Should we pay people to get vaccinated? Well, maybe.

This past week, a major US retail company, Dollar General, announced that it would pay its employees the equivalent of four hours’ salary if they would get the Covid-19 vaccine. That’s about $40, based on the average pay at Dollar General. The idea is to give employees an additional incentive, and also to cover the time they might need to take off work to get vaccinated.

This is an excellent idea. Let me explain why.

First, though, I should point out that several prominent economists, including Harvard’s Gregory Mankiw and the Brooking Institution’s Robert Litan, have already proposed paying people to be vaccinated–but their proposal is, frankly, terrible. So let’s start with that.

Now that we have two vaccines, from Moderna and Pfizer/BioNTech, with more on the way, we can finally see an end to this awful pandemic. At the moment we have a supply problem: there aren’t enough vaccines to go around. But soon, perhaps in a few months, we’ll have plenty of vaccines. Then the problem becomes getting enough people vaccinated to create “herd immunity.”

(Aside: herd immunity has been discussed ad nauseum this year, so I won’t get into any details, but it essentially refers to the situation where so many people are immune to the virus that it doesn’t spread any more. We probably need 60% of the population to be immune (estimates vary) in order to reach herd immunity.)

A well-informed person might think this won’t be a problem: billions of people are desperate to get the vaccine right now. But the anti-vaccination movement has been spreading misinformation about Covid-19 vaccines since the beginning of the pandemic, long before we even had a vaccine. (Yes, I know it’s patently ridiculous to make claims about a non-existent vaccine, but they did, aplenty. I’m not linking to any of their claims here because I don’t want to give them the traffic.)

As a result of the relentless anti-vax propaganda campaign, a substantial portion of the population is at least “vaccine hesitant,” meaning they’re not sure if they want the vaccine. They are worried primarily about safety, even though the data is very clear that these vaccines are remarkably safe. (It’s true that a tiny number of people have had allergic reactions, but this data is public and no one’s hiding it.)

So we need to convince some people that it’s in their own best interests to get vaccinated. A small number of deeply confused anti-vaxxers, such as the people behind the mis-named NVIC, are probably unreachable. They simply won’t listen, preferring to believe their own misinformation and conspiracy theories. But for the large number of people who are merely hesitant, a positive incentive might be just the thing to convince them to get vaccinated.

Enter the economists. Robert Litan first proposed paying people to take the vaccine back in August, and Gregory Mankiw strongly endorsed the idea, writing:

“what’s the best way to achieve herd immunity? Again, simple: Once a vaccine is approved, pay people to take it.”

Such confidence! Actually it’s quite a good idea in principle. But Litan and Mankiw then went off the rails, proposing that we pay everyone $1000 each to get the shot. Litan admitted that he didn’t have any data to support this particular amount, but he called it a “strong hunch.”

That’s a $300 billion program. Neither Litan nor Mankiw was bothered by this.

There are some gigantic problems with this proposal. First, because it’s such an enormous amount, it’s extremely unlikely that it will ever happen. It’s just the kind of hypothetical, pie-in-the-sky proposal that gives academics a bad name. Because it will never happen, Litan and Mankiw will never have their idea tested in real life, and no doubt they will continue to claim it would have worked.

Second, though, is a much bigger problem, as pointed out by economists George Loewenstein and Cynthia Cryder in the New York Times, and by medical ethicists Emily Largent and Franklin Miller in JAMA. The problem is that if you offer to pay a lot of money to do something, then people conclude “this is something you would not want to do without compensation.” In other words, it’s dangerous or somehow bad.

Thus a large payment may merely heighten people’s suspicions that the government (or “Big Pharma”) is up to no good, and that’s why they have to bribe people to take their suggestions. The last thing we need right now is to increase people’s mistrust of vaccines.

In addition, paying so much money for each shot is, as Largent and Miller point out, a bad investment. Sure, $300 billion is much less than Covid-19 is costing us right now, but it’s still a huge sum, and those funds could be better spent on many other things, such as helping to support states that are still struggling to set up facilities to administer the vaccine.

Now let’s go back to the Dollar General plan. Dollar General is paying the equivalent of four hours’ worth of salary, about $40 on average, to each employee who gets vaccinated. As I said above, this is an excellent idea.

Why is this better than the $1000 per person plan from the economists? First of all, it costs far, far less than the economists’ plan, which makes it far more likely to happen. Second, Dollar General is paying people to defray the actual costs–in time–that they will incur in order to get the vaccine. So it’s not so much a bribe as it is a modest reimbursement. Third, by providing a modest payment, they provide a relatively bigger incentive to low-income groups, and they avoid paying billions of dollars to high-income people who are already highly motivated to get the vaccine.

