Should governments use cash incentives to nudge people to get vaccinated?

By Aysu Bicer

ANKARA (AA) – In the healthcare sector, money incentives to steer the public into making better choices have grown more and more popular. Insurers and companies have been dishing out dollars to nudge people to take their meds, give up bad habits, and hit the gym.

But if such incentives are championed in normal times, might the same strategy be sound for promoting the use of vaccines against coronavirus, the largest healthcare crisis of the modern era?

For some time now, a majority of US companies have offered financial incentives to employees who take part in programs beneficial to their health, or alternately penalize those who indulge in health-damaging habits.

In 2009 General Electric, which provides health insurance for its employees, began offering incentives to some of its employees who quit smoking for a year. The company found the results so promising that it expanded the program for all its workers in the US.

In a similar initiative in England, schizophrenic patients who came in for their monthly dose of anti-psychotic medications got £15 ($21) in the pocket.

Cash incentives have also been used for such varied causes as persuading young women to avoid cervical cancer and convincing young men to get themselves tested for syphilis.

- Paying people for the jab

At this point, a number of questions may help us explore the idea of paying people to get vaccinations:

Is it cost-effective to pay people for COVID-19 inoculation?

Is such a policy viable in the context of coronavirus misinformation and distrust of public health authorities?

What does behavioral science say about offering such incentives?

In his 2012 book What Money Can't Buy, Harvard law professor and philosopher Michael Sandel stressed that two questions can be asked about paying people to make healthy choices: Is the incentive program working? And, is it objectionable?

From an economic point of view, he explained, the defense of paying people for a healthy life can be a simple economic cost-benefit analysis.

Why should such incentives be found objectionable if money helps protect people from, for example, a dire pandemic and thus reduces the need for much more expensive healthcare spending later? The saying “A stitch in time saves nine” seems to present a compelling argument.

But amid the worldwide drive to encourage vaccination for COVID-19, some academics warn that governments paying people to get the shots in fact could have unexpected downsides.

For though the need to avoid getting potentially deadly diseases might seem motivation enough for vaccination, the massive misinformation and conspiracy theories in the age of viral memes and social media present new challenges.

Thus, vaccine skepticism is one of the main concerns that governments are being forced to tackle in order to deal with a serious health threat.

- Cash incentives ‘unwise’

"It is potentially unwise even for wealthy countries to offer payment in exchange for vaccination," Cynthia Cryder, a professor of marketing at Washington University in the US state of Missouri, told Anadolu Agency.

And for countries with fewer resources, the idea seems even less likely to be a good one, she underlined.

According to Cryder, when people are offered payment in exchange for a behavior, they often infer that the behavior must be less desirable in some way than if they were not offered payment.

In this case, she said, the unfortunate inference could be that the vaccine carries risks that make payment necessary for the public to accept it.

This could help fuel skepticism and conspiracy theories about the safety of vaccines – precisely the opposite of the attitude needed to encourage vaccination.

"It's way logical for governments to opt for a public health campaign rather than using cash incentives," said Cevat Giray Aksoy, an economics professor at King's College London.

Offering cash incentives would attract thousands of people seeking to cheat the system, he warned, adding that governments could instead use such funds for furloughs, childcare support, educational support, or public awareness campaigns.

"It sounds ridiculous to me to give money to people so that they could be persuaded regarding the vaccines," he said.

-‘The price we pay’

On the other hand, some economists, like Robert Litan of the US’ Brookings Institution, defend the idea of a COVID-19 vaccine payment as a “nudge” for encouraging good behavior.

He proposed a payment of $1,000 per person so vaccine-skeptics get the needed shots, arguing that governments should be ready to open wide the public coffers to achieve this goal.

"We just have a lot of people in this country who either don't trust the government or they don't trust vaccines or whatever. I view the payment for a vaccine as the price we pay for having a divided country," he told NPR, the US’ National Public Radio.

Oxford philosopher Julian Savulescu made similar claims in a piece for the Journal of Medical Ethics, saying offering monetary incentives for vaccination works better than punishments for failure to obey vaccine mandates.

While encouraging a hesitant public with money is backed by some experts, the benefits of this nudge policy must be weighed against the ammunition such a policy might give the conspiratorially minded.

Obviously, there are heavy economic and societal costs to people refusing vaccination, and falling short of herd immunity endangers the community at large.

Yet it seems the benefits of paying people to get the jab during the pandemic may be a self-defeating initiative.

Given the enormous quantity of misinformation circulating via social media – a virtual tidal wave of false reports about the coronavirus – a monetary reward would unwittingly reinforce conspiracy theories, discouraging trust in the vaccines just when it is needed most.