Fiscal vaccine incentives backfire – multiple warrants – their studies are cherrypicked and a host of literature disagrees

Nevertheless, human behavior is not always as simple as implied by traditional economic models. Violations of these models have been long reported by researchers from psychology and behavioral economics. Indeed, leading behavioral scientists have recently suggested that paying financial incentives for COVID-19 vaccinations may not only be ineffectual, but could actually backfire by reducing overall vaccine uptake. As Volpp, Loewenstein, and Buttenheim (2021) argue, ‘considerable research shows that payments in some contexts can send the signal that an action is undesirable, unpleasant, or even dangerous and not worth taking based purely on personal benefit. Financial incentives are likely to discourage vaccination (particularly among those most concerned about adverse effects)

Incentives could be ineffectual or backfire for multiple reasons. First, when people are motivated to get the vaccine for intrinsic motivations, like being a good citizen and contributing to the public good, an extrinsic motivation, like a cash payment, may ‘crowd-out’ the intrinsic motivations. The motive to be a good person may actually be stronger than the motive to earn a few bucks, and the two motives may not comfortably co-exist in a given context, like vaccination. Second, people may see the choice to accept a vaccine (putting a foreign body in their own bodies) as a ‘sacred value’ that is unaffected by monetary incentives. This concern relates to a broader problem of ‘commodification’, and whether everything can and should be priced.

Third, and perhaps most importantly, a payment could signal that the vaccine is extra risky, a concern which has been observed when paying human subjects to participate in research studies. If high prices on products signal high quality to consumers, then a high payment being offered to consume a product (a negative price) may signal larger-than-expected risks.

Similar debates have played out in other public health contexts, such as the effect of paying for blood donations, where ethical theorists and lab data suggested that incentives may backfire and actually reduce donation rates. Nonetheless, when rigorous field studies were eventually completed, they consistently found that large positive effects of incentives on organ donation behavior.33 The perceived risks of vaccination (and of not vaccinating) may be quite different than for blood donation or other domains where incentives have been tested.

There is no empirical research that speaks directly to the question of whether incentives for a COVID-19 vaccine would be effective, but there has been research on the effects of incentives for other vaccines. A 2014 systematic review of four studies of financial incentives for parents to promote pediatric vaccinations concluded that there was insufficient evidence to determine effectiveness. On the other hand, a 2019 review of interventions to encourage Hepatitis B vaccination among substance users included three randomized controlled trials testing monetary rewards, and concluded that they were the most effective interventions. Likewise, in a randomized field trial of human papillomavirus (HPV) vaccines in England among 17–18 year old girls, researchers found that paying the USD $73 equivalent nearly doubled the rate of uptake (22 per cent versus 12 per cent). Several field experiments in developing countries have found substantial effects as well. For example, a tetanus vaccination campaign in Nigeria randomized women to receive either the equivalent of US $0.03, or $2, or $5.33 as conditional cash payments for vaccination. The higher payments caused dramatically higher uptake (55%, 76%, and 86%, respectivel