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Experts Urge Empathetic Approach to Convincing Mask Opponents

Duke faculty discuss effective public health messaging during the pandemic

Part of the The Briefing: The Impact of COVID-19 Series

As the 2020 freedom-vs-facemask culture war rages on in America’s social media feeds and grocery store checkout aisles, a panel of Duke experts suggests an empathetic, non-adversarial approach to get more people to cover up.

The advice came during a weekly media briefing Wednesday featuring three Duke professors who took questions from reporters regarding the challenges of public health messaging.

Here is a YouTube video of the briefing:

Here are excerpts:


Gavan Fitzsimons, professor of marketing and psychology

“About a third of the population has what we’d characterize as an extremely strong reactive response when their freedom is threatened. People will go to great lengths to try to restore their freedom.”

“Many people perceive that some of the public health guidelines are direct threats to their freedoms. They’ll go to great lengths to not follow those guidelines. As a result, we see noncompliance with the recommendations.”

“We try to motivate people that have this strong backlash response to try to let them feel they have the freedom to make a choice. When the freedom is theirs, to make a choice, they tend not to bristle and backlash nearly as much.”



Benjamin Anderson, assistant professor of science and global health, Duke Kunshan University

“One of the things that has been very clear in terms of the public health response has been the communication. In China there’s a very centralized approach. They really turned over the response efforts to their public health system. They have a pretty robust public health system that operates throughout the country. There was a very consistent message that was shared in China in terms of how the response was going to be rolled out, what measures were going to be put in place.”

“The (U.S.) leadership on the national level gave more deference to the states. Even though we know that’s probably a good thing in terms of implementation, each state has a different context, it also affected the messaging. What we’re seeing is a lot of different messaging going out across different states, which is really creating a lot of confusion as people are seeing different things presented to the communities in terms of what’s effective, what’s not effective.”

“With that inconsistency, that has created an awful lot of confusion, which has opened the door for more political discourse to kind of take over, which is causing people to not trust the messaging that’s coming out.”



Lavanya Vasudevan, assistant professor of family medicine and community health

“A vaccine is our best shot for ending this COVID-19 pandemic. I’m very concerned about resistance to a COVID-19 vaccine once it’s available.”

“We know from our research that unvaccinated individuals cluster in communities, so there may be communities where vaccine acceptance may be very, very low.”

“We are having trouble convincing people to adopt very simple behaviors. Wearing masks, physical distancing, washing hands. So I’m concerned it may be harder to convince people to adopt more difficult behaviors, such as vaccinations.”

“Resistance to vaccines is not a new phenomenon. Even leading up to the COVID-19 pandemic, we saw some of the worst measles outbreaks we’ve seen in a while. We continue to hear antivaccine rhetoric and antivaccine sentiments throughout the pandemic. All these reasons make me very concerned about vaccine resistance.”

“The best strategy … is to invest in communication. Communicating early, communicating often, communicating through trusted entities. And relaying the importance of vaccines, I think, is critical. Vaccines are our best shot to ending this pandemic.”



Gavan Fitzsimons

“Many of the locally accepted ordinances place the legal burden on the retailer to actually enforce the face-covering guidelines. So it is up to the retailer. There are ways to enforce that will lead to resistance and there are ways to enforce that could minimize that resistance.”

“If you want to minimize resistance, you want to try to give some agency to that shopper. Rather than approach and say, ‘Ma’am, you must wear a facemask,’ you might say, ‘Ma’am, the local law says you must wear a facemask. We have three different types, all of which are comfortable. Which of these might you like to use today?’ ”

“It’s not perfect. But it helps. If the person who feels their freedom is threatened feels like part of the solution … they’re more likely to comply. Giving them a choice helps a lot.”



Benjamin Anderson

“The general consensus is that mandates are effective in reducing, once they’re implemented and adhered to in a reasonable way.”

“At this point a lot of people have locked into certain sources. If they feel like they have a mistrust of a particular source, be it a government official or others, it might be very difficult to restore that trust.”



Gavan Fitzsimons

“The way we communicate is going to be very critical here. Obviously the governor is well-intentioned. But using a term like ‘selfish,’ I think, is going to lead people who are already digging in to dig in even harder.”

“I don’t like to describe people that choose not to wear a mask as selfish. I understand psychologically why they’re doing it. We’re threatening their freedom. So using the term ‘selfish’ is going to lead them to dig in even harder. So the language we use has to be very careful not to trigger the digging-in kind of response.”

“You can’t shame someone who is defending a freedom that they value into not defending that freedom.”



Benjamin Anderson

“Adherence is importance to understand. Not just the adherence itself but the overlay with the data for infection and transmission. It’s similar to herd immunity – do we need 100 percent of people wearing masks in order to have a significant impact on transmission? The current thinking is no, that’s not the case.”



