Experts warn about vaccination complacency

Tom Arbron walked into a meeting last week at a Stamford church and found very few faces covered with masks.

The Norwalk resident said he “was shocked when I observed 90 percent of the attendees were not wearing masks. The room also seemed to be well above 50 percent of occupancy maximum capacity. People were seated at tables with no more than two to three feet separated.”

Experts say the vaccine rollout may be

one reason people are not wearing masks as often, washing their hands as diligently or maintaining six feet of distance, regardless if they have been vaccinated themselves.

It’s an idea called “risk compensation,” said Rick Martinello, director of infection prevention at Yale New Haven Hospital.

“If you’re doing something to decrease your risk with one action, such as getting vaccinated, it’s going to alter your behaviors that may actually increase your risk,” Martinello said.

It’s not just at that church, Arbron said. He’s been paying attention and, in recent weeks, “I’ve been noticing it more and more and more.”

Vaccines and automobile safety regulations

The concept of risk compensation comes from the world of insurance and automobile regulation. When national seat belt laws were debated, one argument was that safety laws like those requiring the use of seat belts would encourage a false sense of security, resulting in people driving faster and more recklessly.

“Basically, when people feel that risk has gone down in the environment, or when they feel that they’re responsible for less of the risk and somebody else is bearing the risk, they tend to take more risks,” said Remy Levin, a professor of economics at UConn who specializes in risk assessment.

So, when some perceive vaccinations are making the environment safer, they may feel free to take other risks. Or, as a state manages a vaccine rollout, it may be encouraged to loosen restrictions, as happened in Connecticut, or completely abandon mask mandates like in Texas.

“One thing that we know that happens when we shift that risk from individuals to companies is that we have this kind of moral hazard effect,” Levin said. “Where people are not as responsible for the risks, they’re not bearing those costs anymore, might engage in more risk-taking as a consequence.”

Chinmoy Ghosh, chair of the finance department at the UConn School of Business, says car insurance is a particularly apt analogy.

“Auto insurance also forces you to act in certain ways,” Ghosh said. “Because if you really are paying for it, then you know that if I do certain things, I may lose the insurance.”

That’s where the moral hazard issue arises.

“I should be looking at the vaccinations the same way that auto insurance is not necessarily to protect myself,” Ghosh said. “It is to protect the other driver.”

It’s harder, Ghosh said, to convince people to care about the welfare of others.

“We do care most for the person in the mirror,” Ghosh said. When we perceive the risk to ourselves to be lessened, we are more likely to engage in behavior that puts other people at risk.

“That’s why we need regulation,” Ghosh said. “[Lax] cultural environment is one of the No. 1 reasons as to why organizations fall into risky situations. There is no doubt about it, that the CEO sets the tone, just like in any organization, the university president and the country’s president sets the tone. It’s a cultural thing.”

Levin said the time frame in which the consequences of risk are experienced has an impact on how we perceive that risk. Put your hand on a hot stove and you know immediately that it was a dangerous thing to do.

“A lot of times the consequences of your actions are not immediately evident,” Levin said. “Even if we think that that’s some of that response, where younger people were taking more risks could be rational, they might not be as cognizant of either the longrun effects or the effects that their actions have on other people.”

Weighing the risks

It’s not that the vaccines don’t offer some protection. They do, and that is a primary motivation for people to make appointments and get vaccinated.

“It makes sense that people who are vaccinated would, in fact, to some degree, change their behavior and maybe take more risks because the technology is making them safer,” Levin said. “It is important to illustrate to people that the vaccine can be life-changing in the sense that it can allow you to do things that you weren’t able to do before, because they are, in fact, safer.”

What ultimately matters is the equation of risk versus reward. Think about seat belts. Does wearing a seat belt result in people driving faster? Maybe, but what matters is whether seat belts save lives.

“The issue is not really whether people take more risks, per se, it’s whether we end up with better or worse outcomes as a consequence of the vaccine,” Levin said.

“There’s always this concern that you hear expressed that if you give people a technology that makes them safer, they’re going to end up taking more risks,” Levin said. “And that effect is going to overwhelm the effect of the technology making things safer.”

The evidence, though, suggests otherwise.

“In fact, the overwhelming empirical evidence across a variety of contexts in the literature is that, generally, safety enhancing technology leads to better outcomes, even if people are engaging in some risk compensation,” Levin said.

The COVID-19 numbers are down, and there is the issue of pandemic fatigue, too.

“Whether it is because of the regulations or because people are more cautious, or whether it is because of changing weather, we will find out later on, we don’t know,” Ghosh said. “But I’m sure that some of the things that people are doing now, including vaccination, must have had some effect for the numbers coming down.”

And even if loosening COVID-19 restrictions in response to vaccinations adds increased risk, it is an incentive to be vaccinated.

“It’s not like there’s no risk, but that’s an acceptable level of risk that you can take,” Levin said. “You’re risking demotivating people on getting the vaccines, and you’re risking not giving people a realistic sense of hope, as far as what’s going to happen with the pandemic, and that can have negative effects as well.”