I posted about masks. Here’s what happened.

On harm reduction, psychological reactance, and why the discourse is failing us

Last week, I shared a post about masking. I emphasized that masks are an incredibly effective prevention tool and that we should be talking about them more. I walked through the evidence: masks work (really well), quality matters (N95s outperform surgical masks, which outperform cloth), and masking works best when more people do it. I shared practical information about the dose-response relationship, about bringing your own N95 if your doctor’s office only offers surgical masks, and about how collective masking is more protective than individual masking alone.

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Dr. Jess Steier | Unbiased Science on Instagram: "Masks are a h…

I also shared my own approach. I mask in healthcare settings, around immunocompromised people (more on this in a sec), on planes, and when I’m symptomatic, even if my COVID and flu tests come back negative. I mask when the people around me ask me to. And I’ve accepted some risk in other settings, partly because I have a daughter with a speech issue who benefits from seeing mouth movements. I take other precautions too: vaccinating, testing before gatherings, and improving ventilation when I can.

I said that people’s risk tolerance varies, and that I wasn’t telling anyone what to do. I was sharing the evidence and being honest about my own tradeoffs.

I knew it would stir people up. Masks are one of those topics where no matter what I say, someone’s angry… and boy, was I right.

But the response surprised me. This wasn’t the usual crowd. Nobody called me a pharma shill. Nobody said masks don’t work. The criticism came from people who understand the science, who mask consistently, and who care deeply about protecting vulnerable communities. They felt my approach wasn’t enough.

I want to take that seriously. Let’s discuss…

The critique I’ll own.

A lot of people pointed out that I said I mask around immunocompromised people, but how do I know who’s immunocompromised? They’re at the grocery store. They’re on the bus. They’re at my kid’s school. I can’t identify them by looking.

That’s fair. They’re 100% right.

One comment put it simply: “Disabled people are everywhere and deserve to be safe everywhere.”

I agree with that. And I want to sit with it rather than get defensive - which, admittedly, is difficult when you have dozens of people telling you to ‘do better’ or sharing how ‘disappointed’ they are to see a public health account posting such ‘irresponsible’ guidance.

My approach isn’t perfect. It’s a series of tradeoffs I’ve made based on my life, my family, my circumstances, and yes, my own risk tolerance. I’m not claiming it’s the “correct” answer for everyone. I’m being honest about what I actually do, which is more than a lot of public health voices are willing to say out loud, out of understandable fear of judgment and shame. The number of colleagues who privately messaged me to say they appreciated someone finally saying this publicly tells me something is broken in how we’re having this conversation.

And yet.

I know some people reading this are already composing their response. “But you just admitted you can’t know who’s immunocompromised. So how can you justify not masking everywhere?”

I hear you. I understand the logic. If immunocompromised people are everywhere, and masking protects them, then the ethical thing to do is mask everywhere if we care about protecting them. I get why that feels like the only consistent position.

But I want to ask you to stay with me for a minute, because I think there’s a bigger picture here. It has to do with the people we’re actually trying to reach, what actually changes behavior at scale, and why masking presents a unique communication challenge.

Why masking is a harder sell than vaccination.

I talk about vaccines a lot. I get asked why I don’t talk about masking as much.

Part of the answer is practical. Vaccination is a one-time action, or at most a once-a-year action. You make the decision, you get the shot, you’re done. The behavioral ask is discrete and time-limited.

Masking is different. It’s not a one-and-done decision. It’s something you do repeatedly, across varying contexts, and with varying levels of risk. It affects communication. It affects how we read each other’s faces. For some people, it’s uncomfortable. For some kids, it creates real challenges. The behavioral ask is continuous in a way that vaccination simply isn’t.

That doesn’t mean masking is less important. It means the communication challenge is different. And I think we need to be honest about that if we want to actually move people.

Where I push back.

A lot of the comments framed masking as binary. Either you mask everywhere indoors, all the time, or you’re selfish and don’t care about disabled people.

I understand where that comes from. Immunocompromised and disabled folks have watched society move on while they’re still at serious risk. They’ve been told to just stay home. They’re exhausted and angry, and they have every right to be.

And yet. I need to say something that might be unpopular: the absolutist approach to masking is not working. It’s not convincing people to mask more. In many cases, it’s pushing them away.

