Want to end the pandemic? Pay people to get vaccinated

When I received my first dose of Pfizer’s COVID-19 vaccine last December, nobody paid me to roll up my sleeve. Yet, as vaccination efforts approach an expected tipping point, at which the amount of available vaccine exceeds the number of willing recipients, with the rate of vaccination far below the threshold required for herd immunity, paying people to take their shots likely offers our society’s best chance at stemming the pandemic.

Private employers — including American Airlines, Marriott and Dollar General, have already taken the lead in this regard — but payouts are generally low: an extra day off or a few hours pay. The sooner the government starts offering larger cash incentives to the public the safer all of us will be; former Maryland Congressman John Delaney has proposed $1,500.

Financial incentives have been shown to be highly effective in persuading patients to obtain a wide range of medical services, from complying with treatments for tuberculosis and hypertension to attending weight loss programs and showing up for post-partum medical appointments.

Programs that spend taxpayer dollars paying people to act in their own best interest may strike some as unfair. Yet in a medical system where we pay for each other’s poor health choices indirectly in the long run, either through Medicare, Medicaid or elevated private insurance rates, paying people to stay well today can spare society costs in the future. Incentivizing smokers to attend tobacco cessation programs now, for instance, is likely far cheaper than paying for their chemotherapy later.

Concerns have been raised by bioethicist Nancy Jecker and others that such payments are coercive. I agree. That is the whole point. Coercion is not inherently unethical. For example, if I park in front of a fire hydrant, the city will tow my car; if I do not show up for work, my employer will stop sending me a paycheck.

Coercion becomes problematic only when it infringes upon some vital liberty or imposes unfair risks on some groups more than others. Paying people to act in ways that will save their lives, and protect their neighbors, does neither.