Anyone who thinks that the social world is orderly and predictable needs to reflect carefully on the way the covid pandemic has played out in the United States and many other countries. For political scientists who are partial to rational-choice explanations of individual behavior — you’ll need to think again. No theory of rationality or rational self-interest I can think of would explain massive anti-vaccination activism. It is plain from the statistics of infection rates, hospital rates, and death rates, that a population that is slow to accept a high percentage of vaccination is a population that is likely to wind up in covid catastrophe. A family that rejects vaccination is likely to suffer serious illness and runs a risky likelihood of hospitalization and death. And an individual who rejects vaccination and goes off on his Harley to Sturgis, South Dakota is flirting with illness and the possibility of hospitalization and death as well. So why would a rational or sensible person make that decision? This isn’t quantum mechanics and high-flying scientific theory; epidemiology is an observational science, and its premises and reasoning can be followed by anyone with a high school education. And the germ theory of infectious disease is one of the most important achievements of medical science — and has been for a century and a half. Would the same anti-vax activist walk into a Chernobyl reactor on April 26, 1986, because he doesn’t believe in radiation, or doesn’t believe that exposure to radiation causes illness and death? So — irrational behavior on a massive scale. Are we in a Salem moment, a period of mass hysteria? Why are so many people behaving in ways that are objectively contrary to their most important interests?
The too-obvious answer is that “some people have been indoctrinated by anti-science propaganda and lies, and have come to believe that covid is a hoax and the vaccines are dangerous and useless”. And in fact, we know that very extensive social media and right-wing media outlets have promulgated exactly those messages — including pervasive Facebook and Youtube channels. But why would perhaps 35-40% of American adults fall for such obvious baloney?
The second too-obvious answer is that Trump and the extreme right — i.e., most of the GOP — found it to their political advantage to encourage belief in these lies. To support Trumpism in the past year is to be a vaccine skeptic and a covid skeptic. The core of Trump’s supporters fall in line in accepting conspiracies and lies — about covid, about the 2020 election, and about Democrats, and GOP leaders have been willing to work to energize and extend this group. This is “extremist populism” and opportunism at its purest — promote the lies even if it means illness and death for school children, neighbors, and family members. This puts the current realities of social behavior around covid into a different light, and one that is a bit more amenable to rational-choice treatment: the strategy is a rational one for the demagogues who are pushing it, but completely irrational for the followers. The political emotions and ideologies of the followers, shaped by social media, lead them to make life choices that put them and their communities at terrible risk.
But here’s the thing: what 2010-era sociologist or political scientist would have predicted that a major global pandemic would occur in the next several decades, that an almost miraculous search for an effective vaccine would be successful in an amazingly short period — and that the pandemic and vaccine would become a political issue leading to mass refusal to vaccinate? All global epidemiologists believed the first proposition — that pandemic would occur sometime; some biological researchers thought that vaccine creation could advance quickly; but I can’t think of any respected political scientist or sociologist who would have predicted the massive movement that has emerged against vaccination and the politicization of the spread of the virus.
This seems to be a good example of “path-dependence” in history. This public health catastrophe we now face could have unfolded differently in the United States. There were GOP leaders in 2019 and 2020 when the virus was first perceived as a major threat to US public health who pursued a science-driven set of policies. But the extremism of Donald Trump and his followers made a science-based approach to public policy and public health untenable for most GOP governors and legislators. (Even today we hear of death threats against public health professionals who argue for a mask mandate in public schools as they re-open this fall.)
If our current situation was path-dependent, then what events led us here? We could probably identify two or three key factors in 2019 and 2020 that pushed the US population off the path of “sane public health thinking” and onto the QAnon path of lies, doubt, and conspiracy theories — the persistent efforts by the Trump administration to minimize and trivialize the virus (and to attribute it to China); the onslaught of organized social media campaigns to the same effect; and an existing baseline of mistrust and disdain for the Federal government (e.g. Ammon Bundy’s takeover of the Malheur National Wildlife Refuge in 2018).
