America’s biggest mistake in fighting Covid-19 began with an assumption made long before the virus behind the pandemic first appeared in humans.
In the federal government’s previous pandemic playbook, the initial actions taken by President Donald Trump’s administration, and advice given by experts, there was a common theme: that America would come together against a major national threat, helping put it down collectively.
Over the past year and a half, we’ve learned how wrong that was. While the US did manage to lock down at first, those lockdowns soon gave way to protests. Not long after the Centers for Disease Control and Prevention recommended masking and most states adopted the advice into mask mandates, masks became political symbols as many Americans rejected wearing one often, if at all. Even after the country built up its coronavirus testing capacity, translating that into collective action through, say, contact tracing, centralized isolation, or genomic sequencing (to track variants) just didn’t happen in most of the US.
Case and death rates have gotten much better recently, thanks to the vaccines. But that’s largely due to a lot of individuals acting in their own interest and getting the shot. The policy proposals to make a more collective push for vaccines — through, for example, vaccine passports — have been widely rejected, including by the White House.
Whenever collective action is called for, Americans don’t do it — or, at the very least, don’t do it sufficiently. America is too politicized, fractured, and, above all, individualistic for a collective move to save it.
“It’s a facet of the United States before Covid, during Covid, and I’m not sure it’s going to change after Covid,” Jen Kates, director of global health and HIV policy at the Kaiser Family Foundation, told me. “That’s one of the challenges the US has faced throughout the Covid pandemic.”
When the US writes its next pandemic playbook, it can’t ignore this reality. Going forward, tackling a pandemic or collective public health threat will require a more individualistic approach to public health — one more focused on clear guidance, risk communication, harm reduction, and making the safest choice the easiest.
The research suggests collectivistic places handled at least some aspects of the pandemic better. But in a highly individualistic society like the US, maybe such approaches are simply unrealistic. After suffering one of the highest Covid-19 death tolls among developed nations and in the world, America may have to find its own individualized alternative.
“We haven’t had a pandemic in our lifetimes,” Kates said, noting that past guidelines were modeled after smaller-scale or older events. “We actually now know what didn’t work. The playbook could be rewritten and should be rewritten to account for what happened in the US.”
America has failed at collective action
Many Americans did take Covid-19 seriously, social distancing and masking up as federal officials and experts asked them to. They have continued to do so, too, getting vaccines as soon as they were available.
But with Covid-19, just a few people can spoil everything. A few people going out, gathering, and failing to wear masks can launch an outbreak across a community. That ends up exposing not just the people in the initial outbreak but anyone else who gets caught in the subsequent contact chain. Maybe someone contracted Covid-19 by hosting an ill-advised Halloween party, and then spread the coronavirus further when he went into work, bought groceries, picked up food at a restaurant, and visited family. A single person’s mistake can have a lot of fallout.
This is a big thing that went wrong with America’s approach to Covid-19. Yes, most people wore masks at least sometimes, and a lot of people made some sacrifice to social distance in the past year. But many others, fueled by Trump’s downplaying of the virus and politics in general, rejected the precautions, describing them as violations of civil liberties. And even those who didn’t reject precautions at times slipped up, going to a Thanksgiving or Christmas party they shouldn’t have, or forgetting to put on a mask before they went out. Many people just got tired — ultimately deciding they’d rather risk getting Covid-19 than continue to warp their lives.
Meanwhile, calls for more collectivistic actions have gone nowhere. Lockdowns quickly proved to be unsustainable, with protests and Trump’s demands to “LIBERATE!” economies soon leading just about every state in the country to reopen too quickly and see a surge in Covid-19 cases. Mask mandates were adopted in most states, but not all. Places that did keep some restrictions, from social distancing to mask mandates, barely enforced them — cops weren’t going around breaking up a lot of house parties. Even after the US built up a respectable number of tests, the idea of using those tests to closely trace contacts and isolate people was widely rejected, as much of the public rebuked the idea of sharing their personal information, especially their close contacts or locations, as a violation of privacy.
Multiply all of this across the whole country and you get one of the worst epidemics in the world.
Much of this was driven by individualism: the sense that Americans can and should make their own choices about their health, with minimal interference from government or, really, anyone else. A recent series of studies in PNAS found that, whether measured at the state or country level, more collectivistic places tended to have higher mask use.
“It’s not just a between-countries story,” Jackson Lu, lead author of the studies, told me. “Our research shows the link even within the United States. Within the same large nation, regions with higher collectivism had higher mask usage.”
Even with a progressive president in office, the rejection of collective action has remained the reality. The Biden administration’s vaccine efforts have worked through individualistic channels, making it as easy as possible for people to get the shot and asking people to do so. Anything close to a form of collective action, like a hard mandate or requirement for vaccine passports, has been repeatedly rejected by federal officials. Among the general public, polls suggest such mandates are generally unpopular, too.
