Three forces have converged to generate the perfect storm of civic irresponsibility.
Welcome to America, a year and a half into the COVID-19 pandemic. Emergency departments and hospitals are swamped with COVID-19 patients. Patients with possible heart attacks and strokes are being turned away.1 Medical staff are feeling overwhelmed and burned out in the face of patients who have refused vaccination.2 Tragically, nearly 9 months after the first safe and effective vaccine became available in the US, only about 54.7% of Americans are fully vaccinated.3 The situation has been rightly characterized as “a pandemic of the unvaccinated.”4
In July of 2020, New York Times columnist David Brooks wrote, “We Americans enter the July 4 weekend of 2020 humiliated as almost never before. We had one collective project this year and that was to crush COVID-19, and we failed.”5
It is extraordinary—and far more humiliating—that at this advanced stage of the pandemic, we are still far from containing, much less crushing, a contagion that has now killed more Americans than the 1918 influenza.6
What accounts for this massive societal failure in one of the world’s most scientifically advanced countries? What accounts for the resistance to vaccination among a substantial percentage of the US population? As psychiatrists, we are accustomed to exploring resistance on an individual level, usually in the context of psychotherapy. But societies and their subcultures may also manifest resistance to public health measures.7 In my view, answers to these questions require a deep dive into the realm of social psychiatry, which Eugenio M. Rothe, MD, has described as follows: “Social Psychiatry is a paradigm that combines medical training with the perspectives of social anthropology, social psychology, cultural psychiatry, sociology and other disciplines relating to the human condition and to mental distress and disorder.”8
In this essay, I want to argue that our failure to contain the COVID-19 pandemic—and in particular, our inability to overcome public resistance to vaccination—stems from the convergence of 3 sociocultural forces: 1) systemic deficiencies in science education in the US; 2) the failure of American civics education to inculcate a sophisticated understanding of individual rights; and 3) the deterioration, over the past few decades, of community and communitarian values in American culture. The confluence of these forces has amounted to a perfect storm, in which the entire nation has become a casualty.
Worse still, these forces have been amplified and strengthened by massive amounts of misinformation regarding vaccination against COVID-19, promulgated by social media; several prominent politicians; and, alas, even by some irresponsible physicians.9,10
I hasten to add that I am considering those forces that foster a deliberate decision to refuse vaccination, not to situations in which access to COVID vaccines is severely limited—a significant problem in some minority communities.11 I am also omitting discussion of individuals who have documented medical contraindications to receiving the vaccine; or those who claim—controversially—that they are opposed to vaccination for religious reasons.12,13
Deficiencies in US Science Education
Consider this plaintive question: how on earth do we educate the general public regarding m-RNA vaccines, in a country where 42% of Americans believe that ghosts really exist; 29% believe in astrology; 21% believe the government is hiding space aliens; and 14% of Americans believe in Bigfoot?
I wish I were making up these figures, but reliable surveys support those numbers.14 I think it fair to say that suboptimal science education in the US bears at least some of the blame for these beliefs—or at least, blame attaches to our country’s failure to support optimal science education. It is telling, for example, that less than one-third of California students met or exceeded standards on a new science test developed by the California Department of Education.15
And while 92% of American Association for the Advancement of Science (AAAS) scientists say scientific achievements in the US are the best in the world (45%), or above average (47%), they are far less sanguine about science education in this country. Fully 75% of AAAS scientists say too little STEM (science, technology, engineering, and math) education for grades K-12 is a major factor in the public’s limited knowledge about science.16
Given this backdrop, it is not hard to understand the difficulty of explaining the nuances of COVID vaccines to the general public—or reassuring individuals that approved vaccines are safe and effective, notwithstanding some rare but serious side effects.
