Why Paying People To Get the Coronavirus Vaccine Won’t Work

Yves here. The very fact that this piece on getting the dogs to eat the vaccine dogfood is the lead story at The Conversation indicates the officialdom recognizes it has a problem. It’s apparently not lost on the authors that recent poll findings that 60% say they are likely to get the vaccine is the current upper bound of what will happen. It’s well known in consumer research that simply asking if someone will buy XYZ product produces inflated purchase estimates. Respondents have a bias to want to please the questioner, and they assume they want to hear approval. Here, there could be an additional influence of saying you’ll get the vaccine when you might be ambivalent, of not wanting to appear anti-vaccine or anti-science.

Remember also that getting a vaccine is not free, even if there is no charge: you have to take the time to go and actually get the shots. For parents with jobs and childcare duties, finding schedule slack is hard.

Admittedly, the point of the vaccine cheerleading is to increase that 60% figure, but it’s not clear how many of that 40% are open to changing their views in the near term.

If someone were clever, the payment could be made part of Covid relief: “You’d get your $1200 when you get your Covid shot.” And if pressed as to why: “We need you to do this so we don’t have to keep fighting in Congress over bailout bills that may not get done.” The $1200 payments were already means-tested, so there would be no inducements to the well off. But this approach would be operationally complex and the US isn’t very good at that.

Diehard neoliberals would come to the same conclusion as the authors via a different chain of reasoning. The problem isn’t paying people per se, since neoliberals think every problem can be solved by price, but that many people would need a very very high price to take what they see as unproven and therefore risky treatments. So paying a high enough price to everyone to adequately compensate the skeptics would lead to unaffordably high costs, and there’s no ready way to price discriminate yet get enough overall uptake.

By Ana Santos Rutschman, Assistant Professor of Law, Saint Louis University and Robert Gatter, Professor of Law, Saint Louis University. Originally published at The Conversation

The first COVID-19 vaccine to gain emergency use authorizationin the U.S. could roll out within days, as Pfizer and BioNTech’s candidate was endorsed by an external advisory panel to the Food and Drug Administration on Dec. 10. Two days earlier, an internal FDA panel endorsed the vaccine. These were the last required steps before the FDA authorizes the vaccine, which will soon be administered to health care workers across the country.

But while health care workers, who will be first to receive the vaccine, appear eager to get the shot, others are not so convinced. In fact, recent studies indicate that many Americans do not plan to get a COVID-19 vaccine, even if one is available at no cost.

If levels of vaccination are not robust, it will take longer to reach herd immunity, or widespread protection within a population. In response to these concerns, several people have suggested that the government should provide a monetary incentive to COVID-19 vaccination.

We are health law professors and, in our view, it is important to understand how these monetary incentives work as COVID-19 vaccines become available, why payment for vaccination may exacerbate vaccine mistrust, and how this incentive fits into the broader history of monetary incentives in public health.

The Idea Behind Monetary Awards for COVID-19 Vaccination

In summer and early fall of 2020, several surveys indicated that the number of Americans planning to get vaccinated against COVID-19 was lower than desirable. Experts estimate that achieving herd immunity require anywhere from 67% to 85% of Americans to be vaccinated. A recent survey by the Pew Research Center showed that only 60% of American were considering getting a COVID-19 vaccine.

If vaccination rates are indeed low once vaccines become available on a large scale, it will take the U.S. longer to curb the pandemic. Moreover, many Americans expressing COVID-19 vaccine mistrust are part of are members of racial minorities, which are precisely among the groups hit the hardest by the pandemic.

The idea of monetary incentives seems straightforward: Pay people to get vaccinated. One of the earliest proponents, economist Robert Litan, called the idea an “adult version of the doctor handing out candy to children.”

Litan suggested that the government should pay US$1,000 to each person who receives a COVID-19 vaccine. He admitted in his proposal that he had not relied on any studies or data to get to this number, explaining that the proposed payment amount was a “hunch.”

His idea has since been endorsed by prominent commentators. These include economist Gregory Mankiw and politician John Delaney, who suggested that the incentive should be increased to $1,500.

When Money Works and When It Doesn’t

Paying incentives to people who take on health risks to help others is not new. The most common example is clinical trials. Participants in these trials often receive set payments typically ranging from $25 to $1,000, to cover the costs of participation and perhaps to compensate for participants’ time.

