The science is clear: Masks save lives.
In their latest forecast, researchers from the University of Washington Institute for Health Metrics and Evaluation predict that nearly 220,000 people will die of COVID-19 by November 1 in the United States.
"If 95% of Americans wore masks when leaving their homes, that number would drop by nearly 34,000," the scientists wrote in an email. "Those who refuse masks are putting their lives, their families, their friends and their communities at risk."
But resistance to wearing a mask persists in the United States, especially in the South and Midwest, as reported in The New York Times.
For many mask opponents, the issue is politics, not public health.
President Donald Trump only this week publicly supported wearing a mask. Previously, he had refused to wear one in public.
Georgia's Republican governor, Brian Kemp, has blocked the mayor of Atlanta, a Democrat, from issuing a mask mandate.
Digging in
“The refusal to wear a mask is selfish. It infringes on the life and liberty of everyone else in the store,” North Carolina Governor Roy Cooper, a Democrat, said at a press conference earlier this week.
That may be true, but the message is not helpful, said Duke University marketing and psychology professor Gavan Fitzsimons.
“Many people perceive that some of the public health guidelines are direct threats to their freedoms," Fitzsimons said. "They’ll go to great lengths to not follow those guidelines."
"Using a term like ‘selfish,’ I think, is going to lead people who are already digging in to dig in even harder,” he added. “You can’t shame someone who is defending a freedom that they value into not defending that freedom.”
For the sake of health and the economy, that behavior has to change. But how?
A public health ad campaign might be one way. But it has to be done right.
"What you cannot do is shame. Shame doesn't work," said Andrew Schirmer, co-president of the public relations agency Ogilvy Health.
Message from God
Maybe people will listen to Morgan Freeman.
In the first of a series of celebrity-voiced ads that New York state is releasing, the actor's mellow baritone voiceover says, "When you wear a mask, you have my respect. Because your mask doesn't protect you. It protects me."
Ogilvy didn't produce the ad, and Schirmer doesn't love it. But Freeman, an actor well known for roles as God and the U.S. president, might help lend the ad an air of seriousness, he said.
"I do believe there are many people that are moved by gravitas," Ogilvy said.
His agency went in a different direction, however.
A lonely Jason Voorhees, the hockey-masked star of the “Friday the 13th" slasher film series, wanders the streets of New York in an ad Ogilvy produced.
"It's not easy. The mask kinda makes people uncomfortable," Voorhees says. Pedestrians and subway riders give him a wide berth as strolls through the city.
As he sits alone on a park bench, a little girl skips up to him and hands him a surgical mask. He puts it on over the hockey mask, and the girl nods.
"Wearing a mask can be scary," on-screen text reads. "Not wearing one can be deadly."
Lessons from AIDS, polio
The ad acknowledges that people don't like wearing masks. That's a lesson health experts learned from efforts to get people to wear condoms during the AIDS crisis.
“No one’s like, ‘Whoo-hoo, I get to wear a mask today!’” sexual health expert Jill McDevitt told The New York Times.
The child as the messenger is the key to the Ogilvy ad, Schirmer said.
"It's the innocent little girl who's actually going to open up her arms to help this guy because he's being shunned," he said.
"It's not a finger wag," Schirmer added.
Schirmer has worked on public health campaigns for polio vaccination in areas of Pakistan and Nigeria where suspicions run high and trust in government and health experts is low – a situation much like present-day America, he said.
The stakes were higher in Pakistan. Vaccinators were being killed because of mistrust.
What helped was linking the effort back to the community, Schirmer said.
One ad showed a man praying in a mosque, socializing at a tea house, sending his children to school – and then, at the end, putting on his vaccinator uniform.
"We are all intertwined," the ad said.
"Every individual is a part of something," Schirmer said, and getting at those social connections is key to messages that resonate.
The legal route
Another way to change behavior: pass a law.
"I think we've passed the point where we can only depend on persuasive messages," said Columbia University public health professor Ronald Bayer.
Smoking bans, and seat belt and helmet laws have all run into the same pushback from people who feel their rights are being infringed.
"That freedom to not wear a seat belt mattered a ton early on," Duke's Fitzsimons said. But messaging on the issue "was consistent and repeated and eventually the freedom to not wear a seat belt faded and it became a not-important freedom anymore.”
Two states with Republican governors, Ohio and Indiana, along with Democratic-led Minnesota, issued mask mandates this week.
Fitzsimons said that, plus the president's endorsement of masks, will help.
"It will take some time for the political link to dissipate here in the U.S.," he said, "and for us hopefully to see the same kind of acceptance of the recommendations that we’re seeing in other countries around the world.”
