Incentives a game-changer in vaccine uptake
In many countries, Covid vaccination has been viewed as a race, with the finishing line being double vaccination of a high proportion of the population. Unfortunately, those countries who were initially successful face the challenge of a runner that has reached what they thought was the finishing line being told to run on, as more vaccinations are needed.
In Africa, where just 9% of the continent’s total population is fully vaccinated, the race has yet to start.
In response to the emergence of Omicron, many countries are now offering “booster” vaccinations. It is uncertain whether additional Covid vaccinations will be needed in future, but governments should be prepared for a situation where ongoing vaccination cycles are required to suppress Covid.
Alongside the development of vaccines that are effective against emerging variants, a major challenge will be getting people regularly vaccinated. Flu vaccination provides a guide to the possible scale of this challenge. Take the US, where the Centres for Disease Control and Prevention recommends almost universal flu vaccination every season, yet only half the population follow these guidelines.
Many governments have dabbled with incentives such as cash, shopping vouchers and lotteries to increase vaccination uptake, but largely as one-off initiatives. A key component of an effective longterm Covid vaccination strategy is likely to involve vaccine incentive, in the form of either carrots or sticks.
An economic rationale for carrot-type incentives is that vaccination is a way of rewarding the societal benefit it generates. Another approach is to penalise those who are unvaccinated using stickbased incentives, such as mandatory vaccination or requiring the unvaccinated to pay an additional “health tax”, as has recently been proposed in Quebec, Canada.
Cash incentives could have an important role in increasing vaccine uptake in low- and middle-income countries, such as most of sub-saharan Africa. Beyond altruism, the global societal benefits of high vaccine uptake in Africa are great.
Omicron has shown that new, more transmissible variants can quickly have a global impact. As a recent expert group commissioned by the UK government concluded, increased global vaccination has the potential to reduce the emergence and establishment of variants, globally.
While there is a strong rationale for using incentives as part of the global vaccine rollout, we need more evidence to better predict what effect they will have.
Importantly, evidence on the effectiveness of different incentives for Covid vaccination has been mixed. For example, a recent Swedish experimental study showed that even a modest monetary incentive of $24 (R374) could raise Covid vaccination rates, but various evaluations of vaccine US lotteries have drawn opposite conclusions about their effectiveness.
To find out what might work in Africa, we are collaborating with researchers from the University of Ghana on a field experiment. This will evaluate whether a $3 or $10 incentive payment can boost vaccination uptake.
If effective, how could such payments be financed? Dr Rabah Arezki, a former chief economist of the African Development Bank, has estimated that a system of effective cash payment across Africa would add about $9-billion to an estimated $15-billion cost for providing and administering Covid vaccines in Africa.
Such sums would need to be financed by the international community.
Rather than relying on voluntary donations from wealthy countries, the world needs a new type of tax that could be used to combat Covid and prevent future pandemics.
There are strong economic arguments for a tax on international airline travel.
Global population mixing, which even at the height of the pandemic amounted to about 5-million international passenger movements a day, is what makes pandemics so hard to control.
Incentives, funded by an airline tax of a few dollars a ticket, could help us edge towards the elusive finishing line.