Researchers don’t intend for these payments to induce subjects to take risks they would otherwise refuse. But there is a concern that, if clinical researchers pay potential subjects for risk-taking, their clinical trials will prey on poorer people for whom the payment would make the most difference. The law withholds authorization for clinical trials where there is reason to suspect that large payments were inducing people to take risks against their better judgment.

While a number of studies demonstrate that nominal payments rarely cause a person to consent to clinical research the person believes is risky, data show that payments as high as $1,000 cause potential participants to perceive the proposed research as highly risky. Those individuals seek out risk information and review it more closely than others who were offered significantly smaller payments.

Monetary compensation is also available in other cases. For instance, payments for the donation of plasma currently ranges from $30 to $60. Compensation for the donation of gametes is also possible, with $35-$125 being the range for sperm donations, and $5,000-$10,000 the range for egg donations.

There are also cases in which it’s been effective to nudge people to stop unhealthy behaviors. Studies have shown that paying people to stop smoking can be a powerful incentive. These studies offered smokers rewards that ranged from $45 to $700. People who received a reward were less likely to restart smoking, even after the monetary incentive ended.

Conversely, the Uniform Anatomical Gift Act expressly prohibits payment for organ donations. Here, the concern is that allowing payments would undermine the altruism underlying the current system such that nobody would give their organs for free if there is a market for them. And where there is a market, it will exploit the poorest among us, who are the most vulnerable.

In countries that do not prohibit payment for human organs, there is anecdotal evidence of unscrupulous brokers and health care providers who profit from the desperation of wealthy recipients at the expense of impoverished and vulnerable donors.

Why Money for COVID-19 Vaccination Is Different

In the medical context, monetary incentives are typically not available when participants take a health risk that nonetheless provides them with some likely personal benefit. Instead, payment is more likely for people who agree to participate in clinical trials where the participants are unlikely to benefit medically from their participation. This also applies to payments for donations of plasma and gametes given that donors do not benefit medically from their participation.

[Get our best science, health and technology stories. Sign up for The Conversation’s science newsletter.]

A massive payment plan designed to promote COVID-19 vaccination would be very different from current monetary incentives. In addition to its novelty, our concern is that such a scheme would have unintended consequences.

First, we have no actual behavioral studies in this area – as opposed to the case of smoking cessation rewards. Similarly, as the proponents of vaccination rewards admit, there is no data on how to set the appropriate reward.

Second, the proposal might backfire. People who already do not trust vaccines may consider the mere availability of payment as confirmation that vaccination is especially risky or undesirable. And people or organizations interested in promoting disinformation about vaccines may portray payment originating from the government as “proof” of deep-state or hidden agendas associated with vaccination. If people perceive the monetary incentive in this way, that could contribute to increased vaccine hesitancy – precisely the opposite of what it is intended to do.

Third, we worry about the socioeconomic underpinnings of this proposal. An amount close to $1,000 is supposed to prompt a person to change attitudes toward vaccination. In practice, this means that richer individuals, who might not be moved by $1,000, can just ignore the reward. Poorer people, however, are expected to change their behaviors in exchange for money. This is a paternalistic approach that does not help build trust in the government and public health authorities among poorer communities.

For these reasons, we urge caution to regulators and legislators in this area. We all want the pandemic to come to an end as soon as possible. But we need to get the incentives right, which entails relying on data, and not just on unstudied theories.

Print Friendly, PDF & Email


  1. cocomaan

    Add in another factor that I didn’t see in the article:

    If the vaccine lasts only a certain amount of time, and for the sake of argument needs to be boosted annually, are people going to go out and get a second round of doses if they only got an incentive the first time?

    I have seen no indication that any vaccine is a “one and done”. They all have a half life.

    What about an incentive for going and getting the second dose, since most of these are two dose vaccines IIRC?

    1. Jen

      Another factor the don’t mention, which, to me, seems it should be screamed from the roof-tops is that we don’t know if either of these vaccines prevents transmission. Preventing transmission does seem rather significant in terms of returning to normal, no? I mean, it’s awesome, if true, that people won’t get sick but how does this whole “herd immunity” thing work if people don’t get sick, but can still transmit the disease? Especially if the vaccine is neither universally available nor accepted.

      What happens to public trust if people assume the vaccine will stop transmission, when it may, in fact, not do so?

      Side note: I was on a call yesterday with a few admin types a deanlet who is also a primary care physician. One admin type ventured the opinion that with a vaccine coming we should probably anticipate a lot more travel in late 21/early 22. PCP was dead silent but the grimace on his face spoke louder than words.

