During a pandemic, no one’s health is fully in their own hands. No field should understand that more deeply than public health, a discipline distinct from medicine. Whereas doctors and nurses treat sick individuals in front of them, public-health practitioners work to prevent sickness in entire populations. They are expected to think big. They know that infectious diseases are always collective problems because they are infectious. An individual’s choices can ripple outward to affect cities, countries, and continents; one sick person can seed a hemisphere’s worth of cases. In turn, each person’s odds of falling ill depend on the choices of everyone around them—and on societal factors, such as poverty and discrimination, that lie beyond their control.
Across 15 agonizing months, the COVID-19 pandemic repeatedly confirmed these central concepts. Many essential workers, who held hourly-wage jobs with no paid sick leave, were unable to isolate themselves for fear of losing their livelihood. Prisons and nursing homes, whose residents have little autonomy, became hot spots for the worst outbreaks. People in Black and Latino communities that were underserved by the existing health system were disproportionately infected and killed by the new coronavirus, and now have among the lowest vaccination rates in the country.
Perhaps that’s why so many public-health experts were disquieted when, on May 13, the CDC announced that fully vaccinated Americans no longer needed to wear masks in most indoor places. “The move today was really to talk about individuals and what individuals are safe doing,” Rochelle Walensky, the agency’s director, told PBS NewsHour. “We really want to empower people to take this responsibility into their own hands.” Walensky later used similar language on Twitter: “Your health is in your hands,” she wrote.
Framing one’s health as a matter of personal choice “is fundamentally against the very notion of public health,” Aparna Nair, a historian and an anthropologist of public health at the University of Oklahoma, told me. “For that to come from one of the most powerful voices in public health today … I was taken aback.” (The CDC did not respond to a request for comment.) It was especially surprising coming from a new administration. Donald Trump was a manifestation of America’s id—an unempathetic narcissist who talked about dominating the virus through personal strength while leaving states and citizens to fend for themselves. Joe Biden, by contrast, took COVID-19 seriously from the off, committed to ensuring an equitable pandemic response, and promised to invest $7.4 billion in strengthening America’s chronically underfunded public-health workforce. And yet, the same peal of individualism that rang in his predecessor’s words still echoes in his. “The rule is very simple: Get vaccinated or wear a mask until you do,” Biden said after the CDC announced its new guidance. “The choice is yours.”
From its founding, the United States has cultivated a national mythos around the capacity of individuals to pull themselves up by their bootstraps, ostensibly by their own merits. This particular strain of individualism, which valorizes independence and prizes personal freedom, transcends administrations. It has also repeatedly hamstrung America’s pandemic response. [Continue reading…]