Paying people to vaccinate may work, but is it ethical?

Paying people to vaccinate may work, but is it ethical?



For Americans who are not sure about vaccinations, there is a great price to pay.

May 12, Ohio Republican Governor Mike DeWine (Mike DeWine) Announce Five kinds of US$1 million lottery prizes are provided to vaccinated people.Meanwhile, in West Virginia, young people Attracted to shoot There are $100 savings bonds and a state university Provided by North Carolina The vaccinated students have a chance to win accommodation costs.a lot of Company is paying More money was vaccinated for employees through bonuses or extra paid vacation.

Efforts to get as many people as possible vaccinated are commendable and may work.But leading Behavioral Scientists Worry If people are more skeptical of vaccination, then paying people for vaccination may be counterproductive.Ethicists think this is wrong, the reason is Worries about fairness And fair.

as a Behavioral Scientist and Ethicist, I will conduct extensive research to help answer these questions. It shows that incentives may help save lives, and if structured properly, there is no need to trample on individual rights or incur huge costs for the government.

In the United States, incentives and restraints have been used in healthcare.U.S. Private Medical Insurance System Expose the patient A large number of deductibles and co-payments are not only used to pay for expenses, but also to reduce medical services that may be considered wasteful-for example, considering that increased costs for emergency room visits may prevent those who are not actually in the emergency room Of people need this kind of care.

in practice, this means Encourage patients to refuse emergency and routine care, as both methods have to bear the cost.

Pay for health behavior

As far as COVID-19 is concerned, the vaccine has been provided to consumers free of charge, which undoubtedly encourages people to be immunized.Studies have shown that reducing out-of-pocket costs can increase compliance with life-sustaining drugs, whether or not avoid Heart attack or management diabetes.

Paying for medication goes further than simply reducing costs.And if The design is reasonable, Such incentives can change healthy behavior.

It turns out that payments and cash rewards can effectively encourage Donate blood, Keep using blood thinners, Blood glucose monitoring, physical activities with Quit smoking.

Especially for vaccination, Human papilloma virus in England; Hepatitis B In the U.S. and U.K.; and Tetanus Toxoid In Nigeria. The impact can be huge: For example, for a group in the HPV study, the vaccination rate more than doubled if there was an incentive.

For COVID-19, there is no field research so far, but there are some investigation experiments, Including one of my team with 1,000 Americans, Found that incentives are likely to work. In our case, the tax cut was motivated enough to encourage those who are hesitant about the vaccine to say that they will do it.

Coercion problem

Even if incentives can save lives by increasing vaccination, there are still other ethical considerations.A key question is Protect your own choice People Decide what they put on themselves. This may be especially important for the COVID-19 vaccine, it can— Although authorized Safe and effective drugs-not yet fully approved by the U.S. Food and Drug Administration (FDA).

However, people who are already paid often participate in clinical trials of drugs that have not yet been approved by the FDA.Ethicist Worried If the attractiveness of money is so great that it overwhelms a person’s free choice or worsens their overall condition, then such payment may be “mandatory.”

People may question “Mandatory Provide payment. However, even if the offer is mandatory, if a greater degree of immunization can be successfully carried out, the payment may still be reasonable to save lives in the pandemic.

During the smallpox epidemic nearly 100 years ago, the U.S. Supreme Court Maintain state power Mandatory vaccination. Compared with compulsory vaccination, Encourage vaccines to appear harmless.

Exploitation and paternalism

But some people are still worried.Bioethicist Emily Largent with Franklin Miller Wrote in a recent paper Payments may “unfairly” take advantage of “US residents who lost their jobs…or fell into poverty during the pandemic”, which may make them feel that they “have no choice but to receive cash vaccination”.other Already noticed Vaccine hesitation is higher in non-white communities, where incomes tend to be lower Trust medical institutions.

Ethicists and policy makers should indeed focus their attention on the poorest members of our community and strive to minimize racial differences in health outcomes and wealth. However, there is no evidence that funding is actually harmful to this group of people. Collecting money is a good thing. Suggest that we must protect adults by refusing to provide money, Encounter paternalism.

Some ethicists also debate This money is best spent elsewhere to increase participation.Countries can spend money to ensure that vaccines are accessible to everyone, for example, by bringing them to Community events and churches.Money can also support various struggles Misinformation and communication The importance of shooting.

Incentive cost

As a policy solution, fiscal incentives can be expensive.feels like Ohio, Lottery is a way to limit the total cost of rewards, while giving millions of people more opportunities to receive rewards.

Tax laws can also allow free vaccination.Tax deductions and credits are usually to encourage certain behaviors, such as Savings or Property rights.Now some states have big Budget surplus And is considering tax cuts. If a state now declares vaccination as a condition, then everyone who refuses to get a vaccination can save the government money.

Ultimately, well-designed vaccination incentives can help save lives without keeping ethicists awake at night.

Christopher RobertsonProfessor of Law Boston University

The article was republished on conversation Under the Creative Commons Source article.


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