Who wears a mask? In short, not enough people. The Centers for Disease Control and Prevention guidelines recommend that Americans wear face masks to limit transmission of COVID-19, yet Americans have low compliance levels with this policy. While 65% of Americans self-report regularly wearing a face covering in stores, only 44% report that other people in their communities regularly wear a mask. Another study found that observed mask wearing in public rose sharply in March and April 2020, but has since plateaued and hovers around 59% today. These aggregate numbers hide salient trends: Men, those without college degrees, those in rural areas, and those who are younger and have fewer preexisting medical conditions are less likely to report wearing a mask.
Another major predictor of mask wearing is political party; Democrats are more likely to wear masks than Republicans (76% versus 53%), even after controlling for differences in COVID-19 impacts in their communities, with conservative Republicans self-reporting mask wearing at 49%. Individuals who report voting for President Donald Trump in 2016 are at least 25% less likely to wear a mask than individuals who did not.
Why does this matter? Mask wearing is clinically proven to decrease transmission of COVID-19. Wearing a mask decreases the risk of getting COVID-19 by at least 30% and decreases the transmission of COVID-19 to others by at least 65%.
Put in perspective, if 95% of Americans wore masks from today to Feb. 1 of next year, more than 62,000 lives could be saved. Moreover, Goldman Sachs suggests that if everyone wore masks, the U.S. could avoid a $1 trillion economic loss — equivalent to 5% of national gross domestic product — by preventing future “lockdowns.” America is predicted to face a second wave of the virus — and in fact, the virus count is now increasing in a majority of states. Comprehensive scientific models suggest a national winter surge in cases, leading to 2,250 deaths a day by mid-January 2021, unless behaviors change.
So, if masks can offer so much benefit, why aren’t people wearing them? Well, firstly, behavioral economics holds that the perceived relevance of information available to us matters. If individuals do not know of anyone who has had COVID-19 or do not see those around them wearing masks, they are less likely to wear a mask themselves. Behavioral economics also describes optimism bias, which is particularly common among younger populations who overestimate the probability of positive events, such as not becoming seriously ill, and underestimate the probability of negative events, like death.
Studies have also found that men are more likely to be affected by optimism bias, including with regard to COVID-19. Perhaps the biggest contributing factor, however, is reactance bias — the human tendency to reclaim our sense of freedom when we feel it being taken away. At the start of the pandemic when rural, predominantly Republican America was told by urban, predominantly Democratic America to wear masks, it likely sparked a reactant reflex. Governors refusing to issue mask mandates due to perceived constraints on liberty, the connection between lockdowns and mask use, and President Donald Trump’s refusal to wear a mask, all likely entrenched reactant beliefs.
So what do we do with this information? There has been a recent push for a national mask mandate. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, suggested a national mask mandate last month. While a national mask mandate might be the best policy tool from a public health perspective, behavioral economics suggests that its effects will be limited unless reactance bias is addressed. A blanket mask mandate would likely increase adherence among those who sometimes wear a mask, but very possibly activate further reactance bias and decrease adherence among those who seldom wear a mask, severely limiting the policy’s efficacy.
In order to decrease the transmission of COVID-19, there needs to be an emphasis on addressing reactance to masks. In addition to increased regulation encouraging mask wearing, there needs to be policies of sustained public service announcements (PSAs) that are direct and localized, and that reframe mask wearing as a way to support an individual’s freedom to gather and to engage in commerce — instead of being an infringement on personal rights. Research shows that in times of uncertainty people look to local communities for information. Local PSAs may mitigate reactance biases associated with top-down mask mandates and may activate availability biases by suggesting that COVID-19 is a present problem for the local community.
Hana Ryan (firstname.lastname@example.org) is a graduate student at Johns Hopkins University in the School of Advanced International Studies, where she focuses on economic policy.