COVID-19: Vaccination incentives might be effective
As we claw our way out of the pandemic, state governments across the country are offering all kinds of rewards for getting vaccinated against COVID-19. In return for getting your shot, you could take a thrilling lap around the Talladega Superspeedway in Alabama, win a free fishing and hunting licence in Maine, or get your own custom shotgun in West Virginia. In California, residents who get vaccinated have a chance at $1.5 million as part of Gov. Gavin Newsom’s vaccination lottery programme, Vax for the Win.
There’s some evidence that these incentives are working. Since California launched its lottery on May 27, over 900,000 residents began their vaccination process. According to the California Department of Public Health, the state saw a 13% increase in vaccinations from the last week of May to the first week of June.
The data aren’t rock solid, however. That 13% refers to both first- and second-dose shots, which obscures the full picture. Between June 4 and June 10, about a week after Newsom announced the lottery, the number of Californians getting their first dose of vaccine dropped to the lowest level since January.
There are confounding factors as well, such as particularly low vaccination rates over Memorial Day Weekend, and the fact that teens became eligible for Pfizer’s vaccine two weeks before the lottery began, prompting a new wave of shots. Not to mention there’s no way to prove correlation versus causation when analyzing the impact of the lottery.
So it’s unclear at this point whether Newsom’s giveaways really have driven vaccination rates up. But even if they have — even if there were clear data showing that incentives work — they’re still not a good idea. That’s because vaccination incentives send the wrong message, encouraging Americans to get their shot because there’s a personal reward in it for them, not because it’s the right thing to do for them and their communities.
From a public health standpoint, we should embrace incentives if they increase vaccinations. But from a cultural and social perspective, these incentives threaten to set a dangerous standard and promote a self-serving mindset that has already set us back in the fight against the coronavirus.
A unique combination of American tendencies make vaccination incentives especially problematic. As we trudged through last winter, some of the most deadly months of the pandemic, it often felt like things were stacked against us. We weren’t just battling a virus; we were also deeply, fundamentally divided over our priorities and values.
Face masks, which should have been a simple protection measure, became a politicised symbol of government control. When the government asked us to stay home, people took to the streets to hold anti-lockdown protests across the country. And as more Americans died daily, others downplayed the threat and recklessly spread the disease at large gatherings.
“This was a problem that our culture was not particularly suited for,” said Thomas Talhelm, associate professor of behavioural science at the University of Chicago. “We have this reflexive aversion to enforcement.”
We’re also paranoid about losing our individual liberties, Talhelm said, and we often put our own interests first. These qualities don’t apply to every American, of course, but they do constitute a large swathe of the cultural landscape. And these qualities all fall under the umbrella of individualism, an ethos in which our country is rooted.
Individualistic societies value self-reliance and autonomy. They prioritise individual rights and elevate personal freedoms over collective freedoms. There’s nothing inherently wrong with individualism, and in fact, the individualistic nation of Germany managed the pandemic with care, for the most part. Nor is it accurate to characterise the entire American population that way, or blame all our pandemic failures on individualism alone.
But there’s no denying that within certain communities, a perfect storm of stubbornness, distrust of authority and an individualistic mindset produced a cohort of Americans who refused to obey lockdown laws, wear masks or socially distance. They simply didn’t believe, or they just didn’t take seriously, the clear message from public health officials that these measures saved lives.
By creating vaccination incentive programs centered around personal reward, state governments are complicit in that perfect storm. Haven’t we learned by now that selfishness is not the way to beat COVID-19?
Vaccination incentives encourage the same harmful, individualistic habits that did so much damage in the earlier stages of the pandemic. When states announced these programmes, they essentially put their stamp of approval on the self-centred mindset that has dangerously driven so many Americans’ choices thus far.
“The incentives sort of imply that you shouldn’t do it for other reasons,” Talhelm said. “Setting up the system like that is sending people a message, whether it’s intentional or not.”
Incentives also help establish a potentially dangerous norm. We’re likely going to need to get vaccinated against COVID-19 regularly, and we can’t afford to offer millions of dollars in prizes every time. Vaccination hesitancy is not a new phenomenon, but this is the first time we’re trying to combat it with highly publicised, valuable rewards like scholarships and vacations.
“It’s not something that’s sustainable in the long term,” said Catherine Flores, executive director of the California Immunisation Coalition. Monetary incentives have never before been seriously considered as a tool to counter vaccination hesitancy, she said, especially not on a statewide level.
If the incentives are making a positive difference right now, then they’re worth it. But that doesn’t mean they’re helping us prepare for the challenges we’ll face in the future.
Many Americans already had an incentive to get their shot long before states started announcing lotteries: They didn’t want to get themselves or their loved ones sick with a potentially fatal disease.
There are a range of reasons Americans might voluntarily skip their vaccination, Flores said, including legitimate health concerns on the one hand and misinformation on the other. But if there was anything that could convince those who are vaccination hesitant to go and get their shot, you would think it would be the prospect of emerging from the pandemic and saving lives.
As it turns out, that may not have been enough of a motivator this year. But perhaps the fearful possibility of returning to the bad old days of lockdowns, masks and social distancing will be incentive enough when the time comes for the next round of COVID-19 inoculations.
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