Without disagreeing with anything you say in this welcome and intelligent essay, the "deaths of despair" argument doesn't quite explain something we're seeing here in the Deep South: Covid is also killing extremely well-educated but unvaccinated white men: e.g., doctors. In my small town in Alabama, the Delta variant just killed a top doctor in a high-prestige specialty. The explanation may lie partly in the strong evangelical religion here: It may not be that such men "despair" (or lack faith in the future) so much as that they have too much faith in faith. Researchers may need to factor into future studies religion (along with poverty, lack of education, etc.) and try to tease apart, as challenging as it might be: What's being caused by an absence of something (such as money or schooling) and what's being caused by the presence of something (such as an overarching pietist, fundamentalist, or evangelical religion).