Pay people to get a covid vaccine?

[Katy]

https://www.sciencedaily.com/releases/2020/11/201105183844.htm

This ethicist thinks it's the best thing to do if/when a vaccine comes out. Maybe it's a few years of thinking the ends never justifies the means, but this gives me the squicks.  I can't logically identify why though.  What do you think?

[Not_a_Number]

Hmmm, doesn't bother me. 

[Corraleno]

Well we need a significant percentage of the population to get it in order to achieve herd immunity, and unfortunately between the conspiracy theories and the overall politicization of all things Covid, only 50% of the population now say they plan to get it. And that percentage has continued to drop since spring, when it was 72%, so it's possible that it could go even lower by the time a vaccine is actually released. The sooner we get to herd immunity the sooner life, and therefore the economy, can return to normal, so anything that can improve vaccination rates would be a good thing. And I suspect that financial incentives would be better received than a mandate (although I assume it will be mandatory for most schools & colleges.

[Twolittleboys]

I don't think it will really be necessary to pay anyone to get the vaccine (at least initially). First of all, there likely will be far less vaccine available at first than needed so only a fraction can get it anyway. Then I do believe there will be a lot of pressure on getting it from various sides: You want to travel and enter country X? Prove that you had the shot. You want to go on a cruise? Prove you had the shot. You want to attend a large conference? Prove you had the shot etc. By the time sufficient vaccine is available and all the people eager to get it (or forced to in order to live their lives) have received it, the vaccine won't be new anymore so more people will be willing to get it. At that point I think enough people will have been treated to get close to herd immunity, between shots and having had the virus.

[Danae]

I can think of situations where paying people to get vaccines would be very squicky.  If it was a riskier-than-most vaccine and we paid poor people to get it to create enough herd immunity that the well-off people didn't need to would be one example.  

But Target gives a $5 gift card when you get a flu vaccine and that doesn't bother me.  

[Ausmumof3]

I think it’s a bad idea purely for compliance reasons.  Early in the Covid pandemic we were talking about experimental vaccines and a friend shared that at some point they had been offering iTunes vouchers to kids getting some vaccine (maybe the new meningococcal).  It was enough to make here suspicious and wary of the vaccine.  Might not work that way on everyone but certainly will on some.

Secondly what happened here was first they incentivised vaccines then they took the incentive away and linked parenting payments to vaccination status.  Given that many people need those payments to survive it effectively took away their ability to refuse.  I don’t like any form of coercion when it comes to medical stuff.  On the other hand it’s not a really solid boundary.  So that if it’s really the only way to get society safer Id probably come around to it but it’s not my preference.

[Guest]

I just want it to be available for no out of pocket cost, whether you have insurance or not. 

[City Mouse]

The article talks about “incentivizing” not necessarily monetary payment. I could definitely go along with that - the freedom to not wear a mask at Disney world or on a plane with proof of immunization.  Although I could see social backlash in that type of situation where other patrons do not know the reason for no mask wearing and make things difficult for the vaccinated person.

actual cash payment doesn’t bother me either. I have received monetary compensation for participating in a medical study in the past, and the study had nothing to do with any medical condition that I might have or not have. It was related to nutrition in children.

Edited November 8, 2020 by City Mouse

[Splash1]

Our area is advertising paying $740 to have a covid vaccine for the study.

[Corraleno]

I think the idea that people who get the vaccine can go without a mask is more problematic than just offering 50 bucks or something. What proof of vaccination will people need to show every time they want to go somewhere? Will the doctor or pharmacy that gives you the shot provide some kind of ID card? What's to prevent millions of antivaxxers from printing fake vaccine cards, like the fake medical exemption cards that antimaskers print? Will every store have to station people at the door to check everyone's vaccine card? Will they be able to distinguish real ones from fake ones?

I also think the idea of having to show a vaccine ID card would totally play into the conspiracy theories about the vaccine being part of a nefarious plot by Bill Gates and others to microchip and control and track the population. And I can foresee all kinds of legal challenges to the idea of having to provide personal medical information in order to have the same "rights" (i.e. to not wear a mask) as others, objections that masks would serve to visibly stigmatize those who refused the vaccine, etc.

