The announcement of a new vaccine incentive comes amid increasing concern over the spread of the Delta variant of the COVID-19 virus. The Centers for Disease Control announced yesterday that even fully vaccinated people should wear a mask in areas with “substantial or high transmission” of the virus.
According to a map from the CDC, all five of New York City’s counties have “substantial” levels of community transmission, meaning the new recommendations apply in the city.
“If we somehow don’t get to true immunity, our economy will be operating with a huge weight on its chest,” Robert Litan, a non-resident senior fellow at the Brookings Institution who served in the Bill Clinton administration, told Insider in November.
A financial shot in the arm could be just what is needed for Americans unsure about vaccination.
On May 12, 2021, the Republican governor of Ohio, Mike DeWine, announced five $1 million lottery prizes for those who are vaccinated. Meanwhile, in West Virginia, younger citizens are being enticed to get the shot with $100 savings bonds, and a state university in North Carolina is offering students who get vaccinated a chance to win the cost of housing. Many companies are paying vaccinated employees more money through bonuses or extra paid time off.
As a behavioral scientist and ethicist, I draw on an extensive body of research to help answer these questions. It suggests that incentives might work to save lives and, if properly structured, need not trample individual rights or be a huge expense for the government.
In the United States, incentives and disincentives are already used in health care. The US system of privatized health insurance exposes patients to substantial deductibles and copays, not only to cover costs but to cut down on what could be deemed as wasteful health care – the thinking being that putting a cost to an emergency room visit, for example, might deter those who aren’t really in need of that level of care.
In practice, this means patients are encouraged to decline both emergency and more routine care, since both are exposed to costs.
Paying for health behaviors
In the case of COVID-19, the vaccines are already free to consumers, which has undoubtedly encouraged people to be immunized. Studies have shown that reducing out-of-pocket costs can improve adherence to life-sustaining drugs, whether to prevent heart attacks or to manage diabetes.
A payment to take a drug goes one step further than simply reducing costs. And if properly designed, such incentives can change health behaviors.
And for vaccination in particular, payments have been successful for human papillomavirus (HPV) in England; hepatitis B in the United States and the United Kingdom; and tetanus toxoid in Nigeria. The effects can be substantial: For example, for one group in the HPV study, the vaccination rate more than doubled with an incentive.
For COVID-19, there are no field studies to date, but several survey experiments, including one my group conducted with 1,000 Americans, find that incentives are likely to work. In our case, the incentive of a tax break was enough to encourage those hesitant about vaccinations to say they would take the shot.
But already people are often paid to participate in clinical trials for drugs that have not yet been approved by the FDA. Ethicists have worried that such payments may be “coercive” if the money is so attractive as to override a person’s free choices or make them worse off overall.
One can quibble about whether the term “coercion” applies to offers of payment. But even if offers were coercive, payments may still be reasonable to save lives in a pandemic if they succeed in greater levels of immunization.
Ethicists and policymakers should indeed focus on the poorest members of our community and seek to minimize racial disparities in both health outcomes and wealth. But there is no evidence that offering money is actually detrimental to such populations. Receiving money is a good thing. To suggest that we have to protect adults by denying them offers of money may come across as paternalism.
Some ethicists also argue that the money is better spent elsewhere to increase participation. States could spend the money making sure vaccines are convenient to everyone, for example, by bringing them to community events and churches. Money could also support various efforts to fight misinformation and communicate the importance of getting the shot.
The cost of incentives
Financial incentives could be expensive as a policy solution. As in Ohio, lottery drawings are one way to cap the overall cost of incentives while giving millions of people an additional reason to get their shot.
The tax code could also allow for a no-cost incentive for vaccination. Tax deductions and credits are often designed to encourage behaviors, such as savings or home ownership. Some states now have big budget surpluses and are considering tax relief measures. If a state announced now that such payments would be conditional on being vaccinated, then each person declining the shot would save the government money.
Ultimately, a well-designed vaccination incentive can help save lives and need not keep the ethicists up at night.
According to state data, Ohio administered more than 25,400 COVID-19 vaccines on May 14 – two days after Gov. Mike DeWine announced the program during a televised address the evening of May 12. It was the highest number of shots the state had administered in three weeks, when residents received 28,000 shots on April 23.
DeWine’s announcement drew ire from some in and outside his own Republican Party, who questioned the use of millions in pandemic relief funds, local CBS affiliate WHIO reported.
“I know that some may say, ‘DeWine, you’re crazy!” DeWine said in a tweet last week announcing the “Vax-a-Million” program. “This million-dollar drawing idea of yours is a waste of money.’ But truly, the real waste at this point in the pandemic — when the vaccine is readily available to anyone who wants it — is a life lost to COVID-19.”
People in Connecticut who have been vaccinated against COVID-19 can get a free drink at participating restaurants. The state of Kentucky partnered with Walmart and Kroger to give every vaccinated adult a lottery ticket, which carries a top prize of $225,000. And New Jersey Gov. Phil Murphy announced that vaccinated people could get a free beer after they had been vaccinated with his “shot and a beer” campaign.
According to data analyzed by Johns Hopkins University, about 35% of Ohio residents are fully vaccinated against COVID-19. The state with the highest percentage of fully vaccinated people is Connecticut, with more than 44%.
The first Ohio drawing winner will be announced on May 26. The other four winners will be announced on the four Wednesdays that follow. If a 12- to 17-year-old wins the drawing, they’ll get a full-ride scholarship to any Ohio state university.