Masks are lifesaving public health tools — let’s rate them accordingly

With the weather warming and vaccinations against COVID-19 significantly increasing, many Americans are shedding their masks as they venture out of their homes. Of the millions of people who get outside to enjoy summer activities, many will use sunscreen, a public health prevention tool for protection against skin cancer, the most common cancer in the U.S. and around the world. While skin cancer poses a significant public health threat, wearing sunscreen is a health behavior that can help shield consumers from sunburn and its damaging effects. 

The Food and Drug Administration (FDA) regulates sunscreens to ensure they meet safety and effectiveness standards. The agency requires that manufacturers clearly communicate the sunscreen’s level of protection on product packaging through a universal standard known as “SPF,” which indicates the amount of ultraviolet radiation exposure it takes to cause sunburn when using the product. The FDA requires that the product’s SPF rating be displayed prominently on the packaging — the higher the SPF, the greater the protection — empowering consumers to choose one that will best meet their needs among the hundreds of products available in the marketplace. 

We need this kind of federal labeling program to inform consumers about the effectiveness of the thousands of masks on sale for COVID-19 prevention. Consider that more than 33 million people have been infected with COVID-19 and 595,000 have died in the U.S. Over the past year, research has revealed that masks are a very effective preventive tool against viral spread. But unlike choosing a sunscreen for its SPF rating, consumers can’t tell whether the mask they have provides 90 percent protection against virus particles or 10 percent. Establishing a mask rating system would allow people to select these lifesaving products based on a scientific evaluation of their performance and give Americans greater confidence when they return to workplaces, schools and social gatherings that they have an effective tool if needed. 

Additionally, there are still tens of millions of unvaccinated Americans, children under 12 years of age are not yet eligible for COVID-19 immunizations, masks are required on mass transportation and planes, certain businesses are requiring them and some individuals might simply prefer more protection in certain settings. Furthermore, a mask labeling program would allow people who are especially vulnerable to getting sick from the virus, such as immunocompromised individuals, to select masks that provide them with maximum protection. 

The establishment of such a mask certification and labeling program is overdue. In November 2020, we proposed that the federal government develop a certification and easy-to-use rating system for the percentage of viral particles filtered by masks, with package labeling that includes this information. While the U.S. Centers for Disease Control and Prevention (CDC) has revised its guidance to educate consumers on the benefits and best practices of mask wearing, recently endorsing layering masks and emphasizing the need for proper fit on the face, the wide variety of masks available in the marketplace, with many manufactured in other countries, calls out for more information about which ones work best. 

In this next phase of the pandemic, we should apply our nation’s technology expertise to provide consumers with information about the effectiveness of masks to guide public decision making about which ones to wear in various risk situations, while also preparing for the flu season and responding to other health concerns in the future.  

While the FDA regulates cloth face masks, surgical masks and respirators intended for medical purposes, the National Institute of Occupational Safety and Health (NIOSH), a CDC agency, tests and certifies respirators, such as N-95 masks, and other forms of personal protective equipment (PPE) used in occupational settings. We recommend that the CDC develop and implement a parallel certification program for masks worn by the general public. In concert with its national network of accredited personal protective technology laboratories, the CDC should establish a program to evaluate masks’ filtration capacity and set benchmarks for these consumer products. 

The results of a mask’s laboratory testing should be clearly labeled by manufacturers, as is done for sunscreens, reflecting the level of filtration effectiveness and other criteria that would be established by the CDC. Instructions for how to properly wear the mask, whether it’s intended to be reusable, and how to clean it should also be included, as should warnings about any unregulated materials in a mask insert that might pose respiratory hazards. Federal and state initiatives that distribute these products at sites such as community health centers should use masks certified by this program.

In the absence of federal government action on this issue as the pandemic emerged, ASTM International (formerly known as the American Society for Testing and Materials), an organization that develops voluntary standards for a variety of products, developed mask standards for manufacturers that provide a proof of concept for our proposed national mask certification program. In February 2021, ASTM established minimum requirements for private sector manufacturers on the construction, filtration efficiency, and breathability of masks, as well as on their size, fit, durability and requirements for cleaning. ASTM’s mask rating system includes two filtration performance levels: greater than or equal to 20 percent and greater than or equal to 50 percent. For reference, N95 respirators filter 95 percent of particles. This ASTM initiative provides a roadmap for how the federal government could develop a federal mask certification and labeling program for consumers. 

With the coronavirus still rapidly mutating around the world and millions of unvaccinated people, the U.S. must continue to update its national strategy to defeat this disease and prepare for future health challenges as well. While the Biden administration has made significant progress in establishing, implementing and upgrading our country’s action plan, we still have work to do to beat the virus we face today and those that will emerge in the future.  

Louis Pasteur once said, “chance favors only the mind which is prepared.” The establishment of a federal mask certification and labeling program will help prepare our nation in the 21st century to more effectively fight COVID-19 and mitigate other respiratory infectious disease threats. By ensuring that masks have been scientifically certified as public health tools in combination with vaccinations and other non-pharmaceutical interventions, we can better protect our health now and in the years ahead from microbes that throughout history have killed more people than wars. Let’s remain vigilant and be better armed against them. 

Rear Admiral Susan Blumenthal (ret.), MD, MPA, former U.S. assistant surgeon general, is senior medical adviser at amfAR, The Foundation for AIDS Research, director of the Health Innovations Lab at New America, and a visiting professor at the MIT Media Lab.

Emily Stark is a research associate in health policy at New America.