[medawyn]

I think it's fairly routine for companies/insurance companies/pharmacies to incentivize the flu shot.  I see it annually: stores that provide a gift card or points; insurance companies that provide cash or reduce a payment; places of employment that offer some kind of bonus or perk.  It seems better to me than either penalizing employees  who choose not to be or can't be vaccinated or requiring the vaccine on a large scale.

[SKL]

Well, what are the implications of the likely fact that most people opting into this would be poor?
 

1) The risks of a relatively new vax are concentrated on the poor.

BUT on the other hand,

2) The poor are supposedly most affected by Covid anyway, so the benefits of the vax are also concentrated on the poor.

But on the third hand,

3) People who are that in need of money might be more likely to have already had Covid, as they are more likely to have kept working in / kept sending their kids to places where the virus was spreading & less likely to have the time & money for preventative measures.

Personally I would find it icky also ... I mean, why wouldn't informed consent be enough?  If I need to be paid to take a vax, I'm thinking there's some issue with the vax.

I could get on board with making it free and easy to access for those who want it.

[SKL]

I'm a big no on making a vax mandatory for any activity, other than certain jobs that involve high risk.  Even for school kids, I would be against it because it is too new.

[ktgrok]

I can get a $10 gift card at Target or Publix for getting my flu shot, so I don't see a problem with doing the same for Covid. 

And as much as yes, it is a new vaccine, it's also a new illness. I'd prefer not to have to get either, but in reality, I have to pick between those two if I want to get back to a semblance of normal life. 

[gardenmom5]

They couldn't pay me enough if I had inadequate confidence in the vaccine.  

[katilac]

People get paid to participate in medical studies all the time. 

[gardenmom5]

10 hours ago, Danae said:

 

But Target gives a $5 gift card when you get a flu vaccine and that doesn't bother me.  

That's a widely available vaccine.    Target is just trying to get you to come into their store where you'll probably spend multiple times that $5 gift card.

[Ausmumof3]

8 hours ago, City Mouse said:

The article talks about “incentivizing” not necessarily monetary payment. I could definitely go along with that - the freedom to not wear a mask at Disney world or on a plane with proof of immunization.  Although I could see social backlash in that type of situation where other patrons do not know the reason for no mask wearing and make things difficult for the vaccinated person.

actual cash payment doesn’t bother me either. I have received monetary compensation for participating in a medical study in the past, and the study had nothing to do with any medical condition that I might have or not have. It was related to nutrition in children.

Unfortunately that’s probably not realistic with the current vaccine front runners because they only prevent disease not infection meaning even after vaccination you will be able to spread it just won’t get severely ill yourself.  Hopefully as time goes on we will have better vaccines that can actually stop the infection itself.

[Momto6inIN]

I think there's a tremendous, huge, can't emphasize it enough difference between Target or a private insurance company incentivizing a vaccine and the government doing it, which is what the article is proposing. No way. Your squick perceptors are right on.

[mom2scouts]

Two thoughts came to mind while reading this, but I'm not really sure whose posts to respond to:

1. My aunt is a nurse/director in a nursing home. They have already selected the pharmacy which will provide the vaccines and it doesn't seem like residents of the facility will have the option to refuse (if they want to stay there).

2. DS is finishing phase 3 of his trial and is paid $5 per week to contact the researchers and answer a few questions to let them know if he's still Covid-free. The belief is that the person is only being paid for their time and not for getting the vaccine because of ethical concerns that people will join the study for money. They don't want to coerce people to volunteer or let money cause them to make a poor choice to participate. DS is the kind of person who will try all kinds of things because he thinks they're interesting or because he thinks their potential is worth a bit of risk. I don't know if money affected his decision or not. I'm not sure how the medical ethics will affect the decision to pay or not pay people to get the vaccine.

ETA: DS is in the Pfizer trial that is in the news today claiming 90% effectiveness. 

Edited November 9, 2020 by mom2scouts

[TechWife]

We pay people to do other things that benefit society by giving tax incentives for things like solar panels. Farmers get paid to plant or not plant certain things for economic purposes. Companies get benefits for creating jobs and get tax cuts for opening new offices or building new manufacturing plants that hire a certain number of people. I don’t think this would really be any different. 

