Public health professionals are focused on expanding coronavirus infection testing nationwide. “Testing is outbreak control 101, because what testing lets you do is figure out who’s infected and who’s not, and that lets you separate out the infected people from the noninfected people and bring the disease under control,” Harvard professor Ashish Jha says. As Tom Frieden, a former director of the Centers for Disease Control and Prevention, told The Washington Post, “Our ability to get to the new normal depends to a great extent on our ability to test, isolate, contact trace and quarantine.” Public health leaders are essentially unanimous: This is, they believe, America’s most viable escape route from the pandemic. It’s what has largely contained the virus in multiple countries, including Germany, Singapore, South Korea and Taiwan.

But what works there may not go over well here. Even under the best circumstances, national testing programs pose enormous technical challenges — How many tests? Who makes the tests? Where should they be processed? — that experts are working to solve. But even a technically sound program is useless without widespread consent. And obtaining such consent “would require a major reduction in our liberties and a prolonged period of increased surveillance,” as journalist Stephen Bush points out. Will Americans accept those reductionswillingly and quickly enough to implement an effective testing regimen? It’s hard to imagine.

In countries with successful testing programs, the relationship of citizens to the government differs from that of the United States in important respects. According to a 2018 Gallup poll, Germans are almost twice as likely as Americans (59 percent vs. 31 percent) to have confidence in government. This may help explain Germans’ greater willingness to comply with testing regimens and mask-wearing guidelines — and why Germany has almost two-thirds fewer coronavirus deaths per capita than the United States. Consider, in contrast, that data from the Pew Research Center show that only 17 percent of Americans say they trust the federal government to do what is right “just about always” or “most of the time.”

East Asian democracies such as Singapore, South Korea and Taiwan with successful testing programs differ from the United States in having democratized relatively recently. These nations carry what foreign policy expert Hans Kundnani calls an “authoritarian residue,” which promotes compliance with government-imposed coronavirus measures. For example, in the 1970s and 1980s, participation in government monitoring of stool samples was mandatory for South Korean children. Those children are now the adults who comply with the dramatic quarantine restrictions and testing protocols that have given South Korea one of the lowest coronavirus death rates in the world.

Americans’ relative lack of deference to their government extends to matters of health. Of all wealthy democracies, only in the United States have legions of voters fought for decades to prevent a government guarantee of health care for all citizens. Americans and the politicians they elect are also highly protective of personal health information — often with good reason. The app at the heart of Singapore’s coronavirus tracing system records people’s disease status in a fashion that clearly would be illegal under U.S. law. So would the South Korean app that alerts you to the identity of infected people nearby. Clusters of gun-toting protesters opposing public health measures are a real — and uniquely American — problem, but it’s the much more prevalent distrust in government’s role in public health that would curtail the success of any test, trace and isolate program. 

Public health experts should be thinking through what happens when they introduce the programs they’ve devised. What will we do when millions of Americans flatly refuse to be tested for the virus? What should we do if those who test positive deny reality and refuse to change their behavior?  (According to a Washington Post-University of Maryland poll, only 58 percent of Americans say they are very or somewhat worried about getting the infection and becoming seriously ill.) What if some governor in a state that refused Medicaid expansion, such as Kristi L. Noem (R) of South Dakota, decides that test, trace and isolate is the next frontier of opposition to big government?

The public health field is underestimating the extent of these challenges. That is probably because virtually everyone in the field thinks that emergencies of this sort should override concerns about individual privacy and autonomy. By its very definition, public health prioritizes an entire population’s well-being, even in cases where it crimps individual liberty (such as taxing cigarettes or supporting mandatory seat belt and vaccination laws). Public health schools conform to the broader academic pattern of leaning left, including in generally viewing expanded government as a means to a better society. It’s public health after all, not private health.  

You don’t have to venture far off campus to see that many Americans do not share this faith in government or willingness to limit individual freedom and privacy for population benefit. That doesn’t mean that efforts to test, trace and isolate won’t be successfully implemented anywhere in the United States. Some towns, cities, counties and states will have enough political assent to suppress virus flare-ups. But the virus knows no borders, in a nation this big and this mobile, so you can’t designate a “no peeing” section in the swimming pool. On balance, we probably will end up something like herd immunity-aspiring, light-touch Sweden, only without the benefit of guaranteed health care. This won’t be because we universally agreed to choose such a policy, but because we couldn’t universally agree — and never have — about fundamental issues surrounding politics and health.

Twitter: @KeithNHumphreys