  2. zagonostra

    Another reason it won’t work is because you have a whole section of the population which categorically mistrusts the government and its intentions. Just look at below quote from Louis Farrakan. He is not alone, you can find similar views expressed on sites such as Alex Jones and David Ickes, which most people discount but which nevertheless have millions of die-hard followers.

    Whether this is dis-information or not is not the point, paying people to take the vaccine would in many instances, as is suggested in the article, backfire: People who already do not trust vaccines may consider the mere availability of payment as confirmation that vaccination is especially risky or undesirable


    We will not accept your vaccine so you can slow down, because whenever you bring it out, it’s for your people. You give it to them because we are not accepting death. You are the very representative of death itself: the pale horse. Everywhere you have gone in the world, hell went right behind you. We are sick of hell and we are sick of death. So all of you that have made a covenant with death, your covenant is going to be annulled … your agreement with hell will be broken.”—The Honorable Minister Louis Farrakhan


    1. Louis Fyne

      You’ve got Alex Jones and one of the Kennedys (forget which one—Robert Jr?) on the same side.

      government distrust is trans-partisan, trans-race/ethnicity, trans-class and ebbs and flows with who is in the White House.

    2. Lemmy Caution

      It’s not just distrust of government. It’s also distrust of big pharma, especially when they’ve got a big, fat liability exemption on their fast-tracked Covid-19 vaccinations.

  3. Lee

    NPR and PBS are pretty much all idpol all of the time and in their wokeness, regularly feature pundits who point out how the virus is hitting black and brown communities hardest, often in the same breath making references to such travesties as the Tuskegee experiment, but then end up encouraging minorities to get the jab. Putting aside the issue of cognitive whiplash, one must pose the question: What could possibly go wrong? While being neither black nor brown myself, it seems to me that from a non-white perspective, “You first, Whitey”, makes a lot of sense.

  4. TBellT

    Heard about this thread from one of the chapos and it made me laugh. But it’s so crazy it might work. Make one vaccine for Biden voters and another for Trump voters. For us in the independent middle maybe we get whatever comes after pfizer/moderna.

  5. BlakeFelix

    I must say that it seems to me that the PMC certainly seems to find their moral compass suddenly when it comes to paying people money. The US these days worrying about poor people risking their health for money is like the Nazis worrying about anti-semitism. That’s your brand, guys. Have they started doing their own cleaning and child care because their employees are taking risks for money? Hell, plenty of doctors are getting paid taking risks, I wonder how many of them are refusing to cash their checks…
    I don’t know how good a policy paying people to take half-tested vaccines is, but that giving poor people money to do stuff they otherwise wouldn’t is immoral is bananas. It CAN be immoral, certainly, but it’s the basis of how stuff gets done, we can’t ALL be PMC getting paid to argue about nonsense all day. The allergies to giving poor people money drives me nuts. Of course giving money to the rich is fine, because they don’t need it…

    1. anon y'mouse

      more ethics training is needed.

      it is wrong to try to induce someone to do something which may not be good for them, in any way. pure force is not the only way that kind of action becomes “wrong”.

      when talking about deliberately invading people’s bodies, the bar is higher and not lower.

      just because people are being forced, and forcing themselves to work in risky situations to “make money” doesn’t make that right either. it makes it a pragmatic matter of survival and tradeoffs.

      since they are offering people money to invade their bodies with things of unknown effect, that suggests that they could also have done so to prevent them from being forced to take risks with their health with regard to working in risky environments.

      so, the only option we have in this society, if not independently wealthy, is to take risks for health in order to get money to survive, and that is what “they” want us to be forced into from the top down. that doesn’t mean that this option is ethical. it is what it is–a forced decision is not a free one, no matter what you offer as an inducement.

      1. BlakeFelix

        Well, ya, but perfect safety is impossible, as my grandfather said, “If the Sioux don’t get you the Apache will.”. It’s unethical in my opinion to be careless with the lives of others, but with a vaccine it’s a complicated trade off (with a LOT of unknowns for COVID at this point). Is it careless to vaccinate, is it more careless NOT to vaccinate? How much choice should be left to the individual? All valid questions in my opinion, and it’s the kind of thing that experts should have at least decent answers for, but they appear to be approving things under obvious duress. I’m just trying to say that total safety is impossible, recklessness is unethical, but as long as we don’t live in some star trek utopia paying people to do stuff is good, not bad, and generally the poorer they are the better it is to give them money. And I think that if society wants to additionally motivate vaccine uptake to reach herd immunity, I’d rather see payments than fines or leper colonies or denial of insurance or whatever.