[katilac]

 

2 hours ago, Momto6inIN said:

I think there's a tremendous, huge, can't emphasize it enough difference between Target or a private insurance company incentivizing a vaccine and the government doing it, which is what the article is proposing. No way. Your squick perceptors are right on.

Can you define the difference you see between a private insurance company offering an incentive and the government offering the same? 

What about a research institute? University, medical center, or partnership. They're always advertising for participants around here. Test a new medicine, get money and varying levels of medical care. 

People without decent insurance, or without money, are going to be more likely to say yes in either situation.

[Pam in CT]

Huh. Thanks -- it's an interesting question.

22 hours ago, Katy said:

https://www.sciencedaily.com/releases/2020/11/201105183844.htm

This ethicist thinks it's the best thing to do if/when a vaccine comes out. Maybe it's a few years of thinking the ends never justifies the means, but this gives me the squicks.  I can't logically identify why though.  What do you think?

First time through, gives me the squicks too. That was my instant gut response. And then, as I turned the question over in my mind, my subsequent responses:

1. (Once it's adequately tested) a fairly sizable segment of people -- health care workers, military personnel, teachers, nursing home residents, students in dorm facilities -- will almost certainly be required to get it as a condition of employment or continued residency. If functionally coerced vaccination *doesn't* squick... why should modestly "nudged" vaccination?
2. There are numerous other contexts in which modest compensation is offered in exchange for taking on physical risk (such as participating in clinical medical trials) or offering up renewable body parts (blood, plasma, sperm). If compensation for those kinds of voluntary exchanges *doesn't* squick... why should compensated vaccination?
3. (As noted by server pp upthread) There are already numerous voluntary programs to nudge people to get other vaccinations, like retail gift cards.  (I don't know as fact that such programs have been negotiated in return for tax advantages to the retailers, but I would expect so.) In any event, if such voluntary nudges for existing vaccines don't squick... why should a similar nudge for a vaccine for a pandemic that has killed upwards of a quarter million people and causing immense continued strain on The Economy?

 

So after mulling on it a bit, I'm backing off the squick.  If the nudge is voluntary and modest (like the $10 gift card), I'm not too persuaded by the uneven-risk-on-less-socioeconomically-advantaged: partly because COVID is already hitting those segments disproportionately, and also because the more "essential" their work is, the more likely they'll be coerced by employment into vaccination anyway.

And even before a vaccine is available, I am already seeing a preliminary this dynamic, which also has socioeconomic implications, begin to play out with repeated prophylactic testing:

14 hours ago, Twolittleboys said:

I don't think it will really be necessary to pay anyone to get the vaccine (at least initially). First of all, there likely will be far less vaccine available at first than needed so only a fraction can get it anyway. Then I do believe there will be a lot of pressure on getting it from various sides: You want to travel and enter country X? Prove that you had the shot. You want to go on a cruise? Prove you had the shot. You want to attend a large conference? Prove you had the shot etc. .....

Both my younger daughter and one of my nephews already are required to be tested weekly as a condition of attending in-person classes; my son is subject to randomly selected testing that works out to more like once every 3 weeks. Once an (adequately tested) vaccine is available, it will similarly required throughout many/most/all private schools, as meningitis is now.. Americans will be unable to enter other countries unless vaccinated (like yellow fever is now for countries that struggle to contain it).  The first airline able to offer fully COVID-vaccinated flights will be able to charge a premium for the service. And etc. That kind of privileged access to COVID-vaccinated spaces will nudge toward faster vaccination rates amove segments with more resources, which makes me more comfortable with nudge programs leaning the other direction.

 

 

[Momto6inIN]

10 hours ago, katilac said:

 

Can you define the difference you see between a private insurance company offering an incentive and the government offering the same? 

What about a research institute? University, medical center, or partnership. They're always advertising for participants around here. Test a new medicine, get money and varying levels of medical care. 

People without decent insurance, or without money, are going to be more likely to say yes in either situation.

