Incentives may be worth a shot

Last week, I read about how the governor of Ohio and his team conceived the idea of the “Vax-a-Million.” In The New York Times, Gov. Mike DeWine wrote about coming up with ideas for vaccine incentives, resulting in a chance for vaccinated adults to win a million dollars, and for vaccinated teens to win a full college scholarship. After announcing the Vax-a-Million, Ohio saw a significant increase in sign-ups across age groups.

The initiative has had its critics. Some have called it gimmicky while some have called it an irresponsible waste of money, though DeWine was quick to point out that the cost of the cash prizes and scholarships are easily outweighed by health care costs of the COVID-19 cases that could be prevented by the increases in vaccination. Most of the response appears to be positive, and other states have begun to sponsor similar programs to incentivize vaccine sign-ups. Others, instead of relying on lottery draws, simply offer money to those getting inoculated.

Vaccine incentive programs have been popping up across the world; the Ohio million-dollar lottery is an extreme example. This is a result of governments realizing that it may take more than education and information to spur on those who are vaccine hesitant, though not outright opposed. In general people can be supportive of, or opposed to, vaccinations; such initiatives target those groups who are in between, who may not have strong feelings about vaccinations, but could be persuaded, or who intend to get inoculated eventually but are in no hurry.

A survey project conducted by the UCLA and collaborators interviewed over 75,000 people in 10 months and recognized, among other things, two factors that can increase responders’ likelihood of getting vaccinated: cash incentives and the promise of being able to go mask-less and move more freely once vaccinated. The latter is something that we may need more data on before fully encouraging, even as the Centers for Disease Control and Prevention, and various states are beginning to relax guidelines on mask-wearing for those vaccinated. The former—incentivization—is perhaps more doable for our setting.

The Department of Health and some local government units, including Quezon City, have reportedly been considering incentives, like money or groceries, for those getting inoculated. Given the data, this is an approach that may well be worth considering. As the last months of vaccine rollout have shown, people may need more than politician endorsements and education campaigns to overcome either vaccine hesitancy or brand preferences. A creative approach for incentivization may be in order.

Any teams dealing with such incentivization approaches will need to tread carefully, however. For one thing, snacks as an incentive, like those previously proposed by Richard Gordon, may encourage citizens to take off their masks to eat at the inoculation venues. More serious, though, are implications of essentially paying citizens, particularly disadvantaged Filipinos, to get vaccinated. George Loewenstein and Cynthia Cryder wrote in The New York Times on the topic of such incentives: “[P]aying will most likely send the message that this is something you would not want to do without compensation.” Some might go as far as thinking that payment can send the message that the activity being incentivized is a risky one; the higher the payment, the higher the risk. In this regard, payments may actually worsen vaccine hesitancy in some groups.

In our particular setting, too, vaccine incentives cannot be dissociated from politicking and corruption. One can only imagine the names and tarpaulined faces of politicians that can be attached to such monetary incentives. Moreover, groups planning incentive strategies must recognize that Filipinos, who are struggling with record highs of unemployment and hunger, are a vulnerable group, and making vaccination contingent on receiving what would essentially be financial assistance is an ethically complex issue.

Sen. Risa Hontiveros recently commented on a proposal to make vaccination a requirement for 4Ps recipients that vaccines shouldn’t be used as bribes. Some suggest alternatives: enjoyable and desirable activities like traveling could be made contingent on vaccination, although such strategies may be easily circumvented by falsified COVID-19 test results and medical certificates. Chances at scholarship offers for young adults or dependents may also be a less ethically fraught incentive. While there is a possibility that payments can backfire, data as a whole suggests that incentive initiatives are worth a shot, and may be the next venue for us to consider in upping our vaccination numbers.

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