Brookings Institution economist Robert Litan has published an insightful new article about paying people to take a coronavirus vaccine once one is approved and ready to distribute (as it may happen sometime next year becomes). I had planned to write a play that would make a similar point. But Litan hit me, and that's why he deserves credit for the idea. As he explains, this could save lives and money, and is probably better than just asking for a vaccination:
When I was a kid, doctors who gave vaccinations would hand out candy or a small toy to take the sting and fear out of the shot. A similar idea could save the U.S. economy if one or more COVID vaccines are FDA approved and widely available for mass consumption.
Infectious disease experts like Minnesota's Michael Osterholm tell us that "herd immunity" – or the point at which the virus spreads like wildfire – is reached when at least 60 percent of the population is immune. A really effective vaccine … will avoid the tragedy of the more than one million deaths it may otherwise take the country to achieve herd immunity.
Provided enough people are taking the vaccine when they can. Since no vaccine will be perfectly effective – Dr. Fauci has said he could live with a vaccine that was 75 percent effective, which might be optimistic – it means at least 80 percent of the US population (60 percent divided by 75 percent) will need to be vaccinated if to suppress the virus to such an extent that enough people feel safe to patronize service businesses and travel so that the country and economy can return to normal appearances.
But now that everything about the virus – its severity and the wearing of masks in public, to name just two examples – has apparently been deeply politicized, is there hope of reaching that 80 percent threshold?
Not according to a poll published Aug. 14 by NPR / PBS / Marist that reported that more than a third – 35 percent more precisely – of Americans are not taking the vaccine when it is available, which means the general public A higher percentage would be only 65 percent, or well below the 80 percent target. Admission rates are predictably different depending on the party. 71 percent of Democrats say they will fire the shot, up from 48 percent of Republicans.
In principle, a President Biden could take executive action or enact laws – provided the Democrats control both the House and Senate and the filibuster rule is abandoned – and punish those who fail to shoot (for example, by requiring vaccination certificates before going in reach the public) spaces). Imposing penalties on those who did not take the vaccine at the beginning of his presidency – even if the penalties were both effective and constitutional, which is by no means clear – would exacerbate polarization, possibly cause violence and prevent any healing in the country, the Biden has promised to initiate….
Fortunately, the "adult" version of the doctor handing out candy to kids suggests a solution: pay people to get the shot (or shots as more than one may be required).
How much? I don't know of any hard science that can answer this question, but my strong guess is that less than $ 1,000 per person is not enough. At this level, a family of four would be paid $ 4,000 (ideally not subject to income tax) – a lot of money for many families in these troubled times, enough to ensure the country crosses the 80 percent immunization threshold.
As Litan explains, even if we end up "paying too much" to get people to take the vaccine, it would still be a massive money saving online. Every day without herd immunity is a day when many human lives are lost and the economy continues to stagnate – which costs us far more than vaccination payments.
I agree with most of Litan's analysis and would like to add a few points.
First, the poll he cites is far from the only one that suggests that many Americans will refuse to take a Covid vaccine. Other surveys paint a similar picture (see e.g. here and here). It is possible that once a vaccine is actually available, such attitudes could wane, and taking that vaccine promises to return to normal life. Vaccination can also be funded by companies that require employers and / or customers to provide vaccination certificates. However, it is difficult to say whether any of these will occur quickly enough or on a sufficient scale. Even a few weeks or months delay in achieving vaccine-induced herd immunity is likely to be extremely costly.
Second, many will be tempted to reject the idea of paying people to vaccinate because vaccination is a moral duty that we must do in order to protect others from the disease. We have a mandatory vaccination against other infectious diseases. Why not this one?
Basically I agree. Compulsory vaccination against deadly infectious diseases can even be justified on libertarian grounds to overcome the strong presumption against coercion. Libertarian political philosopher Jason Brennan has a good explanation for why.
But what is justified in principle is not always the right approach in practice. Forcing tens of millions of people not to get vaccinated is probably a big and painful undertaking. It is far from clear that either the federal government or the federal states are up to the task. Most of the mandatory vaccinations are currently imposed on children. Parents can be encouraged relatively easily to threaten them that their children will otherwise be excluded from schools. Getting vaccinated approximately 300 million (mostly adult) Americans is far more difficult.
Additionally, using law enforcement to coerce so many people can lead to serious abuse. If you (correctly) believe that the police are too often using excessive force, racial profiling, and otherwise abusing their authority, imagine how often these things would happen if millions of people were forced to take a vaccine.
It should be emphasized that African Americans – the group with the worst relations with the police – are also disproportionately suspicious of vaccines. If compulsory vaccination leads to high-profile cases of violence between police and black populations, it could at the same time damage racial relations and undermine the vaccination campaign.
If you think federal law enforcement officers can fill the void with local and state police, it is worth remembering that there is nowhere near enough of the former to get the job done. There are only about 100,000 federal law enforcement officers in the United States (compared to about 700,000 state and local law enforcement agencies), and most of them cannot easily become full-time vaccination officers. Many of the federal law enforcement agencies that we have are known for their brutality and disdain for due process and the kind of abuses we saw recently while on duty in Portland. A government-enforced vaccination mandate could result in such events occurring on a large scale. Paying people to take the vaccine is likely to be more effective, humane, and less dangerous than coercion.
Financial incentives are unlikely to convince die-hard anti-Vaxxers or people with strong religious objections to vaccinations. But these groups are likely only a tiny fraction of the population. The goal should be to win over the much larger group of people on the fence, or just to avoid the hassle and discomfort of vaccination.
I have some reservations about Litan's analysis. First, he realizes, we don't have a good way of estimating the right amount of payment to motivate a sufficient number of people to take the vaccine. However, I tend to agree that $ 1000 per person should be enough, maybe even more than enough. To the extent that Litan notes, the incentive for the poor is stronger, it is a characteristic, not a fault. Poor people are more likely to become infected than relatively wealthy people for a number of reasons.
Finally, I am skeptical of Litan's idea that the government should only pay a small percentage of the money up front and put off the rest until enough people have been vaccinated to achieve herd immunity. This could lead many people to withhold vaccination until it is clear that enough others have done that herd immunity is likely to be achieved. To encourage the fastest and most widespread adoption, it is better to prepay all or most of the money once the person in question is vaccinated.
There are likely aspects of this idea that need to be considered in more detail, including the angles that Litan and I may have overlooked. I hope that experts in various relevant areas will begin to deal with these questions. The sooner the better.
UPDATE: It should be emphasized that this is not the only way to use financial incentives to speed up the vaccination process. In this post, I explained why it would also be right and fair to pay volunteers to participate in "challenge studies" in order to expedite vaccine development.
UPDATE 2: I've made a couple of small additions to this post.