I don't know if I'm articulating this well or not, but I believe it's the power dynamic that makes me uncomfortable. Target and my insurance company hold no power over me that I don't give them or that I can't take away. Beyond my personal buy in, they are also subject to the forces of supply and demand in general.

The government is not subject to those forces and they do have power over me. And so them deciding what I do or don't need and incentivizing whatever they deem that to be makes me uncomfortable. Even though in this case I happen to agree that what they deem I need is good for me, what about next time? Will they up the ante and include a penalty if I don't? I realize that's a slippery slope argument, but in the case of government overreach, I think it's not a farfetched scenario.

[Not_a_Number]

20 minutes ago, Momto6inIN said:

I don't know if I'm articulating this well or not, but I believe it's the power dynamic that makes me uncomfortable. Target and my insurance company hold no power over me that I don't give them or that I can't take away. Beyond my personal buy in, they are also subject to the forces of supply and demand in general.

The government is not subject to those forces and they do have power over me. And so them deciding what I do or don't need and incentivizing whatever they deem that to be makes me uncomfortable. Even though in this case I happen to agree that what they deem I need is good for me, what about next time? Will they up the ante and include a penalty if I don't? I realize that's a slippery slope argument, but in the case of government overreach, I think it's not a farfetched scenario.

I mean, they do it all the time. It’s part of what government does.

[catz]

Doesn’t particularly bother me either.   Assuming we are talking a about a vaccine that cjhecks all the safety and efficacy boxes and is being taken widely and recommended by the medical community who are likely to be offered the option first.   
 

On this note, initial efficacy data is looking very promising 

https://www.bloomberg.com/news/articles/2020-11-09/pfizer-s-covid-vaccine-prevents-90-of-infections-in-large-study

Edited November 9, 2020 by FuzzyCatz

[Hyacinth]

1 hour ago, Not_a_Number said:

I mean, they do it all the time. It’s part of what government does.

And it’s squicky every time. 

[Not_a_Number]

7 minutes ago, Hyacinth said:

And it’s squicky every time. 

I actually think incentives are a much less intrusive and lumbering way for a government to affect things than mandates.

[Hyacinth]

5 minutes ago, Not_a_Number said:

I actually think incentives are a much less intrusive and lumbering way for a government to affect things than mandates.

Absolutely agree! Mandates can be tyrannical. Incentives are merely squicky. 
(Apologies if this response shows up twice.)

[Not_a_Number]

7 minutes ago, Hyacinth said:

Absolutely agree! Mandates can be tyrannical. Incentives are merely squicky. 
(Apologies if this response shows up twice.)

Well, many things are mandates or prohibitions, like laws — they are very binary. Incentives are much more about opting in, so there’s more room to maneuver.

[Hyacinth]

2 minutes ago, Not_a_Number said:

Well, many things are mandates or prohibitions, like laws — they are very binary. Incentives are much more about opting in, so there’s more room to maneuver.

Agreed. 

[Pen]

Would paying people be a nudge to help get it done? Or might it have opposite psychological effect if people might equate a payment with thinking there might be a problem with it so that payment is needed?  

And does it add an incentive or take away from

the incentive of trying to get the individual getting it and the population as a whole safer? 

Or is it a relatively token payment amount like a little toy or lollipop that helps a child feel happier after a vaccination? 

 

On WTM it seems like a lot of people are lie low, wait and see, types. Irl, most people I know have to get out and work etc, and want it ASAP so long as they can afford it. Making it easy and low risk to access (like outdoor drive-through vaccination locations— not having to go into a pharmacy or office) and free (including not just free itself, but not having to pay for a medical visit) would go farther than a payment. 

 

I think that initially targeted to at risk groups, it might become a coveted item driving demand.

 I think it should be available for free. Or at least free for all who need it to be free. And easy, low risk access.  

 

[Momto6inIN]

2 hours ago, Not_a_Number said:

I mean, they do it all the time. It’s part of what government does.

They mandate things I can and can't do to infringe on other people and their rights, but so far I'm not aware of any mandates about something that I have to put into my body. That is a whole different level of power that I am not comfortable with.