Consider the CDC’s recent mask guidance. After the research showed that vaccines truly protect those who are vaccinated and likely prevent the spread of the coronavirus, the CDC and the Biden administration could have leveraged that information to encourage states or Congress to enact a vaccine passport system that would let vaccinated people avoid masking and social distancing. Or maybe the administration could have released guidance tying the lifting of restrictions to specific vaccine thresholds, as Michigan did — encouraging collective action for collective benefit.
Instead, the administration embraced an individualistic approach. If you’re vaccinated, you don’t have to wear a mask, the CDC said. What about those who are unvaccinated? They should keep wearing a mask. But what if people lie? Well, tough luck for them, because they’re really just exposing themselves to Covid-19.
As CDC Director Rochelle Walensky put it, “The science demonstrates that if you are fully vaccinated, you are protected. It is the people who are not fully vaccinated in those settings who are not protected.”
The problem is this isn’t always true. For some immunocompromised individuals, the vaccines may not be that effective. For children and people with other health problems, vaccination may be an impossibility. If those who are unvaccinated don’t wear masks around these groups, there’s a risk of dangerous spread. That could be used as a rationale for more collective action: Keep wearing a mask not because you need it, but because it helps keep people around you safe.
Yet the Biden administration ran with the CDC’s announcement, holding a press conference in which Biden urged individuals to follow it. “It’s vaxxed or masked,” he said.
It was ultimately an acknowledgment: America is an individualistic nation, and a progressive administration alone can’t change that.
The next pandemic playbook has to acknowledge reality
One way to fix these problems would be to try to make Americans more collectivistic. We could tap into better messages and better policies, encouraging people to come together for major crises.
But in reporting out Germany’s Covid-19 failures, one thing that became clear to me is it only takes a bit of dissent and complacency for things to fall apart. America’s federalist structure also makes collective action, handed down from the federal level, extremely difficult. That’s the context in which one very loud politician or a handful of contrarian states have managed to throw the collective project into chaos over the last year and a half.
“Broad, especially federal mandates are often going to be less effective than we would hope,” Daniel Goldberg, a medical historian and public health ethicist at the University of Colorado, told me. “Something like that is completely unenforceable — there’s no way the federal government could enforce a mask mandate in every county.”
In public health, a core concept is meeting people where they are. Well, Americans are in a very individualistic place. That comes with benefits — the PNAS study noted individualism is “an important driver of creativity, innovations, and long-run economic growth.” But in a truly national health crisis, it comes with major downsides, and so it has to be acknowledged and worked around.
“The lessons from epidemics and pandemics is that politics, culture, and socioeconomic variables matter as much as the health aspects of whatever the health issue is,” Kates, of the Kaiser Family Foundation, said. “You cannot separate out the qualities or characteristics of communities from how the response is structured and talked about.”
What could that look like in reality? One approach would be to focus on making the best choice the easiest. The federal government got at some of this during the pandemic, like when it offered paid time off for people sick with Covid-19. But it was never embraced very widely.
For example, US officials spent the fall and winter admonishing Americans for gathering indoors, especially around Thanksgiving and Christmas, in violation of CDC guidance and sometimes state or local laws.
But these same officials typically spent little to no time making it much easier for people to gather outdoors, especially in the cold. Outdoor public or even private spaces — many unused as a result of the pandemic canceling events — could have been spruced up, lined with outdoor heaters to keep people warm as necessary during the winter. Maybe officials could have offered some free food and drinks in outdoor areas, or at least free space and ingredients to cook a meal.
There are other possible examples: To make it easier for people to isolate if they got sick or were exposed to Covid-19, the country could have offered genuinely good spaces in all of those unused hotel rooms for free. To encourage masking, the feds could have produced good-quality masks and provided them for free. To let risky indoor businesses close, governments could have offered a bailout. All of this would have made the right choice easier, even if it wasn’t guaranteed.
It’s the kind of approach already taken in other parts of public health, particularly drugs. Obviously, it would be great if no one used dangerous drugs, and our society goes to great lengths to emphasize that. But the reality is some individuals choose to use drugs anyway. Rather than simply punishing these people, experts have over the years pushed toward a more empathetic approach that combines harm reduction — making drug use less risky by, say, offering sterile syringes or anti-overdose medications — with easy access to treatment. It’s an approach that acknowledges individuals won’t always make the right decisions, but it’s possible to make those right decisions more enticing and accessible.
Some places have moved in this direction recently with vaccine incentives, with many offering free beer and some giving away $100 or a chance at $1 million with vaccination. But these efforts have been mostly small (beer is, unfortunately, not that expensive) and patchwork — with very little done at the federal level.
America may not really know how to do this for pandemics yet. A lot of the playbook was written under the assumption that Americans would take collective action — that they would social distance, mask up, and follow other recommendations. Much of the research focused on those methods.
So the country still has to figure out what a true alternative looks like, requiring more study and policy experiments than it has now. But the past year and a half has demonstrated that it’s worth figuring this out. We shouldn’t tolerate another 600,000 American deaths in the next pandemic.