By Peter Coy | Bloomberg
On Nov. 5, Britain’s Journal of Medical Ethics published an article by Julian Savulescu, a University of Oxford philosophy professor, arguing that the government should pay people to get vaccinated against Covid-19.
The American economist Robert Litan, a Brookings Institution nonresident senior fellow, had the same pay-per-jab idea in August, and he put a number on it: $1,000 per person.
Is paying for vaccinations an ingenious idea that will save lives and livelihoods? Or is it an undue government intrusion into people’s lives? It’s a debate the world needs to have, and soon.
Before delving into the pros and cons, consider two related ideas: University of Chicago economist Michael Greenstone wrote an op-ed for the Washington Post in May saying people should get paid for taking tests for Covid-19. And Rob Thoburn, who calls himself a “brand samurai” on Medium.com, wrote a Nov. 1 piece saying people should be paid “CoviDollars” for remaining free of the disease. He calls CoviDollars “fiscal stimulus checks, with a twist.”
The pandemic has already cost close to 250,000 lives in the U.S. alone while devastating the economy. And although the news on vaccine trials has been promising, a vaccine is no good if people don’t take it. Several surveys have shown mounting reluctance. An Oct. 7-10 survey by STAT and the Harris Poll found that only 58% of respondents said they would get vaccinated as soon as a vaccine was available, down from 69% who said so in mid-August.
In his article, Savulescu seriously considers the option of mandatory vaccinations, arguing that they “can be ethically justified,” but concludes that paying people for jabs is superior. “It is better that people voluntarily choose on the basis of reasons to act well, rather than being forced to do so,” he writes. Which makes sense.
The concept of paying people to take care of themselves precedes Covid-19. Many companies waive or reduce health insurance premiums for employees who participate in wellness programs. (This, of course, is the equivalent of penalizing those who don’t participate, but it feels less coercive.) And there have been many experiments with paying people to stop smokingor lose weight.
So paying for jabs seems like a natural extension. When Litan of Brookings came out with his $1,000-per-vaccination proposal, it was met with enthusiasm by Harvard economist Gregory Mankiw, who wrote in a New York Timescolumn that it was “textbook economics,” which he should know, since he’s written some of the textbooks.
What are the objections? One is cost. But as Litan writes, even if 270 million Americans got paid $1,000 each, the total of $270 billion would be just a fraction of what the federal government has spent and will spend to deal with the economic fallout of the pandemic. Determined anti-vaxxers still wouldn’t get the shot, but the money might persuade enough vaccine vacillators to create “herd immunity.”
A subtler concern is that paying people for vaccines is somehow unseemly or corrupting. Michael Sandel, the rock star Harvard philosophy professor, wrote a whole book called What Money Can’t Buy: The Moral Limits of Markets, published in 2012. “Today, the logic of buying and selling no longer applies to material goods alone but increasingly governs the whole of life,” he wrote. “It is time to ask whether we want to live this way.”
The BBC’s Radio 4 broadcast a 2012 discussion that Sandel conducted at the London School of Economics, titled “Should We Bribe People to Be Healthy?” The choice of the word “bribe” rather than something more neutral such as “incentivize” or “encourage” might have prejudiced the audience against the concept. This was before the pandemic, but audience members had strong opinions about the issue of the day, paying people to lose weight. One woman, a doctor for Britain’s National Health Service, said payments would insult patients’ dignity. She said it was “unimaginable” that she would offer money to an overweight patient who came to see her. Others said that since some people are desperately short of money, offering them cash to shed pounds could be seen as a form of coercion.
OK, but Covid-19 is such a serious health problem that it seems to override some of those concerns. Here’s how Savulescu deals with the objection that money could unduly influence people:
“Because we cannot get into people’s minds, it is difficult in practice to unravel whether undue influence is occurring—how can you differentiate it from a rational decision? In practice, if it would be acceptable to be vaccinated for nothing, it is acceptable to do it for money. Concerns about undue influence are best met by implementing procedures to minimise bias and irrational decision making, such as cooling off periods, information reframing, and so on.”
Savulescu’s precautions seem like a reasonable way to get the benefits of paying for vaccinations without causing harm.