What the research says.

This isn’t just my intuition. There’s a body of research on what’s called “psychological reactance,” which is what happens when people feel their autonomy or freedom is being threatened. When messaging feels coercive, when it feels like “do this or you’re a bad person,” people dig in. They resist. They associate the behavior with judgment rather than care.

One study on mask attitudes found that reactance, the aversion to being told what to do, was one of the central drivers of anti-mask beliefs. Researchers have suggested that public health communicators need to use strategies that reduce this reactance rather than inflame it.

We see this pattern in other areas of public health, too. Studies on sex education have consistently shown that programs incorporating both abstinence messaging and contraception information are more effective than abstinence-only programs. Harm reduction approaches to substance use, from needle exchanges to supervised consumption sites, reduce morbidity and mortality precisely because they meet people where they are rather than demanding perfection.

Why would masking be different?

There’s a broader issue here, too. The absolutist framing treats disease transmission as the only factor worth considering. But human behavior doesn’t work that way. People weigh competing priorities, practical constraints, comfort, and social context. Effective public health messaging has to account for how people actually make decisions, not how we wish they would.

Who I’m actually trying to reach.

My goal with that post wasn’t to preach to people who already mask everywhere. Those folks don’t need me. My goal was to reach people who don’t typically mask at all and give them a framework for thinking about when masking might make sense.

It worked.

I heard from people who identify as skeptics. People who have been critical of public health. People who felt alienated by what they saw as an authoritarian approach to prevention during the pandemic. They told me this post resonated with them. It felt practical. It didn’t feel like they were being lectured or shamed. Some of them said they’d actually consider masking in certain situations now.

That is a huge deal.

These are exactly the people who are hardest to reach. And a practical, non-judgmental framing got through to them in a way that absolutist messaging never would.

“I’ve been looking for practical guidance like this. The all-or-nothing stuff just makes me feel like why bother.”

But it wasn’t just the unsure or unconvinced who reached out. I also heard from people who already mask regularly:

“Thank you for this. I mask in a lot of settings, but I’ve stopped posting about it because I’m afraid of being attacked for not doing enough.”

“I won’t even take photos indoors without a mask anymore because of the vitriol I get.”

These are people who already understand the importance of masking. Who are quietly doing harm reduction every day. And they’re silent because the loudest voices in this conversation have made them feel like anything less than 100% makes them a villain.

The absolutist approach isn’t just failing to persuade skeptics; It’s also silencing allies. That should concern all of us.

What I saw in the comments.

I did an informal thematic analysis of the responses across platforms, and the patterns were striking.

On Instagram, which tends to skew younger and more left-leaning, the dominant response was criticism. Many commenters felt I wasn’t doing enough. The recurring themes: you can’t know who’s immunocompromised, your personal risk tolerance affects others, and anything less than masking everywhere is selfish and indefensible.

On Facebook, the response was almost the opposite. Comment after comment from nurses, people with chronic illness, parents, and other folks sharing their own practical approaches. Healthcare workers saying “masks work, I wear one at the bedside.” People describing the situations where they mask and why. Someone sharing how masking helped their family limit spread during the holidays. Very little criticism.

Same post. Very different audiences. Very different reactions. I’m genuinely curious what drives that difference. Is it age? Platform culture? The kinds of communities people have built in each space? I don’t know. But I noticed it.

On masking and child development.

Because I mentioned that part of my calculus is my daughter, who has speech issues, some people sent me studies showing that masks don’t impede speech development or socialization in children. I appreciate that, and I’m not dismissing that research.

But the evidence is mixed, and we shouldn’t pretend otherwise.

My daughter sees a speech therapist. A huge part of her therapy involves watching lip shaping and tongue placement. Being able to see faces matters for her progress. That’s not a hypothetical concern I invented to justify my choices. It’s our lived reality.

I’m not saying this is true for every child. I’m not saying masks are harmful to kids across the board. I’m saying that for some children, in some contexts, there are real tradeoffs. And we can acknowledge those tradeoffs without undermining the larger point that masks are effective and valuable.

And it’s not just children. The Deaf and hard-of-hearing communities have raised similar concerns - lip reading requires seeing faces, and widespread masking creates real accessibility barriers. Clear masks exist but aren’t widely available.

