It may work to pay Americans to get vaccinated, but is it ethical?

A financial blow in the arm may be necessary for Americans who are uncertain about vaccination.

On May 12, 2021, Ohio Republican Governor Mike Dewin announced five US $ 1 million lottery awards to vaccinated people. Meanwhile, in West Virginia, young citizens are being tempted to get $ 100 savings bonds, and North Carolina State Universities offer vaccinated students the opportunity to earn housing costs. .. Many companies pay more money to vaccinated employees through bonuses and additional paid leave.

The push to get as many people vaccinated as possible is commendable and may work. But top behavioral scientists are worried that paying people for vaccination can backfire if people become more skeptical of the shot. And ethicists argued that it would be wrong, citing fairness and concerns about impartiality.

As a behavioral scientist and ethicist, I use extensive research to answer these questions. This suggests that incentives can work to save lives and, if properly structured, do not have to trample on individual rights or cost the government enormous amounts of money.

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Incentives and disincentives are already used in health care in the United States. The US privatized health insurance system not only covers costs, but also exposes patients to significant deductions and out-of-pocket costs to reduce what can be considered wasteful medical care. It may discourage people who don’t really need that level of care.

In practice, this means that patients are encouraged to refuse both emergency and more routine treatments, as both are exposed to costs.

Pay for health behavior

In the case of Covid-19, the vaccine is already provided free of charge to consumers and definitely encourages people to vaccinate. Studies have shown that reducing out-of-pocket costs can improve life-supporting drug compliance, whether it prevents heart attacks or manages diabetes.

Paying to take medicine does more than just reduce costs. And, if properly designed, such incentives can change health behavior.

Payments and prizes have been shown to be effective in promoting blood donation, anticoagulant compliance, blood glucose monitoring, physical activity, and smoking cessation.

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Especially for vaccination, payment of human papillomavirus (HPV) in the United Kingdom has been successful. Hepatitis B in the United States and the United Kingdom; tetanus toxoid in Nigeria. The effect can be greater. For example, in one group of HPV studies, vaccination rates more than doubled due to incentives.

For Covid-19, there is no field research so far, but some research experiments, including my group of 1,000 Americans, have shown that incentives are likely to work. It was. In our case, the tax cut incentives were sufficient to encourage people hesitant to vaccinate to say they shoot.

Coercion concerns

Even if incentives save lives by increasing vaccination, there are still other ethical considerations. An important concern is protecting the autonomous choices people make in deciding what to put in their bodies. This can be especially important for the Covid-19 vaccine. It has been recognized as safe and likely to be effective, but has not yet been fully approved by the Food and Drug Administration.

However, people are often paid to participate in clinical trials of drugs that have not yet been approved by the FDA. Ethicists are worried that such payments could be “compulsory” if money is attractive and invalidates or generally worsens one’s free choice.

You can wonder if the term “compulsory” applies to payment offers. However, even if the offer is compulsory, payments may still be reasonable to save lives in a pandemic if higher levels of vaccination are successful.

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During the smallpox epidemic almost 100 years ago, the US Supreme Court upheld the state’s rights to mandate vaccines. Incentives to encourage vaccines appear harmless compared to mandating vaccinations.

Exploitation and paternalism

Still, some people are still worried. Bioethicists Emily Largent and Franklin Miller said in a recent treatise that payments could “unfairly” abuse “unemployed U.S. residents … or poverty during a pandemic.” , “Choose but be vaccinated in cash.” Others point out that vaccination is higher in non-white communities, where income tends to be lower, as well as trust in medical institutions.

Ethicists and policy makers should certainly focus on the poorest members of our community and strive to minimize racial disparities in both health outcomes and wealth. However, there is no evidence that providing money is actually harmful to such people. It’s good to receive money. Suggesting that adults must be protected by rejecting them may come across as paternalism.

Some ethicists also argue that it is better to spend money elsewhere to increase participation. The state can spend money to make sure that the vaccine is convenient for everyone, such as by bringing the vaccine to a local event or church. Money can also support various efforts to combat false information and convey the importance of being shot.

Incentive cost

Financial incentives can be expensive as a policy solution. Like Ohio, lottery draws are one way to limit the overall cost of incentives while giving millions of people additional reasons to get their shots.