Tribal Truce — How Can We Bridge the Partisan Divide and Conquer Covid?

“Masks have become a flash point in our culture wars: as a symbol of either a commitment to public health or an infringement on basic liberties, the mask encapsulates the politicization of science. But since human behavior — including wearing or shunning masks — will determine the pandemic’s ultimate toll, communication strategies that bridge our partisan divide over science may prove as important as any novel therapeutic.

Beyond the near complete failure of U.S. federal leadership in combating the pandemic, one significant problem, according to Harvard epidemiologist Marc Lipsitch, has been the absence of consistent communication from nonpartisan experts. During the 2009 H1N1 influenza epidemic, he recalled, scientists and public health officials communicated daily with the public, offering nonpartisan advice. “The sidelining of all nonpartisan technical experts…has made it very hard for anyone to know what they should do,” Lipsitch said. That the administration has not just marginalized experts but has actively attempted to undermine their credibility has sown further confusion and distrust, a problem magnified by the many uncertainties surrounding SARS-CoV-2. But though President Donald Trump weaponizes scientific uncertainty and dismisses evidence of the virus’s widespread destruction, he is also exploiting a distrust in scientists that long predated his presidency.

[..] Examining survey data from 1974 through 2010, University of Wisconsin sociologist Gordon Gauchat found that conservatives expressed greater trust in science than liberals or moderates at the beginning of that period but the least trust by the end. Moreover, rather counterintuitively, Gauchat found that trust in science decreased the most among the most educated conservatives: greater scientific literacy enabled people to find the limitations in the data or to exploit inevitable uncertainties.

Another contributor is a growing strain of anti-intellectualism, a generalized distrust of experts that is resistant to facts, though relatively independent of political ideology. One recent study, for instance, showed that when people with strong anti-intellectual tendencies were exposed to expert consensus on matters such as genetically modified organisms or water fluoridation, they actually doubled down on their opposition to the scientific message. The inevitable and necessary self-corrections involved in the scientific process merely reinforce this skepticism.

[..] Whereas the hallmark of scientific reasoning is the capacity to change your mind when the evidence evolves, the nature of dialogue in our polluted information environment generally rewards the opposite: make up your mind and then find evidence to support it. As easy as it is, then, to retrospectively criticize the initial lack of transparency regarding mask wearing, could even the most crisis-savvy communication have changed the outcome? Probably not.

[..] Tom Nichols, who describes anti-intellectualism in his book The Death of Expertise, told me that, particularly in the United States, rejecting science has become a proxy for personal empowerment and autonomy. Noting that masks immediately became part of a partisan controversy over whether to believe in science and trust experts, Nichols lamented the growing narcissistic tenor of a society whose battle cry is “You are not the boss of me!” Though Nichols has argued that a disaster, such as an economic depression, war, or pandemic, might boost respect for knowledge and ability, the persistence of science denialism despite the presence of two of the three has changed his thinking. “Some people would rather die than wear a mask,” he said. “Once beliefs become fused to your sense of personal identity, they become very difficult to shake.”

This fusion also contributes to what sociologists call “affective polarization”: our current political divides are characterized not only by disagreement with the opposing party’s views, but also by frank contempt for the people espousing those views. Social media platforms, rather than facilitating exchanges of viewpoints, tend to thrive on these divisions and make reasoned debate impossible.

[..] the pandemic may have further alienated the many Americans who already felt that the “expert” or “elite” class didn’t understand their lives. For me, as for many science believers, watching more than 190,000 people die as millions of Americans defy expert advice elicits horror and rage. But though I can’t imagine reacting otherwise, an enlightening piece about class divides recorded by CNN correspondent Fareed Zakaria in mid-May at least helped me broaden my perspective.

“Imagine you are an American who works with his hands,” Zakaria says, “a truck driver or a construction worker…and you’ve just lost your job because of the lockdowns.” What’s it like, he wonders, to be one of these 36 million jobless Americans and to turn on your TV only to hear “the medical experts, technocrats, journalists explain that we must keep the economy closed”? These experts who’ve advocated shutdowns, Zakaria points out, not only have jobs but have been in greater demand because of the pandemic. Emphasizing how worthless and scared the newly jobless might feel, he asks, “Is it so hard to understand why people like this might be skeptical of the experts?”

[..] Given that economic recovery depends on containment of the virus, it seems irrational to defy public health advice for the sake of job preservation. But belief is not rational. Though the foundation of all scientific communication must be facts, insofar as people who distrust science are motivated by the perception that experts view them as idiotic, pointing out the idiocy of their behavior may simply reinforce their alienation.

[..] Julia Marcus, a Harvard epidemiologist, remarked on the lack of empathy in much Covid-related public health messaging. Having studied HIV-related harm-reduction strategies, Marcus likened absolutism in Covid risk mitigation to insistence on lifelong condom use for combating HIV. Some clinicians, she explained, assuming that their patients will use condoms forever, refrain from prescribing preexposure prophylaxis (PrEP) because they don’t want to encourage condomless sex. Then, people who have condomless sex anyway are afraid to tell their clinicians and so don’t receive other risk-mitigation interventions such as PrEP or frequent testing. Similarly, much Covid messaging has “failed to recognize how unrealistic it is to expect people to abstain from the pleasures of life.” Successful harm reduction, says Marcus, requires accepting some level of risk. For instance, rather than repeating “Stay home!” when people disparagingly post pictures of large outdoor gatherings, Marcus’s instinct is to acknowledge that people will gather, and it’s safer outdoors than indoors. After all, she notes, “health is about more than being free of coronavirus. It’s about helping people live their lives safely and sustainably.”

[..] A large body of evidence in social psychology suggests that people respond to social norms, often out of fear of punishment or condemnation. [..] But for people who are resistant to the norm in the first place, shaming can paradoxically backfire. As MIT behavioral scientists David Rand and Erez Yoeli explained, images of people partying in a crowded bar may simply normalize such behavior for people who are skeptical of the precautions anyway. Such doubters may wonder: If others aren’t taking the virus seriously, why should I? Expressing moral outrage still has a role: Rand and colleagues have found that signaling such outrage makes people more trusted by their peers. But if we are all shouting into our own echo chambers about risky behaviors, shaming may better serve our own reputations than the collective welfare.

[..] During our July conversation, I asked Ms. R. if she wanted to remain anonymous. “Do you think I’ll come off like an idiot?” she asked. I was surprised by the question — if she recognized the potential idiocy of her views, why not modify them? — but I’ve struggled more with my hesitance to answer it. I had the power, based on our conversations, to make her seem idiotic, which would win me approval from my tribe. If, on the other hand, I chose parts of our conversations that made her seem reasonable, I risked alienating people, like my colleague, who not only believe in science but have been hurt by others’ rejection of it. Though I haven’t resolved it in my own mind, this conflict — between the desire to belong and the need to understand — seems central to our ongoing divides. For science to lead us out of this pandemic, however, we will need more than just the believers to follow.”

Full editorial, Rosenbaum L. New England Journal of Medicine 2020.10.22