    2. Tom Doak

      Yes, when I first saw the title of this article, I missed the word “vaccine” and thought it was an ironic way of saying that our plan so far has been forcing poor people to work and catch thr virus to achieve herd immunity while the 10% stayed in and avoided it.

  6. flora

    an aside: we in the enlighten west look upon superstitious practices, such as reading tea leaves or chicken entrails to foretell the future, with a sense of superior bemusement. How could they have believed something like that foretold the future?

    The problem isn’t paying people per se, since neoliberals think every problem can be solved by price,

    We have our modern scientific-y equivalent of reading tea leaves: market signals, market signals foretelling the future of… everything. /s

  7. Mikel

    What are people going to be doing in beween the time of the first and second shot? (Insert clownface emjoi)

    Then it’s stiill just theoretical “immunity” until next year when they ask people to do the same shots. (Insert clownface emjoi)

  8. Mikel

    “In fact, recent studies indicate that many Americans do not plan to get a COVID-19 vaccine, even if one is available at no cost.”

    Hard to convince people Pharma, doctors, and the FDA have your best interest at heart after the Opiod fiasco (just to name one major example).

    1. Mikel

      And this:
      Third, we worry about the socioeconomic underpinnings of this proposal. An amount close to $1,000 is supposed to prompt a person to change attitudes toward vaccination. In practice, this means that richer individuals, who might not be moved by $1,000, can just ignore the reward. Poorer people, however, are expected to change their behaviors in exchange for money. This is a paternalistic approach that does not help build TRUST in the government and public health authorities among poorer communities.

  9. Maritimer

    “We are health law professors….”
    You really gotta love the chutzpah of these law perfessurs. The most important piece of information, at least to me, is the fact that Pfizer, AstraZeneca and J&J are criminal organizations.

    To write an article like this about Trust and never mention the above fact, well….makes me even more distrustful. These law folks might also have mentioned the legal ideas of full disclosure and informed consent.

  10. Cuibono

    There is simply NO WAY the sort of monetary incentives will work IMO

    Now $15,000 and you might be onto something!

  11. m

    Everyone seems to believe in corporate capture of regulatory bodies, except CDC, NIH & FDA.
    Didn’t NIH bury some cancer link because they got money from the Koch bros.
    Aren’t most on the regulators part of the revolving door? Work for CDC or FDA for a bit, then go back to Big Pharm? Yes.
    I remember years ago watching a PBS show about how the FDA rubber stamped drugs like Vioxx, only to yank it after people died. That Frontline episode has disappeared, back before PBS sold their soul.

  12. AEL

    For low income earners, paying them dramatically raises the priority of that task.
    It is a two-fer. It helps people who could really use the money and it gets more people vaccinated early.

    1. Massinissa

      Assuming, of course, that the vaccine is perfectly safe.

      It quite possibly is. It’s also possibly not. Hard to tell at this point.

  13. The Rev Kev

    What, has nobody thought of the more likely outcome? If financial incentives won’t do it (and cue the “where is we going to get the money from?” cries) then there will be financial penalties used instead. If grandpa wants his social security check, then he is going to have to line up for a jab to get his “entitlement.” And if young Mary wants her unemployment check, then she can have a jab too, especially if the new laws say that you cannot work at a job dealing with the public if you have not been vaccinated. If neither of them can afford the cost of the vaccination, then their pays can be docked until they have paid back what they owe ‘society’.

    1. cnchal

      > What, has nobody thought of the more likely outcome?

      Vaccinated people will take moar risk and care less, driving the number of infected much higher. That way we can get to “herd” immunity in a hurry.

      I watch the MSM and the orgiastic pronouncements by Bill the reporter at Pfizer’s loading dock about how the miracle vaccine will save the day. Never once were the questions of how many “jabs” were going to be required to keep one “safe” from covid over a year, or how long the vaccination lasts, nor whether vaccinated people can pass it on as if they weren’t vaccinated, asked

      Then there is testing.

      Is it possible to not have covid, get tested and it is positive? Yes

      Is it possible to have covid, get tested and it is negative? Yes

      Then wait days or a week for results, with false signals one is expected to act on, being generated on a continual basis.

      Testing is still garbage and it seems no effort has been expended to improve that.

Comments are closed.