Should We Pay People to Take the COVID-19 Vaccine?

Letting money do the talking is one way to increase COVID-19 vaccine uptake and perhaps alleviate some concern about perceived risks, especially in a climate of vaccine hesitancy, a researcher argued.

Acknowledging it may be difficult to get people to take a COVID-19 vaccine for the common good, they should be compensated for providing a public service, as well as for any perceived risk they may be taking, wrote Julian Savulescu, PhD, of Oxford Uehiro Centre for Practical Ethics, University of Oxford in England, in the Journal of Medical Ethics.

While money payments may not influence diehard "anti-vaxxers," they could make a difference for the 60% of Americans who expressed more of a general uncertainty about vaccination in a recent survey, he noted.

"The advantage of payment for risk is that people are choosing voluntarily to take it on," Savulescu wrote. "As long as we are accurate in conveying the limitations in our confidence about the risks and benefits of a vaccine, then it is up to individuals to judge whether they are worth payment."

Savulescu offered this as a "Plan B" to mandatory vaccination, which he said should only be used in specific circumstances: when there is a grave threat to public health, the vaccine is safe and effective, the pros outweigh the cons of any suitable alternative, and the level of coercion is appropriate.

Peter Hotez, MD, PhD, of Baylor College of Medicine in Houston, observed that for the next few months, producing vaccines for the American population will be problematic, so it won't be an issue in this country for a while.

"Even as the first vaccines become more widely available they may be only partially protective to reduce severity of illness and won't stop transmission anyway so we won't need to pay people for that purpose," he told MedPage Today. "So I don't foresee a reason to pay anyone to get vaccinated against COVID-19."

Savulescu hypothesized about a different scenario, where a vaccine capable of blocking transmission was widely available for the general population. In that case, as young people drive transmission, he said they could be incentivized to take the vaccine because they are at low risk of disease. Older adults may have more to gain from the vaccine, but perhaps they should be compensated for "not using limited health resources." Parents might also be incentivized to get their children to take a COVID-19 vaccine, but only if safety was proven within that population, he said.

And instead of money, the compensation could be "payment in kind," perhaps such as "greater freedom to travel" in the form of so-called "immunity passports," Savulescu said. For example, people could carry a "vaccination certificate" where they would no longer have to wear masks or practice social distancing in public.

"Relaxing this requirement for those who have been vaccinated (or have otherwise immunity) would be an attractive benefit. Moreover, it would help ameliorate the risks the unvaccinated would pose to others," he wrote.

Savulescu also argued for "payment in kind" over actually paying people to take the COVID-19 vaccine because it does not "send the signal that the vaccine is perceived to be unsafe," and a cash payment might introduce "unwarranted suspicion."

But ultimately, were this type of vaccine to be developed, he proposed incentivizing people to take it as a far more ethical alternative compared to mandatory vaccination.

"It is better that people voluntarily choose on the basis of reasons to act well, rather than being forced to do so," Savulescu wrote. "Structuring the rewards and punishments in a just and fair way is one way of giving people reasons for action."

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