How Sociologists Can Battle Covid Denialism

Just when you think American responses to the Covid-19 pandemic cannot get any weirder, along comes another story of inexplicable behavior. In July, it was people wearing disguises in order to get vaccinated without their friends’ or families’ knowledge. That was followed by the news that a Republican elected official was omitting Covid-19 from death certificates under pressure from the families of some deceased, because the families got “upset” at official acknowledgement of the virus. Now enraged mobs are threatening health-care professionals who recommended masking in public schools, in keeping with CDC guidance. What is going on?

The behaviors that usually get thrown into the black box of “irrationality” are sociology’s specialty. And that’s why it’s an especially useful discipline for dealing with the national public-health emergency we face. Insights from sociological theorists like Robert Merton and Erving Goffman can do more than explain the strange pandemic behavior we’ve seen in recent months: They can save lives.

Sociology can make visible a whole range of interpersonal motives and group-level dynamics that are otherwise overlooked by American policy makers. From the way pundits talk, you would think that there was nothing in between the individual on the one hand and massive systemic structures on the other. Popular responses to collective problems tend to follow that pattern. In the face of poverty and the crisis of homelessness, one large segment of the U.S. will shout, “Get a job!” while another might urge, “Occupy Wall Street!” Neither has moved the needle very much.

That bifurcated approach is also failing badly now, unable to explain what’s happening in pandemic-wreaked America, much less offer a way forward. We’ve been bouncing back and forth between the poles of individualism and structuralism, wasting time and resources on solutions that cannot work because they are based on misunderstandings of the problem.

To sociologists, it’s pretty clear that one reason we’re not getting better traction on Covid-19 is neglect of what we call the “group level of analysis.” Pandemics are person-in-society problems: They kill because we are not lone individuals but live in groups. That’s why individual-oriented incentives — like Ohio’s Vax-a-Million program, intended to increase vaccine uptake with cash prizes and college scholarships — haven’t worked. Then again, neither have our big structural advantages: our wealth, our scientific sophistication, our oversupply of vaccines. Despite it all, the U.S. now leads the world in average daily Covid cases: Americans account for just over 4 percent of the global population, but roughly 20 percent of new infections.

Under the circumstances, we don’t have the luxury of dismissing behavior like vaccine refusal and anti-masking riots as “stupid” or “crazy.” And we definitely don’t have time for sloppy thinking, like jumping from “those vaccine (or mask) holdouts won’t listen to experts” to “they won’t listen to anybody.” All of those responses represent missed opportunities to find out what might work to save more lives.

Sociology can help us shift our focus to the pragmatics of this situation: identifying how to reach the apparently unreachable, and what actually matters to them. For instance, this perspective can help us understand why people might seek vaccination in disguise: They’re concerned about saving face within the very specific set of social ties that sociologists call “reference groups.” This term, popularized by Robert Merton, signifies the neighborhoods, churches, workplaces, and friendship groups which provide the resources we need to live, from income and information to salvation and mutual aid. The price of access to those resources is conformity to group norms. That’s why nobody strives for the good opinion of everyone, but rather cultivates the approval of other reference-group members.

In many parts of the United States, refusal of vaccination and masks on religious and/or partisan grounds has become a defining marker of reference-group membership. Refusal to cooperate with pandemic public-health measures is a requirement for belonging and acceptance in these groups. This cannot be altered by more or better information, nor by empathy or shaming from outsiders — all of which have been proposed by smart people who have not understood that this problem is driven by group dynamics.

The real nature of the problem was vividly illustrated last month by the disappointing results of the NFL’s costly efforts to persuade vaccine-refusing players who claimed they were lacking “proper information” about the shots, and just needed “more facts and that stuff.” The coach of the Washington Football Team arranged for these players to speak directly with a scientist who worked on developing the Moderna vaccine — a unique opportunity to get their questions and concerns addressed. Yet many remained unmoved, because lack of information wasn’t really the problem. As some later admitted, they would never accept vaccination, regardless of the science, because the issue for them was actually “My way of living and my values,” including adherence to reference-group articles of faith, such as the belief that “God” or “Nature” is superior to science.

