Want people to get vaccinated? Pay them

Initial US vaccination efforts were a logistical triumph. In April 2021, on a single day, 4 million people were vaccinated — more than 1 percent of the population. Since then, though, vaccination efforts slowed and then stalled.

Today, only 62 percent of the population has been fully vaccinated, according to the CDC. Only 36.5 percent of people have received boosters. This is especially troublesome because boosters are vital for protection from the omicron variant that is currently leading to the worst hospitalization numbers of the pandemic.

The US desperately needs more people to get vaccinated. But policy response has been lackluster. There is a good bit of public support for vaccine mandates, but local and state governments have embraced them only sporadically, and generally with an opt out in the form of regular testing.

Even so, an OSHA regulation requiring vaccines or regular testing for companies with over 100 employees nationwide is facing Supreme Court scrutiny. Politicians have resorted to dire warnings and to emphasizing that people have a duty to others to get vaccinated.

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This puts the onus on the individual for vaccine uptake, rather than on the government to reach people who are in danger.

One possibility that hasn’t been much explored is using a carrot rather than (or in addition to) a stick. Governments should consider paying people to get vaccinated.

A certain number of people will recoil at this idea. The highest-profile anti-vaxxers are belligerent far-right partisans devoted to spreading vaccine misinformation like Fox’s Tucker Carlson and Georgia congresswoman Marjorie Taylor Greene. While Carlson and Greene may well be vaccinated themselves, their followers are often rightwing conspiracy theorists and bad actors.

It’s hard to imagine money swaying them.

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Not all of the unvaccinated are hard-core rightwing partisans, though.

In many states, especially in the South and Southwest, Black and Hispanic groups have substantially lower vaccination rates than white people. Some of these inequities have been reduced through outreach and targeted vaccine efforts; Mississippi, for example, has done impressive work closing the Black vaccine gap. However, Black and Hispanic communities are once again falling behind on booster shots.

These groups tend to vote Democratic. They aren’t embracing vaccine refusal as part of rightwing partisanship. Instead, their low rates reflect mistrust because of an ongoing history of abusive and discouraging experiences with a racist and classist healthcare system.

Perhaps even more importantly, Black and Hispanic individuals are more likely to have trouble accessing vaccines.

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They disproportionately live in segregated areas without a strong healthcare infrastructure and without good public transportation. A poll in May 2021 found that 20 percent of Black and Hispanic respondents said getting to a vaccine site would be difficult as compared to 5 percent of white respondents.

Missing work to get the vaccine, or because of vaccine side effects, was also a bigger concern for Black and Hispanic individuals. They may have less flexible work schedules than white peers or work precarious jobs where they do not get paid time off.

Paying people to get vaccinated would ameliorate exactly these kinds of problems. Paying people $250 to get vaccinated would replace the income for two eight-hour days at a $15 an hour job. Even lower payments – say $100 – could dramatically change the calculus around vaccination, work and transportation costs.

There’s evidence that even smaller financial rewards can lead people to get vaccinated. A study in Sweden from May to July of 2021 offered people only $24 to get vaccinated. The pay bumped up vaccination rates by around 4 percent.

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The US has experimented with some bonuses for vaccines.

Businesses at various points during the pandemic have given away donuts, popcorn, marijuanacand gift cards to people who can show proof of vaccination. Illinois held a $1 million lottery for everyone who got vaccinated.

There hasn’t been much of an effort to simply hand out cash, as in the Swedish study, though. And a free donut or a small chance at a million-dollar payout isn’t going to be much of an incentive if someone is worried that the vaccine will force them to miss two days of work and leave them unable to pay rent.

Part of the resistance to vaccine payments is no doubt fiscal. Illinois’ lottery drawings spent about $10 million. But to give everyone in the state $100 for vaccination would come to $1.2 billion. Nationwide $100 for vaccination would be around $36 billion. Additional payments for additional boosters could add to that total.

Still, I think there’s a strong argument that, given the huge costs of covid, tens of billions of dollars is a reasonable investment in public health.

This is especially the case at a time when the pandemic is ramping up again, and people are once again facing massive economic dislocation and precarity.

We know that direct payments had a huge effect in reducing poverty during earlier parts of the pandemic. If vaccination checks were large enough, they could have a similarly ameliorative effect and increase vaccination rates as well. That seems like a win-win.

Perhaps an equally important cause of reluctance is moral and tactical.

As Rebecca Stropoli notes in the Chicago Booth Review, “paying people to get vaccinated could have potential downsides, such as giving the impression that vaccines are not desirable or lessening the motivation to be inoculated for the public good rather than for financial benefit.”

As far as the first objection goes, we know that the right will spin any vaccine intervention as a negative. Undoubtedly, Tucker Carlson would use vaccine payments to argue that the government is nefariously trying to induce people to accept vaccines.

Nonetheless, what evidence we have suggests paying people increases vaccine rates, and there are good logistical reasons to think it would encourage those with access issues the most. We shouldn’t let fear of bad faith arguments prevent us from adopting useful policy solutions.

The second objection may strike many who aren’t on the right as persuasive. Shouldn’t people get vaccinated out of civic duty, rather than to earn a little money? Vaccines are a benefit in themselves; you shouldn’t need to pay people to get them. Everyone should get vaccinated to ensure their own health, as well as the health of their loved ones and their communities. What ever happened to individual responsibility?

This individual responsibility framework is itself the problem, though.

Yes, people should get vaccines. But the federal government also has a responsibility in the Constitution to “provide for the common defense and general welfare.”

Vaccination campaigns are primarily public, communal efforts, not private moral dramas. It’s up to the government to get shots into arms. If browbeating people doesn’t work, they can’t just give up.

And that’s perhaps the most important reason to at least start to have a conversation about paying people to get vaccinated.

The current effort to shame and stigmatize unvaccinated people isn’t working practically, and it has disturbing implications ethically. We need to see the vaccine campaign as a collective responsibility.

People who aren’t vaccinated are a problem to solve, not refuse to discard. We should value every life. And one way you can show people you value them is by paying them.