https://www.bloomberg.com/opinion/articles/2021-05-16/compulsory-covid-19-vaccinations-may-be-unpalatable-but-necessary
What Happens When Vaccine Incentives Aren’t Enough?
Reluctant citizens can slow down herd immunity despite abundant vaccines. Compulsory shots are unpalatable, but may be necessary
By Clara Ferreira Marques https://twitter.com/ClaraDFMarques/status/1395879644738441216
When much of the world is still desperate for Covid-19 vaccinations, a handful of wealthy places are beginning to have the opposite problem. Hong Kong is one. Despite a free and easily accessible program open to all adults since April, only just over 10% of the population of 7.5 million has had both injections, with low rates even among the oldest. Hesitancy is so high that only half of residents say they intend to get vaccinated.
The combination of political upheaval, distrust in government and success in keeping caseloads low makes Hong Kong an unusual, even extreme, example of reluctance, as seen in studies of attitudes to other control measures, compared to Singapore and Malaysia. But the territory is far from alone as the rich world shifts from shortages to indifference, well before enough people have been inoculated to allow a safe reopening. The question arises of how governments push populations if — or probably when — hints, cash, free burgers and even the prospect of international travel prove insufficient to reach herd immunity, the vaccination rate of roughly 70% or more that’s necessary to protect everyone.
It’s uncomfortable to argue for obligatory jabs, even in a pandemic that has devastated families globally. Yet if we don’t get to better levels once vaccines are fully and freely available, some degree of compulsion may well be necessary. The benefit is too great, and the risk and sacrifice asked of citizens too small, to ignore. Authorities in England estimate that by the end of April, vaccines had averted at least 11,700 deaths among those aged 60 or over. Globally, of course, it’s many times that.
Public health usually operates on a sliding scale of state involvement. The Nuffield Council on Bioethics in the U.K. calls it an intervention ladder, ranging from “do nothing” (the sort of minimal intervention many people prefer) to “eliminate choice.” We remain somewhere around the lower rungs when it comes to Covid-19 vaccines, which are still rolling out. Information is being provided, citizens persuaded, access facilitated. But we’re already rapidly moving up toward the point where officials are beginning to guide choices with incentives in cash and kind.
In recent days alone, Hong Kong has talked about offering vaccinations at workplaces to make it easier for employees. In the U.S., the state of Ohio announced a lottery with $1 million cash prizes. New Jersey has offered free beer for getting a shot and West Virginia is targeting young people with $100 savings bonds. Elsewhere, Serbia promised 3,000 dinars ($31) to vaccinated citizens, one of the first countries to offer cash.
The good news is that there’s still plenty of room for such options to nudge people along. Hong Kong could certainly afford to dip into its fiscal reserves. A generous incentive of HK$5,000 ($640), the same amount offered under a plan to stimulate consumption, would cost a little more than $4 billion if all eligible over-16s are counted — a bit over 1% of gross domestic product and a worthy investment, considering the damage dealt by Covid-19 closures and restrictions. And payments do have an impact.
Unfortunately, encouragement isn’t likely to get us all the way to herd immunity, or not in enough places. So what happens then? Leaving aside employers, where arguments are different, is it acceptable for a government to consider disincentives, mandating vaccines for activities like eating out or even going to school, as already happens for childhood shots in many places? Vaccines are the greatest gift to public health after clean water. Should we consider an even tougher line?