Policy Actions for Upcoming Elections

As the window to request mail-in ballots closes and in-person early voting begins, it will be paramount for local officials to increase their investment in public health infrastructure at voting sites. First, the federal government must collaborate with state authorities to create standards, design internal controls, and provide resources to ensure the safety of voters and poll workers. All poll workers should have access to adequate personal protective equipment, and all polling machines must be disinfected according to recommended sanitation procedures. The federal government should commit to providing emergency funds to states to procure necessary medical supplies and equipment. Additionally, local election authorities should aim to recruit younger poll workers to both foster civic engagement and minimize the danger for elderly adults, who account for the majority of election volunteers.

Second, polling sites will need to be adapted to reduce infection risk without compromising voter engagement. Given that the risk of transmission is elevated in indoor settings, polling stations should consider developing open-air voting sites. Local election boards should also work with community organizations such as churches to ensure that traditional voter mobilization efforts can be adapted to be physically distant. For example, “Soul to the Polls” — where churches organize transportation for their congregations to travel from Sunday services to early voting stations — is an example of an effective voter outreach initiative for Black Americans that may need to be adapted for COVID-19. To increase accessibility and reduce station crowding, polling sites should consider expanding locations and hours of operation.

Conclusion

With the pandemic challenging many Americans’ trust in institutions, ensuring the safety and legitimacy of voting — the very means by which we engage with institutions — is paramount. A prescription for democracy will require both investments in electoral infrastructure (e.g., mail-in voting, open-air booths) and personal protection for poll workers as well as voters. Such actions will not only help prevent potential outbreaks but also improve the convenience and accessibility of the democratic process for future generations.

Victor Agbafe is a medical student at the University of Michigan and a former volunteer with the Harvard Citizenship tutoring program. Kushal Kadakia is a Rhodes Scholar and graduate student in epidemiology and history at the University of Oxford in England.