The counterplan guarantees an income only to citizens who show proof of vaccination. Successfully induces compliance.

Widespread hesitance toward COVID-19 vaccines has the potential to create a gap between the actual vaccination rate and the rate needed to achieve herd immunity. This research investigates the extent to which coupled financial incentives (conditional cash transfers) would help bridge this gap. We find that financial incentives between $1000 and $2000 to receive the vaccine yields an 8-percentage-point increase in uptake relative to baseline. The size of the cash transfer in this range does not dramatically affect uptake rates. However, incentive responses differ dramatically by demographic group. Republicans were less responsive to financial incentives than the general population. For Black and Latino Americans especially, very large financial incentives appear to be counter-productive. We caution that, as an online survey experiment, our study has limitations. Our sample was constructed to be representative of the United States adult population on certain demographics, but excludes adults outside the United States. Even within the United States the sample may exclude some populations, such as those lacking internet access.

We measured self-reported vaccine intentions at one point in time, not actual behaviors in the future. We expect the overall willingness to take the vaccine to change over time, but the marginal effects of incentive may remain more constant. Survey responses are subject to biases, including social desirability, but the anonymous between-subject design helps. And, it is not clear that such biases would interact with and confound our manipulations. We tested a relatively large range of incentives, but further research could explore lower or higher payments, as well as explore framing effects and baseline effects. People may respond differently to receiving a conditional cash transfer (as in our experiment) or refundable tax credit for getting vaccinated versus a fine or civil penalty for not getting vaccinated, even if the economic impact is the same. Another frame is the mere compensation for the time and inconvenience of getting the vaccine (reducing hassle costs to net zero), which some employers are reportedly using. Although we examined demographic covariates, our sample was limited to explore subgroup effects. We also did not measure other attitudes or beliefs, which could moderate the observed outcomes. Our study cannot say whether the offer of payment changes beliefs about the vaccine’s safety or efficacy, for example.

Increasing vaccination rates through incentives faces implementation challenges. For example, policy designers will have to decide whether to pay those who have medical vaccine contraindications and whether to retroactively pay those who were vaccinated prior to the incentive being announced, two actions that may make the policy more politically popular but could reduce the marginal effectiveness of the incentive in changing behavior. Moreover, in the United States, the current mechanism to confirm vaccination, a paper card provided by the U.S. Centers for Disease Control, is not robust against fraud. A digital passport would be valuable for many purposes beyond financial incentives, including conditional mandates (e.g., around workplaces and airline travel). In any initiative to increase vaccination rates, it is also important that all Americans have fair access to the vaccine. Thus incentives should track intended behaviors (vaccination) rather than structural inequities (such as disparate access to the vaccine). We have not calculated the cost-effectiveness of vaccine incentives, and thus cannot say whether it would be a “prudent investment,” a point that some commentators have called into doubt.

If the U.S. government implemented the vaccine incentive as part of a broader stimulus plan, by simply making some payment that it would otherwise make (or a tax relief that it would otherwise provide) conditional on getting the vaccine, then the budgetary impact could be zero or actually negative (if some people still decline the vaccine-plus-incentive). Still, those who decline to be vaccinated could be helped in other ways, to minimize the welfare losses associated with the pandemic and to compensate for other pro-social behaviors. Our purpose is not to provide a full-throated ethical and policy defense, or even a comprehensive analysis, of incentives for COVID-19 vaccination. Yet, we can address some normative concerns that have been raised in the literature (and by reviewers). Some have argued that financial incentives for vaccination would be “paternalistic.” Dworkin defines that term as “the interference of a state or an individual with another person, against their will, and defended or motivated by a claim that the person interfered with will be better off or protected from harm.” The concept seems inapposite for vaccine incentives for at least two reasons. First, an offer of money to persons is not an “interference … against their will” – they are free to take it or leave it. Still, without waging into a semantic debate, one might call incentives a form of “asymmetric” or “soft” paternalism, depending on the giver’s motivation.52 341 Regardless of the label, incentives respect individual choices. Indeed, our data are inconsistent with the claim that incentives would “reinforce paternalism towards racial minorities and economically disadvantaged individuals.” In our data, approximately half of individuals indicated that they would exercise their will to decline the vaccine (Figure 2). Further, the primary purpose of encouraging vaccination is not to promote the welfare of the individual recipient, like say a motorcycle helmet law.

The goal is to provide a public good – population-level herd immunity. Putting the point differently, being unvaccinated is the textbook example of imposing a negative externality risk of infection on other persons. One could imagine tort law trying to internalize the costs of precaution by imposing liability, but in practice it would be infeasible for dead plaintiffs to sue, it would be hard to show specific causation, and many potential defendants are judgment-proof and uninsured for these liabilities. Thus, a prospective regulatory or incentives-based approach is more sensible. More generally, one might worry that large payments would be irresistible (an “undue influence” or “unjust inducement”) to those of limited means, making it nearly impossible for them to form autonomous choices about vaccination. This concern is also sometimes inaptly called ‘coercion’ by bioethicists. Our data does not support these concerns. If money functioned like a light attracting unthinking moths at night, then one might expect the largest money offers to induce the greatest response, and for the ultimate uptake to approach 100%. Those expectations are not supported by our data. Instead, respondents appear to be capable of weighing other factors autonomously. Moreover, this concern about money being irresistible would seem to be of greatest concern for those of lowest income, but we do not observe greater response to the incentive for this group (Figure 2). On the other hand, this lack of uptake suggests that, if implemented in the real world, the incentives may be disproportionately paid to higher-earning people who are more likely to opt for the vaccine, making the transfers regressive overall. Nonetheless, even lower-income respondents benefit from herd immunity. If they value being non-vaccinated more than the cash payment, but nonetheless enjoy the herd immunity results in their communities, then they may be best off overall. This same analysis may suggest that a vaccine mandate would be disproportionately coercive on lower-income people who have stronger preferences against vaccination. Nonetheless, in a world of scarcity with a weak social safety net, people are often called upon to make difficult choices, using their bodies to perform dangerous jobs, for example. Desperation is arguably best addressed by building a stronger safety net, rather than canceling compensation for pro-social behaviors. Ultimately, our data suggests that financial incentives should be on the table for policymakers. They can be used in conjunction with optimal distribution logistics to ensure that the vaccine reaches all the people who want it and optimal messaging to dispel misinformation and to maximize desire for the vaccine. Before incentives larger than $1500 are implemented, further research should explore whether there is in fact a non linear dose-response effect, as suggested by our data. Other approaches should be explored for Republicans altogether. In sum, a well-tailored incentive may help boost vaccination uptake to levels needed to reach herd-immunity.