[Not_a_Number]

Just now, Momto6inIN said:

They mandate things I can and can't do to infringe on other people and their rights, but so far I'm not aware of any mandates about something that I have to put into my body. That is a whole different level of power that I am not comfortable with.

There are local vaccine mandates in places, have been for a while, no? You need shots to go to school.

[Momto6inIN]

Just now, Not_a_Number said:

There are local vaccine mandates in places, have been for a while, no? You need shots to go to school.

I disagree with those rules too 😁 (and no, I'm not an anti vaxxer, my kids are all up to date, I just happen to hate the government intrusion into people's personal decisions)

But I do think we at least have the option of not sending our kids to school if we really feel strongly about vaccines.

 

[Momto6inIN]

48 minutes ago, Hyacinth said:

Absolutely agree! Mandates can be tyrannical. Incentives are merely squicky. 
(Apologies if this response shows up twice.)

Yup!

[Bootsie]

2 hours ago, Hyacinth said:

Absolutely agree! Mandates can be tyrannical. Incentives are merely squicky. 
(Apologies if this response shows up twice.)

But the only way the government has money for incentives is through a mandate that people pay taxes.

[Paige]

I don't feel it is ethical. If the vaccine has side effects, and they all do, then who will be disproportionately affected? You have to have free, voluntary, informed consent. It's like paying for organs, IMO. 

[mom2scouts]

5 hours ago, Not_a_Number said:

There are local vaccine mandates in places, have been for a while, no? You need shots to go to school.

Not really. The school tells you your children can't go to school without vaccinations, but I was surprised to learn there are several exemptions, including philosophical reasons. I know several anti-vaxxers who send their children to public school, camp, and other places that say they require vaccines.

[Corraleno]

11 minutes ago, mom2scouts said:

Not really. The school tells you your children can't go to school without vaccinations, but I was surprised to learn there are several exemptions, including philosophical reasons. I know several anti-vaxxers who send their children to public school, camp, and other places that say they require vaccines.

That definitely varies by state. Some states only allow medical exemptions.

[Corraleno]

8 hours ago, Momto6inIN said:

I don't know if I'm articulating this well or not, but I believe it's the power dynamic that makes me uncomfortable. Target and my insurance company hold no power over me that I don't give them or that I can't take away. Beyond my personal buy in, they are also subject to the forces of supply and demand in general.

The government is not subject to those forces and they do have power over me. And so them deciding what I do or don't need and incentivizing whatever they deem that to be makes me uncomfortable. Even though in this case I happen to agree that what they deem I need is good for me, what about next time? Will they up the ante and include a penalty if I don't? I realize that's a slippery slope argument, but in the case of government overreach, I think it's not a farfetched scenario.

But we're talking about incentives, not mandates. If you don't want a flu shot, you can decline the incentives from Target and your insurance company. If you don't want a covid vaccine, you could decline the incentive from the government. How are those things different?

The government gives incentives for lots of things: If you want a tax break for charitable giving, you can give to charity and take the tax break, or you can choose not to make charitable gifts and not use the tax break.  If you want a tax break for investing in tax free bonds, you can do that or you can choose other investments and forego that particular incentive. There's no coercion there — take the benefit or don't take the benefit.

 

[Not_a_Number]

5 hours ago, Momto6inIN said:

I disagree with those rules too 😁 (and no, I'm not an anti vaxxer, my kids are all up to date, I just happen to hate the government intrusion into people's personal decisions).

But only some decisions, right? Because there are MANY laws out there, and if you wanted, you could argue that all of them are government intrusions. 

[Momto6inIN]

5 hours ago, Corraleno said:

But we're talking about incentives, not mandates. If you don't want a flu shot, you can decline the incentives from Target and your insurance company. If you don't want a covid vaccine, you could decline the incentive from the government. How are those things different?

The government gives incentives for lots of things: If you want a tax break for charitable giving, you can give to charity and take the tax break, or you can choose not to make charitable gifts and not use the tax break.  If you want a tax break for investing in tax free bonds, you can do that or you can choose other investments and forego that particular incentive. There's no coercion there — take the benefit or don't take the benefit.