Nuance isn’t the enemy here. Pretending tradeoffs don’t exist is.

Harm reduction is not betrayal.

We don’t approach other public health issues with an abstinence-only mindset.

We don’t tell people “use condoms every single time, or don’t bother having sex.” We don’t say “if you can’t quit drinking entirely, don’t try to cut back.” We don’t say “if you’re not going to eat perfectly, why bother eating vegetables?”

We meet people where they are. We give them tools. We celebrate incremental progress. We understand that perfection is the enemy of good.

If someone who never masks starts masking on planes and at the doctor's, that’s a win. That’s reduced transmission. That’s fewer infections. That’s not nothing.

If someone who was skeptical reads a post that feels practical and non-judgmental and thinks “okay, maybe I’ll throw one on at urgent care,” that’s a win.

If we demand 100% compliance from everyone, we will get 0% compliance from a lot of people. That’s not moral victory, it’s a public health failure.

Back to the “you can’t know who’s immunocompromised” point.

I want to return to this because I don’t want to seem like I’m dodging it.

You’re right that I can’t know; no one can. You’re right that immunocompromised people are in all the spaces I move through. You’re right that if everyone masked in indoor public spaces, those folks would be safer from disease transmission.

I’m not arguing with any of that.

But I think it’s worth stepping back and acknowledging that people mask for different reasons, and the calculus shifts depending on which one you’re doing.

Some people mask primarily to protect themselves. They’re immunocompromised, or high-risk, or simply can’t afford to get sick. They can’t rely on others to mask, so they do it for their own protection. Some people mask primarily to protect others - source control when they’re symptomatic, or in settings where they know vulnerable people are present. And some people do both.

When I mask at the doctor’s office or on a plane, I’m mostly protecting myself. When I mask with a cough, I’m protecting others. These are different calculations. And I think flattening them into one moral obligation - “mask everywhere or you’re selfish” - misses that complexity.

For what it’s worth, I think we, as a society, should care a lot more about protecting each other. I wish we had a stronger culture of staying home when sick, of source control, and of considering the people around us. That’s a value I strongly hold. But building that culture requires more than individual behavior change. It requires structural shifts - paid sick leave policies that actually let people stay home, workplace norms that don’t penalize illness, and healthcare access that doesn’t force people to show up contagious because they can’t afford to miss a shift. Shaming individuals into compliance without addressing those barriers isn’t how we get there.

What I’m arguing is that the way we talk about this matters. And right now, the discourse around masking has become so charged that it’s actively counterproductive. It’s not bringing more people into the fold. It’s driving them away. And it’s making people who do mask, but imperfectly, afraid to talk about it at all.

I don’t have a perfect solution. I don’t think there is one. But I do think that shaming people into compliance has never been an effective public health strategy, and I don’t see why masking would be the exception.

On zero transmission.

I know this will frustrate some people, but as a pragmatist, I don’t think zero transmission is a realistic goal. That’s not defeatism. It’s the same logic we apply to every other public health issue. We don’t expect zero car accidents, zero unintended pregnancies, zero alcohol-related deaths. We aim to reduce harm, knowing we can’t eliminate it entirely.

I understand why some folks feel differently, especially those who are high-risk and have the most to lose. But public health has always been about tradeoffs and risk reduction, not elimination. That doesn’t mean we stop trying. It means we’re honest about what success actually looks like.

Masking is part of that equation, not the whole answer.

Where this leaves us.

I’m going to keep being honest about what I do and why. I’m going to keep sharing the evidence about the incredible effectiveness of masks. I’m going to keep trying to reach the people who might actually change their behavior.

And I’m going to keep acknowledging that my approach isn’t perfect, and that the folks doing more than I am aren’t wrong to do so.

To the masking advocates who are frustrated with me: I’d ask you to consider two things. First, the person you’re criticizing agrees that more people should mask and is actively encouraging it. Second, the silent people reading your comment, the ones who didn’t respond, might be internalizing the tone and deciding this conversation isn’t for them.

The goal isn’t to be right. The goal is to reduce harm.

I think we want the same thing. I think we disagree about how to get there.

I’d rather have that conversation (civilly) than pretend it’s not happening.

Stay Curious,

Unbiased Science