It is important to understand that betrayal of those group beliefs is met with consequential real-world sanctions. The person perceived as betraying the group is stigmatized — a fundamental group process that leads to exclusion from normal social interactions and crucial resources. As Goffman wrote, this means being treated as a “traitor” to a group: “a blemished person, ritually polluted, to be avoided, especially in public.” Cutting off stigmatized persons from their reference groups is seen as morally justified and necessary for group survival because “the person with a stigma is not quite human.”

The stakes could not be higher. That’s why some teenagers have been getting vaccinated in secret: Some fear punishment from anti-vaccine parents, including homelessness; one teen who openly defied his parents to get vaccinated reported receiving death threats. If reference groups are willing to punish children in this way, adult members have good reason to be fearful of the consequences they might face, like losing their jobs or their families. A high-profile example came to light this week when a senior executive at the National Religious Broadcasters organization — an evangelical Christian communications network — said he was fired for publicly disclosing that he had been vaccinated and for encouraging others to get the shot. In light of such consequences, it becomes clearer that the people wearing disguises to get vaccinated are acting quite rationally.

Hokyoung Kim for The Chronicle

Goffman and Merton help us see the social logic behind these decisions, which may seem illogical when considered by outsiders. Questions like “Don’t they want to live?” or “Can’t they see that science works?” seem sensible enough, but they miss the dynamics of social identity and affiliation motivating much of the strangest behavior we have seen in this pandemic. By delving into those group-level factors, we can prepare for the challenges that lie ahead.

One of the biggest of those challenges looks to be resistance of masking requirements: a seemingly simple and effective tool for reducing the spread of Covid-19 that has nonetheless led repeatedly to violence, including multiple murders. Even more puzzling, some of the high-profile public figures who have come recently to endorse vaccination — such as Florida‘s Gov. Ron DeSantis — remain vehemently against masking, to the point of outlawing mask mandates for organizations within the state. You might expect masks to be an easier sell than vaccines, since masks aren’t injected into the body and are temporary. But that overlooks the social problem masks pose: they’re visible, and therefore stigmatizing within certain reference groups. One can get vaccinated in secret, but there is no way to wear a mask in secret. On the contrary, mask wearers literally “lose face.” For many, that is a fate worse than physical death.

The good news is that stigma is malleable. Recently, vaccination has been destigmatized in some reference groups that once opposed it; this has occurred through public endorsements of the procedure by partisan leaders such as DeSantis, as well as by Alabama‘s Gov. Kay Ivey, and the Louisiana Congressman Steve Scalise, who got vaccinated on camera. The Arkansas gubernatorial candidate Sarah Huckabee Sanders later penned an opinion column to encourage partisan reference-group members to get the shot by referring to it as “the Trump vaccine.”

As manipulative or insincere as such approaches may seem, they offer genuine reason for hope: Behaviors can be reframed to move them from the realm of stigma into the range of acceptable activity for reference-group members. This offers a way to resolve the tension they experience between wanting to avoid needless death and wanting to keep relationships intact with family, friends, and employers. Both are matters of their survival in a very pragmatic sense, and ultimately the resolution of that tension will help ensure survival for the rest of us.

The same can happen for masking and other public-health measures. But the destigmatization process can only be undertaken by reference-group members. For those sick of vaccine holdouts and mask refusers, sociological theories can offer you some respite: Being nice (or cruel) to them won’t change a thing. Following Merton and Goffman, the trick will be to identify potentially influential people in those reference groups and encourage them to publicly endorse mask-wearing. By doing so, they can lower the social costs of changing course and adopting the public-health measures we know will save lives. It worked with the shot: vaccination uptake rose immediately and dramatically after reference-group leaders like Scalise and Ivey made it acceptable. It can work with masking, too; we just need to understand social forces and to harness them for our survival.