Deficiencies in American Civics Education
If we can point wistfully to the woeful state of science education in the US, we can justify even more gloom regarding civics education in this country. Civics, to be clear, refers to “the study or science of the privileges and obligations of citizens.”17 Unfortunately, there is evidence that, in the US, “…Civic[s] knowledge and public engagement is at an all-time low.”18 For example, a 2016 survey by the Annenberg Public Policy Center found that only 26% of Americans can name all 3 branches of government, which was a significant decline from previous years.19 According to the (nominally nonpartisan but left-leaning) Center for American Progress, “Most states have dedicated insufficient class time to understanding the basic functions of government at the expense of other courses.”18
In my view, one consequence of inadequate civics education in the US is a widespread misconception of what constitutes an individual right. This has played out during the COVID pandemic in ways that put the public’s health in grave jeopardy. Thus, many vaccine refusers or anti-vax activists argue that vaccine refusal is an individual right or liberty.20
But legal scholars hotly dispute this claim. For example, law professor Mark Hall, JD, director of the Health Law and Policy program at Wake Forest University, argues that, “Because one person’s choice affects the health of other people and the public at large, people do not have a fundamental right to refuse vaccination.”21
This position was affirmed by the US Supreme Court in the famous 1905 case, Jacobson v. Massachusetts, which upheld the states’ authority to mandate vaccinations for smallpox. That same principle was likely applied when associate justice Amy Coney Barrett, JD, left standing Indiana University’s COVID vaccine mandate.22
The Deterioration of American Communitarian Values
And finally, the third force in the triadic perfect storm: the gradual erosion of community and communitarian values in the US. As philosopher Aeon Skoble, PhD, has noted, the term communitarian refers broadly to the concept that: “…the community can be thought of as a bearer of rights, or at least as the holder of interests, to which an individual’s interests may have to be subordinated in some cases.”23
David Brooks has fleshed out this concept, arguing that American society in recent years has lost: “…a civic consciousness, a sense that we live life embedded in community and nation, that we owe a debt to community and nation, and that the essence of the admirable life is community before self.”24
Perhaps the communitarian ideal is most strikingly illustrated when we meet up with its polar opposite—what I would characterize as a puerile sense of personal entitlement, acted out as passive-aggressive behavior.25 In my view, this attitude was forcefully illustrated by one congressman from Ohio, who commented in May 2020, “I will not wear a mask . . . quite frankly, everyone else’s freedom ends at the tip of my nose. You’re not going to tell me what to do...”26
As the writer Damon Linker, PhD, expressed the problem in this country27:
…individualism, cultural libertarianism, atomism, selfishness, lack of social trust, suspicion of authority…it takes a multitude of forms. But whatever we call it, it amounts to a refusal on the part of lots of Americans to think in terms of the social whole—of what’s best for the community, of the common or public good. Each of us thinks we know what’s best for ourselves. We resent being told what to do. If wearing a mask is unpleasant, we don’t want to be forced to do it. In fact, a governing authority—or really, anyone, even fellow customers at a grocery store—reprimanding us for failing to do our part for public health is enough to make us dig in our heels and stubbornly refuse to go along.
The Israeli diplomat Abba Eban (1915-2002) once quipped that, “Men and nations behave wisely when they have exhausted all other resources.”28 It is painful to contemplate how many more resources—human, material, and spiritual—some of our fellow citizens will exhaust before behaving wisely during the COVID-19 pandemic. As psychiatric physicians, we may well encounter patients who refuse to take even basic health precautions during the pandemic, including availing themselves of the approved vaccines. While we owe these individuals respectful listening and empathic understanding (a tall order, given the harm they inflict on society) we are surely under no obligation to condone their behavior.
Furthermore, as guardians of the public health, we need to adopt a social psychiatry perspective in order to understand the sociocultural forces at work in this pandemic, particularly those that have created a perfect storm of civic irresponsibility. Finally, as physicians and concerned citizens, we must work to strengthen science education; improve civics education; and mend the fraying fabric that knits us together as a human community.
Dr Pies is professor emeritus of psychiatry and lecturer on bioethics and humanities, SUNY Upstate Medical University; clinical professor of psychiatry, Tufts University School of Medicine; and Editor in Chief emeritus of Psychiatric TimesTM (2007-2010). He is the author of The Levtov Trilogy and Just Take it One Miserable Day at a Time.
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19. Annenberg Public Policy Center. Americans’ knowledge of the branches of government is declining. September 13, 2016. Accessed September 30, 2021.
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21. Todd S. Do mandatory vaccines violate human rights? Quartz. August 5, 2021. Accessed September 30, 2021.
22. Klasfeld A. Justice Amy Coney Barrett rejects Indiana Students’ bid to block COVID-19 vaccine mandate. Law & Crime. August 12, 2021. Accessed September 30, 2021.
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25. Pies RW. Masks, machismo, and the American man-child. Psychiatric Times. June 29, 2020. Accessed September 30, 2021.
26. Fieldstadt E. Ohio lawmaker refuses to wear mask because he says it dishonors God. NBC News. May 6, 2020. Accessed September 30, 2021.
27. Linker D. Coronavirus is revealing a shattered country. The Week. July 1, 2020. Accessed September 30, 2021.
28. Americans will always do the right thing — after exhausting all the alternatives. Quote Investigator. Accessed September 30, 2021.