CDC mask guidance relies on the honor system. Will people do the right thing?

CDC mask guidance relies on the honor system. Will people do the right thing?

The Centers for Disease Control and Prevention has determined that people who are fully vaccinated against COVID-19 can resume their pre-pandemic lives without wearing masks (unvaccinated people are still encouraged to mask up in most cases, save for outdoor activities with household members or fully vaccinated people). And the health organization is trusting the public to abide by an honor system that relies on people to follow rules without oversight. Will it work?

“Anyone who is fully vaccinated can participate in indoor and outdoor activities, large or small, without wearing a mask or physical distancing,” Dr. Rochelle Walensky, the director of the CDC said in a May 13 press conference. After the announcement, states like Kentucky, Washington and Oregon immediately adopted the guidance while others reviewed it or vowed to enact it in the near future. “At this point, I think people are going to self-attest,” Connecticut Gov. Ned Lamont said, while explaining that businesses could individually decide whether or not to require proof of vaccination. “I hope we can count on them to do the right thing.”

A discarded face mask
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Companies also had a diverse response: Starbucks, Costco and Trader Joe's dropped indoor mask requirements, but Home Depot said vaccinated customers may need to wear masks when required by state and local ordinances. Gap Inc., which owns Old Navy, Banana Republic and Athleta, will require masks for employees while "recommending" them for customers who are not fully vaccinated (except in places where masks are legally required).

Even small businesses followed suit. The proprietors of Saratoga’s Broadway Deli in Saratoga Springs, N.Y., accepted the CDC guidelines on May 19, when Gov. Andrew Cuomo enacted them, but posted their discontent to Instagram: “It was a d*** move by the government to put the onus of public health on the shoulders of business owners.”

On Twitter, suspicion grew that blind trust allowed unvaccinated folks to bend the rules, given the national vaccination rate — only 39.5 percent of the population is fully inoculated against COVID-19, according to the CDC — and would endanger children under the age of 12 who are not eligible for vaccination (although Fauci predicted that younger kids could be vaccinated by the end of this year or early 2022).

“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," Dr. Kavita Patel wrote in an op-ed published by the Hill. “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."

Walensky defended the guidance during a May 16 interview with NBC's Meet the Press. “We are asking people to be honest with themselves,” she said. And Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, addressed the challenges facing businesses. “I mean, you’re going to be depending on people being honest enough to say whether they were vaccinated or not,” he told CNN.

According to Johan Bester, director of bioethics at the University of Nevada, Las Vegas, without federally mandated “vaccine passports,” digital databases that indicate vaccination status (an idea the White House rejected on privacy and discriminatory concerns), the CDC has resorted to the honor code.

“We’re caught between two different desires — to return to normal life and protect unvaccinated people who are still vulnerable to COVID-19,” Bester tells Yahoo Life. “Without being able to verify who is vaccinated, the honor system is all we have left. Otherwise, it’s not tenable for the economy, public well-being or vaccine messaging, to [restrict] vaccinated people.”

Bester says there is reason to be skeptical that people who are unvaccinated by choice will wear masks. “We know that these people are generally less worried about COVID-19 or face masks,” he says. Indeed, a Morning Consult survey showed that 51 percent of unvaccinated people are comfortable getting back to normal life without masks, compared to 34 percent of vaccinated people.

“Short of a mandate that enforces government power — which is not a long-term solution anyway— people who are skeptical of COVID-19 likely won’t comply,” says Bester. “Trust in public health is very important.”

And this far into the pandemic, public trust is sorely lacking. A survey conducted by Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health between February and March found that only 52 percent of people have “a great deal of trust” in the CDC, with lower percentages supporting the Food and Drug Administration and local and state health departments.

“People generally want to trust others, however the truth in America has become relative,” says Bester. “The question is not, ‘Is what you're saying true?’ but rather, ‘What is your political affiliation?’”

Moral responsibility can also be cultural. Daniel Swartzman, an associate professor emeritus in health care administration and public health sciences at Loyola University Chicago, says the United States may have achieved herd immunity against measles through required vaccinations for school-age children, unlike the U.K., which relied on voluntary compliance.

“Humans are not innately ornery about being made to do things,” he tells Yahoo Life. “However, over the past 50 years, Americans have fetishized this idea that individuals get to make all their decisions by themselves. … Wearing a mask is primarily to protect the other — that’s what public health is about. We didn’t mandate masks because our political system views individuals as the primary unit of analysis in society and not the community.”

Swartzman says health policies have always been a balance between public and private will, and cites as an example the resistance to seat belts before the passing of safety laws. (According to the National Highway Traffic Safety Administration, although cars have been equipped with seat belts since the 1950s, only 14 percent of people buckled up in 1984.) “What changed? We mandated seat belts, and over time, we’ve accepted them.”

Still, while there will always be outliers, Swartzman suspects that people who lie about their vaccination status to forgo masks in a coffee shop, for example, are among a small but complex population. "Some feel, ‘I can do whatever I want — it’s my body,’ however, these are often the same people who volunteer in church or help their neighbors,” he says. “So they care to a certain degree, but lack the moral obligation to be caring in another particular context.”

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