Immune Incentives — Strategies for Increasing Covid-19 Vaccine Intake

The once promising pace of Covid-19 vaccination in the United States slowed from a peak of 3.38 million on April 13, 2021 to less than 2 million per day in May. Until recently, Americans were competing for limited vaccination quotas — situations that raised equity concerns — but now supply has outstripped demand in many countries and mass vaccination clinics have been closed. ..

Still, the United States remains far from the herd immunity target of about 80%. About 47% of Americans receive at least one Covid-19 vaccine. How can you motivate millions of people to get involved?

Increasing concerns are raised about the inadequacy of standard “information and education” approaches to encourage vaccination, and some state governments and businesses have begun paying people to get vaccinated. I am. Incentives range from $ 100 savings bonds and gift cards in West Virginia to free beer and other drinks in New Jersey and Connecticut, and crispy cream donuts nationwide. The best stakes are New York, which offers a $ 5 million grand prize-winning lottery, and five lottery tickets each give $ 1 million to vaccinated adults and a full-ride college for vaccinated children. Ohio is the state that awards scholarships. Do such incentives represent the desired path forward?

There is a specific logic for providing financial incentives. This can be used to offset the indirect cost of vaccination. This includes the time spent planning, traveling, or waiting for a reservation. Loss of income for hourly workers. Or expenses such as childcare. These costs disproportionately discourage low-income people from getting vaccinated, and payments can guarantee that vaccination is actually “free” for everyone.

In addition, economists usually acknowledge that government intervention in the face of externalities, the impact of individual behavior on others, plays a role. The classic negative externality is a factory that pollutes the air. Without government sanctions, many factories “overproduce” pollution because dirty technology is cheaper. Vaccination provides positive externalities and protects not only vaccinated people but also others. In the free market, people can underestimate the beneficial effects of their actions on others. Therefore, products with positive externalities can be underproduced. Subsidies and incentives are logical policy approaches in the presence of positive externalities.¹

In addition, incentives are useful in situations where behavioral changes can reduce future health care costs.² In the case of Covid-19 vaccination, the positive rewards of incentives can be significant. In the United States alone, the cumulative economic cost of a pandemic is estimated to be over $ 16 trillion.³

Finally, incentives can change even unruly health behaviors such as smoking and lack of physical activity, but when the incentives end, people can return to those behaviors. Therefore, incentives are especially effective in changing one-off behaviors, such as cancer screening and vaccination.^Four

Financial incentives are attractive, especially given the decline in vaccination rates and the social demands to end the pandemic, especially if incentive-based programs focus on persistently low vaccination rate groups. Some people who are reluctant to vaccinate may choose to vaccinate “for incentives.” This allows you to overcome inertia and resistance from a group of peers.

Even though incentives can lead to short-term increases in vaccination, multiple strategies are needed to boost herd immunity. Campaigns need to identify the causes of resistance, including safety concerns (such as pregnant women), and communicate transparently to build public trust. Vaccination policies also need to be coordinated with efforts to address systematic racism that limits access and uptake to black and brown communities.

Given that more than 100 million Americans are now fully vaccinated, it may seem unfair to give “late hires” incentive payments. Therefore, incentive programs need to compensate previously vaccinated people. Suppose 60% of adults are vaccinated and the program sets a goal of reaching 80% with an incentive of $ 100 per vaccinated person. If the incentive is provided to everyone, the program will cost $ 400 per incremental vaccinated person. To control costs, programs can target awkward young people and people living in zip codes who have low vaccine intake or high incidence of illness, but the efficiency of such delivery. There is an important trade-off between and fairness.

In addition, many Americans have clearly recognized and freely pursued the value of Covid-19 vaccination, but vaccination incentives have shown that vaccines are somehow undesirable or unsafe. It is considered to be present and can cause repulsion.^Five Also, given the political disparities in vaccine intake, government-sponsored incentives could create further resistance.

It is important to consider that booster shots will probably be needed in the future. Providing incentives can be costly and can set unwanted precedents, and people will expect and wait for the next incentive.

Ultimately, a well-designed incentive program can increase vaccination rates in the short term, but it can pose significant implementation issues and provide perfect timely rewards. Is the key to program effectiveness and reliability. We believe that we need to consider three alternative strategies whenever possible to offer sustainable solutions rather than incentives to boost vaccination.

First, patient-care organizations can require employees to be vaccinated with Covid, just as many of them have long needed flu vaccination. No intervention strategy is as effective as requesting vaccination.^Four And our agency, Penmedison, recently announced that it will require vaccinations for employees of all healthcare systems. Healthcare workers in the United States are denying Covid-19 vaccination at an alarming rate. At one nursing home, 90% of the population was vaccinated, but only half of the employees followed. One unvaccinated employee infected multiple residents, killing one vaccinated and two unvaccinated residents (https://nyti.ms/3w6bUvJ). This lack of preventable safety should be unacceptable to healthcare professionals. Mandatory vaccinations at schools and workplaces, especially in high-contact environments such as meat packaging factories and prisons, can significantly reduce future Covid-19 casualties in the United States.

Second, access to activities that involve close contact between people may only be granted to vaccinated persons. So far, among Americans, this approach is primarily to the pursuit of the elite, such as attending a live National Football League draft, a summer trip to the European Union, or enrolling in a boarding college this fall. I opened the door. Some institutions emphasize the fact that full direct participation in higher education, subject to vaccination, also reduces the risk to the surrounding community. Recently, some restaurants, gyms and sports stadiums have begun to limit access to vaccinated people or create special seating sections.

Such accidental access is a social incentive rather than a monetary one, and the desire to “return to normal” can be a powerful motivation. The wider the range of organizations that adopt such policies, the greater the proportion of the population who choose vaccination.

The third option is to increase the health and life insurance premiums for those who have stopped vaccination. This approach has the potential to redistribute higher expected health care costs in a fair manner to those who have already been vaccinated.

Incentives alone are unlikely to provide herd immunity to end a pandemic. A series of $ 1 million jackpots deployed in Ohio is an interesting alternative to testing, but it’s unclear if this will be a widely accepted approach. We need to take further steps to adopt a combination of behavioral policies that protect our health and economic health over the years to come.