Above I asked whether a vaccine skeptic might have walked into Chernobyl reactor in 1986 because she didn’t believe in radiation sickness. In a way, the example might be more illuminating than was first evident. A viral epidemic — even a highly deadly one — is not like an open reactor core. Everyone who is exposed to radiation levels found in the exploded Chernobyl reactor core will die, and will die in visibly horrible conditions. But even a highly contagious virus like the Delta variant of the covid virus is less visible than the glowing remnants of the Chernobyl fuel rods. Today the state of Florida has an extremely high incidence of new covid infections — 100.9 per 100,000 population. (Mississippi is even higher, at 114.1 per hundred thousand; whereas Michigan and Massachusetts are at about 19-20 per hundred thousand.) So Florida is a catastrophe. And yet the vast majority of Floridians do not often see the results of the pandemic on a daily basis. Only .1% of the population are infected each day; a tiny risk, one might say. Floridians see news reports about rising rates of infection and hospitals approaching full capacity, but these are just words in a torrent of media that they have come to mistrust. Further, they can also go to a bar or restaurant and not see anyone getting sick, and they may avoid infection themselves for months or years (through good luck or simple precautions). What is a catastrophe at the community level is invisible to the majority of Floridians — until their own parent, spouse, or child is infected. And then it is just “bad luck”. So most Floridians, most of the time, have a daily experience that seems to support the “no big deal” framework rather than the “rapidly spreading horrific disease” framework. But a viral epidemic is different from car crashes: more infected people leads to an even greater number of infected people in the next cycle. It is an exponential process. So it is urgent to take measures to reduce contagion at an early stage of the pandemic — which is precisely what many Red states have refused to do.
Public health during pandemic is not an individual choice. A policy depending on “responsible choices” by individuals (concerning social distancing or masking, for example) is wholly inadequate to the problem. The slogan used by anti-maskers during current raging debates over mask requirements in public schools — “My child, my choice” — is absurd on its face. The unmasked child is a risk to others; so it is not simply a matter of personal choice — any more than would the choice of bringing bottles of gasoline to school be a matter of personal choice. And, further, one’s own child is dramatically less likely to become infected if other people’s children are masked. Public health requires rational standards of behavior and a high level of compliance. But in many GOP-ruled states, officials have refused to set such regulations.
It seems, then, that American mass behavior during the past 12 months shows a very large dose of irrationality, and this level of irrationality is dangerous in the setting of a viral pandemic. And it did not have to be this way. If the vast majority of Americans were behaving intelligently with respect to their own health, they would be accepting the advice of scientific and health experts about the safety and efficacy of the vaccines, and they would be supporting the call for masking until the viral surge of infections falls to an acceptably low level. Each individual would be better off if he or she got vaccinated and wore a mask. And the same is true collectively: the whole community — whether Columbus, Ohio or Miami, Florida — is better off if the infection rate (R) is brought down below 1.0 and the hospital utilization rate is at a sustainable level.
Further, the pandemic threatens public health in more ways than the possibility of acute respiratory illness for one individual. When hospital intensive care units fill up, they lose the capacity to treat acutely ill patients of every variety. By remaining unvaccinated, becoming ill, and winding up on a ventilator in an ICU, the individual has harmed her own health; but she has also made it more difficult for other members of the community to gain access to the intensive care that they need as well. Each Floridian is more likely to survive a serious auto accident or a heart attack if there is an ICU bed available to treat her — and this is a community-level fact. So whether we care primarily about our own health and the health of our families, or we care also about the wellbeing of our neighbors and fellow members of the community, sensible decision-making leads to sensible health behavior: vaccination, social distancing, and masking. The fact that 39% of the population in the US are still entirely unvaccinated (August 27) seems to document irrational personal choices on a massive scale.
This seems to pose a very important and difficult problem for the social sciences. Is prudence such a weak influence on the typical person’s choices as it appears? Is there a kind of “crowd” behavior at work that makes individual prudence and rationality irrelevant — an echo chamber that makes independent thinking impossible? Is there some special difficulty in reasoning about an invisible diffuse risk like covid that is part of the problem? Are the avenues of social media messaging so powerful that large portions of the public lose their capacity for intelligent, sensible thought? What can we learn, in short, by studying the patterns of behavior that have emerged in the US over the past eighteen months? Are we living through a “natural experiment” in mass behavior when a population is faced with a novel and widespread threat?