“Why should I have to wear a mask, just because other people are too stupid not to get vaccinated?” a friend recently asked me. “I got the vaccine. If I get the Delta variant, I’ll either have no symptoms or only very mild ones.”
My friend is hardly alone. Millions of Americans are confused and blame the Centers for Disease Control (CDC), President BidenJoe BidenManchin to vote to nix Biden's vaccine mandate for larger businesses Congress averts shutdown after vaccine mandate fight Senate cuts deal to clear government funding bill MORE and state and local officials for shifting recommendations that seek to prevent further viral spread and disease.
Yet, two underlying factors help fuel this resistance to recommendations and have strikingly received relatively little attention, and now need to be more fully addressed: cognitive biases in the human brain, and poor public understanding and literacy regarding science and math.
In her book, “Purity and Danger,” the anthropologist Mary Douglas described how people tend to divide the world into the two separate domains: “risky” and “safe.” We categorize situations as either good or bad, and have difficulty conceptualizing ambiguities, uncertainties and notions of relative safety.
The Nobel laureate Daniel Kahneman, in his bestseller “Thinking Fast and Slow,” presented psychological research that elucidates Douglas’ findings: In assessing risks, humans instinctively engage in “fast” rather than more deliberative “slow” thinking. People tend to draw on biases and simple mental heuristics, or frameworks, of which they are unaware — and which often mislead us. Our brain’s default is to jump to conclusions that situations are either risky or not, rather than only partially or relatively so.
Understandably, millions of people want certainty, and assume that it is possible, but unfortunately, it is not, as long as the pandemic continues to unfold. COVID-19 prevention involves weighing multiple uncertainties and nuanced probabilities and tradeoffs. Vaccine and mask effectiveness is high, but not 100%. Going to restaurants, gyms and theaters, as well as flying in planes provide welcome freedom and can be relatively low risk, yet are not wholly danger-free. Data do not yet exist to know how effective each manufacturer’s
vaccine is against the emerging Lambda variant and others, how much each vaccine’s efficacy may decrease in a year and how prevalent significant symptoms will be among vaccinated individuals.
My vaccinated friend recognized that the Delta variant could potentially infect her, but she assumed that her symptoms would be nonexistent or minimal, and that she was thus safe and didn’t need to worry about it or wear a mask.
Yet, even people who develop only “mild” symptoms — and thus don’t require hospitalization — can nonetheless suffer from weeks of mental and physical fatigue and/or become “long-haulers” with months of disabilities that impede employment. She may also infect other individuals who avoid vaccination not because of stupidity, but because they are infants, young children, pregnant women or immunocompromised.
Science and math literacy and education can help people grasp these complexities, and counteract innate human biases, but lag in the U.S. far below that of all other industrial countries. In students’ science proficiency, the U.S. now ranks 33rd in the world, below Russia, Vietnam, Slovenia, Argentina and the Organization of Economic Cooperation and Development average. Most Americans do not know that humans evolved from earlier species, and lived at a different time than the dinosaurs.
The U.S. has grossly underfunded and underappreciated needs for state-of-the-art teaching in these fields. Junior and senior high school science classes generally still rely on rote memorization of facts, such as Boyle’s Law and the Periodic Table, rather showing how science consists of exciting ongoing processes of discovery, and how knowledge expands and shifts over time.
Policymakers, physicians, teachers, social scientists and others must now do more to recognize our brain’s biases and our nation’s low-scientific literacy, and overcome these challenges, enhancing public understanding of science both in classrooms and on the news.
The pandemic is not disappearing soon, and we will face future threats from additional variants, viruses and climate change, continuing to require heightened public understandings of science and probabilities. We all need to work harder to educate Americans about the rationales behind prevention decisions — why safety measures are changing because the pandemic is evolving, not because of fickle experts.
Transparency and providing data are critical. Holding back data, as the CDC did regarding the super-spreader event in Provincetown, Mass., may reduce public fears in the short term, but in the long run, lower public trust and acceptance of prevention recommendations. Some members of the public may misinterpret data, but far more people will likely appreciate the rationales and follow prevention guidelines.
The good news is that we are living in a unique, teachable moment — a chance to enlighten the public about the complexities as well as the power of science. People are educable, comprehending probabilities in other domains. The public recognizes, for instance, that in predicting the weather, the chances of rain are frequently 20 percent or 50 percent, not 0 percent or 100 percent; and that seat belts do not prevent all traffic deaths, but can reduce them. Drawing on such familiar analogies can now help.
Officials should emphasize, too, how scientists have been correct about crucial aspects of the pandemic, developing highly-effective vaccines for hundreds of millions of Americans in only around 18 months — an unprecedented achievement.
Critically, we should also invest in science education. Congress recently passed the US Innovation and Competition Act, spending $250 billion on technology to catch up to China. But the legislation did not include enhancing science education in grades K-12 and college, which is crucial, too. We also all know people who are wary of Covid prevention measures, with whom we could talk one-to-one.
Such efforts to educate COVID-weary Americans may encounter some resistance, but are essential and will yield vital long-term benefits.
When I told my vaccinated friend why I thought she should wear masks indoors at restaurants, gyms and theatres, she frowned. But as I continued to explain the reasons, she listened — and eventually tilted her head slightly back and forth, weighing my arguments. She then took a deep breath, slowly nodded and said, though in a quiet voice, “you’re right.”
Dr. Robert Klitzman is a psychiatry professor, director of the online and in-person Masters of Bioethics Program and a co-founder and former co-director of the Center for Bioethics in the Vagelos College of Physicians & Surgeons and the Mailman School of Public Health at Columbia University. He is the author of nine books, including “Designing Babies: How Technology is Changing the Ways We Create Children” (2020), “The Ethics Police? The Struggle to Make Human Research Safe” (2015) and “Am I My Genes?: Confronting Fate and Family Secrets in the Age of Genetic Testing.” Follow him on Twitter: @RobertKlitzman.