 

I realize they're not talking about a mandate at this point. But if the carrot doesn't work, the stick is usually next. Again, like I said before, it's the imbalance of power that makes me uncomfortable. Kind of like a random guy in a bar asking me out is an annoyance, but my boss doing it is harassment.

 

4 hours ago, Not_a_Number said:

But only some decisions, right? Because there are MANY laws out there, and if you wanted, you could argue that all of them are government intrusions. 

I'm in favor of the government protecting people's rights from each other - and not incidentally from itself, which is kind of the whole point of the Constitution. But personal decisions that don't infringe on anyone else's rights? Yeah, I pretty much want the government to leave all those alone.

[Not_a_Number]

2 minutes ago, Momto6inIN said:

I'm in favor of the government protecting people's rights from each other - and not incidentally from itself, which is kind of the whole point of the Constitution. But personal decisions that don't infringe on anyone else's rights? Yeah, I pretty much want the government to leave all those alone.

There are very few things that genuinely infringe on no one's rights, though. Like, your choice not to vaccinate your kid does infringe on my right to a disease-free school. I know you can argue that's not the same thing, but it's not like it's just a random decision to mandate this. 

ETA: the "you" is generic, not specific! 

Edited November 10, 2020 by Not_a_Number

[Momto6inIN]

32 minutes ago, Not_a_Number said:

There are very few things that genuinely infringe on no one's rights, though. Like, your choice not to vaccinate your kid does infringe on my right to a disease-free school. I know you can argue that's not the same thing, but it's not like it's just a random decision to mandate this. 

ETA: the "you" is generic, not specific! 

Except none of us have a right to a disease free anything. We may really want it, and it may be a really good and desirable thing, but we don't have a right to it.

Edited November 10, 2020 by Momto6inIN

[Not_a_Number]

Just now, Momto6inIN said:

Except none of us have a right to a disease free anything. We may really want it, and it may be a really good and desirable thing, but we don't have a right to it.

We have a right to life. I would argue that filling schools with disease interferes with it. 

[Momto6inIN]

Just now, Not_a_Number said:

We have a right to life. I would argue that filling schools with disease interferes with it. 

I don't think the right to life means I have a right to a life free from exposure to disease or risk. You can feel free to disagree, of course 😁 but IMO that's not really a reasonable expectation to have of a government and thus probably not what the Constitution means.

[katilac]

9 hours ago, Paige said:

I don't feel it is ethical. If the vaccine has side effects, and they all do, then who will be disproportionately affected? You have to have free, voluntary, informed consent. It's like paying for organs, IMO. 

Which makes for another great discussion - why is paying for organs so horrific on a moral level?

Is it a horrific thing to do because poor people are more likely to be swayed by money into doing something dangerous? If so, how is that different from poor people being swayed into taking extremely dangerous jobs because they need the money? They join the military when they have no calling or inclination to do so, they take jobs offshore, and so on. Why is one physical risk for money acceptable and another not? 

[Not_a_Number]

24 minutes ago, Momto6inIN said:

I don't think the right to life means I have a right to a life free from exposure to disease or risk. You can feel free to disagree, of course 😁 but IMO that's not really a reasonable expectation to have of a government and thus probably not what the Constitution means.

Of course, it's all interpretable 😉 . And our understanding of disease is a little different than it was back then, anyway, so their views on disease wouldn't be super useful to us. 

I think we do have laws about lots of things that cause harm in aggregate but not nearly every time. So, laws about cars for example... 

[Paige]

40 minutes ago, katilac said:

Which makes for another great discussion - why is paying for organs so horrific on a moral level?

Is it a horrific thing to do because poor people are more likely to be swayed by money into doing something dangerous? If so, how is that different from poor people being swayed into taking extremely dangerous jobs because they need the money? They join the military when they have no calling or inclination to do so, they take jobs offshore, and so on. Why is one physical risk for money acceptable and another not? 

I don't know. With organs and medical procedures it's coercive and we have a history of taking advantage of people. Medical procedures have an inherent power imbalance even among people who would normally be equals. 

The other issues are also legitimate and I have no answer, but I don't think the answer would be to expand the coercive opportunities.