CDC lifting mask use: The honor system isn’t good enough
After 15 months of mask wearing, social distancing and partial isolation to combat COVID-19, the Centers for Disease Control and Prevention’s (CDC) guidance to remove masks in most settings for vaccinated individuals should have been truly a great day for America. Instead, it has been met with confusion and concern, revealing a unifying theme — we just don’t trust each other.
As one of the most public facing health agencies in the world, the CDC has received its fair share of criticism. Now, however, the agency is receiving its sharpest criticism for essentially declaring victory against the pandemic. Much of the criticism has been leveled by physicians and public health professionals, as well as respected academicians. The concerns are varied, and highlight distrust we have for those around us to behave in interest of public health.
The honor system, as Dr. Anthony Fauci has suggested, that Americans will need to follow under this new guidance to decipher who is and who is not vaccinated is simply magical thinking. People are much more likely to lie, especially if they enter a business or establishment with the majority of persons unmasked and they are simply asked to self-report vaccination status. And while it would be simple to blame the individual and shame them, the psychology behind lying about health conditions (in this case being fully vaccinated for a viral disease) has been studied and there are a variety of reasons including the desire to not be judged by others.
In the absence of an explicit standardized mechanism for proof of vaccination, American businesses, retailers and employers will likely take to paths: the aforementioned honor system or an electronic form of proof of vaccination, such as the approach taken by New York state. But with dozens of apps in development and countless more in planning, it is conceivable that Americans will need to have multiple mechanisms to prove vaccination. Furthermore, retailers, who have struggled economically in the pandemic will be less likely to have any barriers to entry when they are starved for foot traffic. When only 36 percent of our country is fully immunized, it is highly likely that you will be in mixed company, and in many places, the majority of people inside a setting could be unvaccinated.
Of course, the risk of infection to the vaccinated individual is low — but it’s not zero — and we are also still trying to understand the real-world evidence across all three available vaccines. Available data to date has largely been in health care workers, who are not representative of the entire population. Add to that the facts that children under the age of 12 have no option to be immunized and persons with certain chronic conditions might not have as much immunity, it is clear that Americans need more confidence before taking their masks off.
The solution would be both to require proof of vaccination and for the federal government to issue minimum technical standards for the private sector solutions — something similar to standards we use in many other sectors such as banking, health care and energy.
The government can issue guidance, similar to its approach with mobile health applications while allowing for third-party solutions that could easily exchange information across various devices, platforms and take into account language, health literacy and other barriers to access. Any “certified” technology solution could be used as proof, agnostic of developer and simply expected upon entry to any public setting.
A technology-based approach to proof of vaccination could also prove to be important to provide push notifications for key events as well as to allow for the user to enter any adverse effects or symptoms related to COVID-19, as well as results of testing if appropriate. Deidentified data collected would serve to advance knowledge around breakthrough infections and detect hot spots offering another advantage to a ubiquitous approach that exceeds the hope and prayers of an honor system.
These standards and technology solutions won’t take long to develop since many are already in the pipeline, but a federal certification or approval will remove the burden on businesses to play “vaccine police” but maintain consumer foot traffic.
Despite all this and even with proof of vaccination, many Americans might continue to wear a mask in settings — and there are good reasons for that. That does not mean that the vaccines are not a miracle, that they are not effective or that they don’t really work. It means that our nation has lost over 600,000 lives and millions more are experiencing Long COVID-19 — and to dismiss that would simply lack the appropriate degree of humility for the little red spiked virus that has defined our lifetime.
Kavita K. Patel is a physician at Mary’s Center, a federally qualified health center in Washington D.C. and a nonresident fellow at the Brookings Institution. She was a director of policy in the Obama administration.