This opinion piece will be sharply critical of the new CDC guidance on masking for individuals who have been fully vaccinated against COVID-19, so I want to begin by saying the agency has been, and remains, the envy of the world. There’s good reason why China, Korea, Europe, and Africa all named their public health agencies after the CDC. When CDC speaks, scientists fall behind in lockstep, and the public trusts and follows its advice.
But not this time. Its mask guidance has been greeted by scientists and the public alike as confusing, inconsistent, and frankly, unsupported by scientific evidence. I’ll explain why.
The CDC has lurched from over-caution to abandoning all caution. Just over 2 weeks ago, the CDC recommended universal masking in indoor spaces. The nation’s top health officials pleaded with the public to wear masks or face dire consequences. Now CDC states that the fully vaccinated “can resume activities that you did prior to the pandemic” without wearing a mask or distancing. In other words, CDC gave a bright green light to return to normal — indoor dining, shopping, and resumption of schools, colleges, and workplaces. It seems a bit premature to declare victory.
You might think there were new, important scientific findings justifying such a dramatic shift — there weren’t. Vaccines are almost flawless at preventing serious disease and death, and they do significantly reduce SARS-CoV-2 transmission. But we knew that weeks ago. The U.S. has vaccinated more people in the last several weeks, but we’ve been on track to do that for quite some time. And remember, CDC guidance doesn’t just apply to affluent zip codes with high vaccination rates. It applies equally to areas that have very low coverage. And in such a mobile society as ours, there will be lots of travel to all areas of the country.
My supposition is that CDC prematurely recommended “back to normal” because it wanted to give hesitant people an incentive to get vaccinated. But there is no behavioral evidence that giving more freedom to vaccinated people will encourage more to be vaccinated. Why? First of all, most Americans won’t even perceive CDC’s new advice as “vaccine” guidance, but rather as “mask” guidance. We see that in all the headlines, and many states are now dismantling, or considering removing, their mask mandates. But there’s more: Individuals opposed to vaccines are just as likely (maybe even more likely) to just take off their masks as they are to get a jab.
There is a galling disconnect in federal policy on COVID-19. CDC is telling states, the private sector, and the public that it is vital to differentiate between the vaccinated and the unvaccinated. But at the same time, the Biden administration has made that all but impossible. The administration stubbornly refuses to offer any way to demonstrate proof of vaccination. Other places like the European Union and Israel have successfully used digital health passes (so-called “vaccine passports”) as a way to ensure a safe return to normal. Will anyone have confidence being in a restaurant, mall, church, or gym if they’re not sure that all of the maskless people crowding around are fully vaccinated?
So, what will be the outcome of the CDC’s new guidance? It’s highly likely that both vaccinated and unvaccinated individuals will throw away their masks. This poses a significant risk of a surge of cases and hospitalizations. Over 60% of Americans are still not fully vaccinated. Many immunocompromised people are vulnerable even if fully vaccinated because they can’t mount a full — or often any — immune response. Children under 12 years old aren’t eligible for vaccination. All these groups remain at risk. If even one unvaccinated person is in an indoor crowded space without a mask, it poses a risk of spread.
And just look at the CDC website. It actually contains joyful images of unmasked people happily living their lives. But the images are deeply troubling. One is a group of unmasked adults and children playing. But wait, the children can’t get a vaccine. Another is a gym class, but these have caused major super-spreader events. Yet another photo shows a person shopping without a mask, but what about the supermarket worker who may not be vaccinated or has undergone cancer therapy?
This is why a public health agency like the CDC has to take a population approach. The impact of their new guidance on the public is predictable. But what I foresee isn’t a surge in hesitant people now eager to get the jab. I see unvaccinated people feeling they have a license to throw away the masks they have always disliked. What behavioral scientists understand is that culture and peers have major influences on how we behave. If everyone around you is wearing a mask and distancing, it is likely you will. But if many, or even most people, are maskless, you will remove your mask as well. People won’t be making “nice” distinctions based on the CDC guidelines.
And speaking of confusing distinctions. Under the new guidance, vaccinated people must wear masks in an airport or bus station, and in a homeless shelter or prison. But they can remove their masks in a crowded restaurant or mall. And they can go to church and sing, or join a gym class with heavy breathing and shouting. How does the epidemiological evidence support all those distinctions?
I’ve worked with the CDC for decades, from the AIDS pandemic through to SARS, influenza, Ebola, and Zika. I know the staff are world class scientists and they work tirelessly for the public good. They are our modern-day heroes. It is therefore agonizing to see the erosion of public trust, first with the truly unconscionable undermining of the agency by the Trump administration. And now, feeling tugged in opposite directions by Congress and the public. We need an independent CDC with a steady hand. CDC must be guided by the science, but it also has to become a talented health communicator that gains public trust and shapes public behavior. The latter has been sadly absent during the COVID-19 pandemic.
Lawrence O. Gostin, JD, serves as faculty director and founding chair of the O’Neill Institute for National and Global Health Law at Georgetown University, where he holds the school’s highest academic rank, “University Professor.” Gostin is also a professor of medicine at Georgetown, a professor of public health at Johns Hopkins University, and directs the World Health Organization Center on National and Global Health Law.