Lavanya Vasudevan

“There’s definitely data to show that vaccination rates have dropped since the shutdown began. Part of it is because clinics were not offering vaccinations. In many cases parents were afraid to take their children to clinics for fear of COVID infection.”

“We have not seen many impacts in terms of outbreaks so far because people mostly have been sheltering in place. And there have been travel restrictions. But I am afraid that as things open up further, travel restrictions are loosened and children go back to school, we should be definitely concerned about other outbreaks. We don’t want a situation where we have the COVID-19 outbreak happening and other outbreaks happening in parallel.”

“We are coming up on the flu season, so this is another thing to keep in mind. We need people to get vaccinated against flu in the fall. That’s another huge impact on our hospital systems in the fall and spring.”



Gavan Fitzsimons

“I’m optimistic. We’ve seen some movement in the last couple days across the political spectrum to unify behind a mask/face covering strategy. That, I hope, will take some of the politicization out of the system. If you compare other countries around the world, wearing a face covering is not a political issue. It just simply isn’t.”

“The trouble, of course, is that once there was the link between the political and the wearing of a mask, that’s where that feeling that the freedom to not wear a mask became important to a lot of folks.”

“Once a freedom is perceived to be important to you, it takes quite some time to become less important.”

“I think we have to be patient. It will take some time for the political link to dissipate here in the U.S. and for us hopefully to see the same kind of acceptance of the recommendations that we’re seeing in other countries around the world.”



Gavan Fitzsimons 

“It cannot hurt. It can only help. As long as there’s now a consistent, repeated message both verbal and physical – wearing an actual mask and letting people see that it’s important – as long as that’s repeated over and over in the coming months it’ll start to shift and move people’s opinions.”

“When seat belt laws were passed … early compliance was very low. Nowadays most people wear seat belts most of the time. So that freedom to not wear a seat belt mattered a ton early on. The signaling was consistent and repeated and eventually the freedom to not wear a seat belt faded and it became a not-important freedom anymore.”



Benjamin Anderson

“Getting trusted voices within the community … it could be religious institutions, it could be service organizations. Having that message that goes all the way down on the local and personal level makes for a more impactful message.”

“If it’s on the national level, it feels more distant.”

Lavanya Vasudevan

“There are two important components: People want facts, but more importantly they want facts from people they trust.”

“People don’t want to be told what to do, but they want to know what their peers and community members are doing. If something is a norm in a community, it is more likely to be accepted.”

“It’s always good to communicate in terms of benefits rather than threats. Talking to folks about the benefits of mask-wearing, the benefits of vaccinations, is always better.”



Lavanya Vasudevan

“We want people to be confident about vaccines. We want them to know that vaccines are safe and effective. We want people to know where to go to access vaccines. And we talk about why vaccines are important.”

“What we can focus on right now is really communicating about the importance of vaccinations. Telling people why they should be vaccinated.”

“There are many people out there who are either not convinced there is a pandemic or don’t think COVID is a threat to them either because of their age or other circumstance. We really need to start communicating about why the vaccine is important to them in terms of benefits rather than threats.”



Gavan Fitzsimons

“There’s quite a lot that business leaders can do. One of the advantages of our free enterprise system is that if a business leader decides to make a change, they don’t have to go through legislative action. They don’t have to negotiate with all the different parties, they aren’t subject to lobbying. If they decide they want to make a change, they just make a change and it happens instantaneously.”

“Early on in the pandemic … Costco implemented a plan where they restricted the number of people coming into the stores. Everyone had to be wearing a mask, both employees and customers. They put plexiglass barriers up to protect their staff. This all happened essentially overnight. If I wanted to go to Costco, I had to follow the guidelines.”

“So, business leaders have certainly an opportunity to take aggressive and immediate action in a way that our legislators, just by virtue of our government, can’t move that fast. I’m always happy to see our business leaders taking aggressive positions to try to protect their customers and their staff.”

The experts:

Benjamin Anderson
Benjamin Anderson is an assistant professor of science and global health at Duke Kunshan University in China, where he studies emerging infectious diseases, zoonotic diseases, and viral respiratory pathogens.

Gavan Fitzsimons
Gavan Fitzsimons is a professor of marketing and psychology at Duke’s Fuqua School of Business. He studies how consumers can be unintentionally and unconsciously influenced, including how they respond to various messages.

Lavanya Vasudevan
Lavanya Vasudevan is an assistant professor in the Department of Family Medicine and Community Health and the Global Health Institute at Duke. She is also a faculty affiliate at Duke’s Center for Health Policy and Inequalities Research.

Duke experts on a variety of other topics related the coronavirus pandemic can be found here.