I suggest we adopt a version of Dollar General’s plan for the entire U.S. population. Why not offer a cash payment of $20 to everyone who gets the vaccine, and pay it immediately? Obviously there would be some logistical challenges to this–we’d need security procedures to make sure the $20 payments were actually handed out and not stolen–but it would be far simpler than arranging the $1000 payments so blithely proposed by the academic economists. And it would only cost $6 billion rather than $300 billion.

A payment of $20 provides a small positive incentive, and it can be justified as paying people for the time they spend getting the shot. Because it won’t seem like a bribe, it will be much less likely to raise suspicions that the vaccine is harmful (which it isn’t, I hasten to add).

So Litan and Mankiw were sort of right: paying people might encourage more people to get vaccinated. But they’re wildly wrong about the size of the payment, which other economists and bioethicists have pointed out would likely create distrust. Dollar General is getting it right: let’s offer everyone a small cash payment if they’ll take the time to get the vaccine. It might just work.

A meditation on the year to come

A mountain in the Eiger valley, Switzerland.

So we've just experienced one of the hardest years in the past 50. The world is still reeling, but we have reasons to hope that our lives on this planet will get better–much, much better–in 2021. Entering the new year, I'm offering this brief meditation (a technique that I would have dismissed in years past, but that I've discovered during the pandemic) with my hopes for better times ahead. Vaccines will soon free us, at long last, from the prison of social distancing that the virus has imposed on the entire population. Emerging from our months of isolation, what will we do first? Next?

Let's imagine, as we meditate, that we will travel, as many of us desperately long to do. On a train, or a plane, or just in a car, finally going somewhere far away with a close companion, with no masks required. Viewing the sights, taking photos, eating at a crowded restaurant, or just walking through a shopping district filled with people. Enjoying the freedom that we took for granted for our whole lives, until the pandemic shut everything down in March of 2020. Sipping an Aperol spritz on a terrace with a scenic mountain view.

Everything we've lost will return again. Let's imagine, closing our eyes for a few moments, what we'll do once we get beyond these last months of the pandemic, once we are free again. Anything is possible, and the future will be better.

Closing the barn door after the virus has escaped

When will we learn? For the past two or three weeks, the world has been fretting over a new Covid-19 virus variant, one that UK Prime Minister Boris Johnson announced was significantly more transmissible than other variants.

Johnson’s announcement has led multiple other countries, including the U.S. and France, to temporarily ban travel from the UK. As scientists began testing for the new variant, at least 3 states in the US–California, Colorado, and Florida–have already reported that they are detecting the new variant too. Expect many more states (and other countries) to report finding the variant in the coming days.

In the UK, the new variant was first detected in September, and by November one-fourth of the cases in London were caused by this variant. That does seem worrisome.

My first reaction upon hearing of this new variant was to ask whether it really is more transmissible or not. The evidence is very preliminary, and it’s still not peer-reviewed, but a very new study from a week ago says that yes, the new variant is 56% more transmissible.

Okay then, that’s not great. But there’s no evidence that the new variant (known variously as B117 or VOC 202012/01) is more deadly, or that the vaccine won’t work against it. It just spreads faster.

My second reaction was about these new travel bans. Why would anyone think that the variant was only in the UK, merely because the UK was open about reporting it? Unless we really know that to be a fact, travel bans are a classic case, as the adage goes, of closing the barn door after the horse (the virus) has escaped.

So has the B117 virus has already spread well beyond the UK? Yes, it appears so.

In a new study released just two days ago on medRxiv, scientists at Helix, a company that has tested millions of samples for the presence of the SARS-CoV-2 virus, looked back at their testing data over the past several months. They found that evidence of the B117 virus in the US extends back at least to October. They also found that the variant is now spreading in the eastern US, in Massachusetts, Ohio, and Florida.

An important caveat is that Helix’s tests weren’t specifically looking for the B117 strain. They instead looked at two key deletions in the spike protein (which I’ve discussed before) that the B117 strain contains, and that their tests can also detect. It might be that they found slightly different strains that shared these deletions, but even if the strains they detected weren’t identical to B117, it’s possible they were equally infectious.

So yes, the new strain seems to be in the US already, and it seems that it’s been here since October. And if it’s been in the UK since September, and the US since October, well then it’s a darned good bet that it’s pretty much everywhere. Banning travel from the UK not only punishes the UK for openly sharing its findings, but it also may prevent other countries from sharing information about newer strains of the virus, should those emerge.

What should we do in response to the new strain? The most effective action will be to roll out vaccines even faster, something that public health authorities across the US are trying to do. So far it is not going well, in part because we have no consistent national strategy. It’s not too late to fix that.

But let’s not pretend that travel restrictions now will do anything to keep this new strain locked up. They’re just closing the barn door after the horse has escaped. Or “Vijgen na pasen” as they say in Flemish, or “arriver apr├Ęs la bataille” in French. There’s an idiom for this behavior in every language, it seems.