Bioethics Forum Essay
C.D.C.’s Latest Mask Guidance: Science, Politics, and Public Health
Throughout the coronavirus pandemic, science and politics have been at play in government policy decisions and communication about those decisions. This statement would seem to be an obvious platitude. However, misconceptions about the role of science and of politics have obfuscated discourse concerning the U.S. government’s pandemic policy decisions. The latest example of this obfuscation is the policy guidance issued by the Centers for Disease Control and Prevention on May 13 that people who have been fully vaccinated against the coronavirus virus no longer need to wear face masks indoors, with some exceptions. This guidance was backed by recent real-world scientific studies that showed a high level of protection from disease and infection for those who have been immunized with one of the three vaccines that have received emergency use authorizations in the U.S.
A prominent mantra in public discourse during the pandemic has been “just follow the science.” And it would appear that this is precisely what the C.D.C. tried to do with its most recent face mask guidance. If “just follow the science” is meant to underscore that public health decisions should be evidence-based in light of rigorous and relevant scientific studies, then it would go without saying. But this mantra suggests that these policy decisions can be determined by science and science alone. Public health decisions, however, always involve value judgments, which are not a matter of science, although they can and ought to be informed by scientific evidence. At stake in the C.D.C.’s decision on face masks for those who are fully vaccinated is a trade-off between protecting the public from the transmission of the virus, with potential consequences for health and health care, and promoting the return of society to pre-pandemic normality. Science alone cannot guide policymakers in deciding what weight to give these competing considerations.
Because science alone can’t determine public health policy decisions, politics necessarily comes into play. However, the role of politics is obscured by the contemporary understanding of “politics” as denoting narrow, partisan thinking and action. For example, in an opinion essay criticizing the C.D.C. for failing to consult with the top levels of the Biden administration before issuing its latest guidance on face masks, Leana Wen wrote that “there’s a big difference between listening to scientists and ceding policymaking to one scientific organization.” She added that intervening by the Biden administration in this case “wouldn’t be about politics; it would be for the public good.”
Wen gets it right that the C.D.C.’s decision was not just a matter of science. But it is off-base to describe consultation with the Administration before issuing such policy guidance as not about politics but about the public good. For central to politics, in a legitimate broad sense of the term, is making decisions aimed at the public good. Indeed, any decision by a government agency is inherently a matter of politics in this broad sense. To be sure, decisions oriented to promoting the public good can be contested with respect to ends and to means. What counts as the public good and how to promote it in a particular context are matters of disagreement and debate—the very stuff of politics.
Wen rightly criticizes the C.D.C.’s decision as premature in light of the fact that less than 40% of the U.S. population had been fully vaccinated and that no mechanism is in place to reliably verify whether someone has been fully vaccinated. The C.D.C. policy seems to be based on the unrealistic assumption that those who are not vaccinated will continue to wear masks indoors in public settings. Responsible politics ought always to have in view potential negative unintended consequences of policy decisions. The C.D.C. guidance likely encourages unvaccinated individuals to forego face masks, especially those who have been politically opposed to mask mandates. Therefore, this policy guidance risks endangering others who have not been vaccinated but are trying to protect themselves from becoming infected. Regardless of whether the C.D.C. was right on the science about vaccination obviating the need to wear face masks, it arguably was wrong on the politics of its policy decision—a decision that Wen described as “an astounding strategic and tactical mistake.” In other words, the C.D.C. erred by just following science without giving due attention to politics.
Conceptual clarity about the scope of science and of politics certainly does not suffice to make sound public health decisions; however, it is vital to realistic appraisal of what is at stake in those decisions.
Franklin G. Miller, PhD, is a professor of medical ethics in medicine at Weill Cornell Medical School and a Hastings Center fellow.