Vaccines are Ready. Come and Get 'Em, Or Should We Institute a 'Pay-for-Jab' Program?

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The day before Thanksgiving, "[t]he US reported more than 2,100 deaths in a single day [and] things are projected to get worse," especially with the December holidays plus New Year's coming up. We've got a season of merry-making ahead of us – which used to include family travel, vacations, and partying – all behaviors associated with COVID-19- spread. Things were looking gloomy – until three vaccine manufacturers recently reported promising and exciting vaccine trial results, which should be ready by spring. If we can just hang on till then, we'll be OK …., that is, if we can motivate the vaccine-hesitant.

Seven vaccine candidates are expected to pass FDA muster in the next months.  By the end of March, we should have enough vaccine available to finish vaccinating health care workers, nursing home residents, and other high-risk candidates. By May, it is expected that 70% of the US population will be vaccinated, at least according to the head of the federal Operation Warp Speed program. That seems a bit overly optimistic given some recent polls stating only 50% of Americans would accept the vaccine once it receives FDA approval. [1] Worse, as a Yahoo Finance-Harris Poll reports, nearly two-thirds of Americans have concerns about the fast-tracked COVID-19-vaccines.

But not everyone needs to be vaccinated for us to achieve population protection or herd immunity. According to the European Centers for Disease Prevention and Control, that level is around 67% for COVID-19, consistent with WHO figures.  Now, all we need to do is figure out how to encourage a mere 17% or so of the vaccine-resistant to comply.

Of course, there is always a subset of the population for whom vaccination is medically contraindicated. And since the vaccine may not work some 10% of the time, we need to add that number as well. So, let's target just half those who currently aren't keen on vaccines and hope to achieve herd immunity's magic level.

The Stick - Leave it to the lawyers to raise the first set of problems.

Some employers are considering making vaccination mandatory. That might help. But several law firms tell us that the Equal Employment Opportunity Commission, EEOC, has requirements that will protect those with genuine sincerely held religious objections, including mandated vaccination.

Not quite. In March, the EEOC issued advisories relating to COVID-19, specifically exempting COVID-19 from their general regulations, deferring to the CDC and other public health officials' recommendations, holding that COVID-19 poses a "direct threat;" defined as a significant risk of substantial harm even with reasonable accommodation. An employee showing "sincerely held" religious beliefs forbidding vaccination [2] could theoretically be allowed to work from home if their refusal doesn't impose an undue hardship to an employer. If State law requires vaccination, any issues relating to employer programs are moot, and employers will not have to bother with workplace rules as the state will take over.

Should we continue COVID-19's current trajectory, states may have no choice but to impose mandatory vaccine requirements, if for no other reason, to prevent overwhelming our healthcare system, but no State wants to go there. Even though compulsory vaccination would be perfectly legal in the midst of an epidemic, and when applied to everyone, even religious convictions won't stand [3]; no one wants to force the issue. And that has produced the latest craziness. So, if the stick won't do it, maybe a carrot would.

The Carrot - the economists chime in further muddying the waters

In August, economist Robert Litan advocated paying people to take the vaccines, suggesting $1000 per vaccination. Rather than forcing them, let's seduce, bribe, or nudge (your word choice) those who are nervous. This would include "people who are maybe distrustful of the FDA [or] people who just don't want to get the shot because it hurts, or people who are worried about the shot effects, or... don't want to go through the trouble of going to the doctor or hospital…."

Without providing evidence, Litan believes that this group comprises "maybe 10%-20% of the population." While it might improve vaccine uptake and reduce spread, this approach won't achieve herd immunity

Then you get the lawyers again, wondering if the government would be required to compensate religious rejectors equally, even if they refuse vaccination, as not getting paid might violate their free exercise of religion. If this concept were entertained, it would undo any inducement value the "pay per jab" might have, motivating anyone sitting on the fence due to safety concerns to claim religious conviction. Many anti-vaxxers rely on a religious argument even if they belong to a religion approving vaccination – as it's more socially acceptable than saying outright one is an anti-vaxxer based on flawed science.

The mixed message problem

Commonly, we compensate volunteers for clinical trials to motivate them to accept the risks of experimental trials. The amount paid to volunteers isn't particularly impressive, usually tied to time and inconvenience, the same basis the lawyers suggest might be suitable for the "pay for jab" program. But why would anyone take $200 for exposure to a risky experimental vaccine when all you have to do is wait a bit, and you can get $1000 for taking a vaccine with a better safety track record?

The program also commingles the concept of being paid for assuming risk. If we ask our citizens to do something supposedly good for them, why are we paying them to do it? The payment itself is an admission of a safety problem.

Then we have those who are sincerely and scientifically concerned, especially frontline healthcare professionals, all slated to be first in the vaccination line. Healthcare professionals want more data about a COVID-19-vaccine before they take it. Reportedly, 66% of surveyed Los Angeles healthcare workers said they would delay taking a vaccine. The American Nurses Association said a third of its members do not intend to take the vaccine at all, and another third are undecided.

"What I hear from physicians is some of the same concerns that are expressed by everyone," she said. "They worry the process has been politicized. They are concerned because they haven't seen any published data yet. And they don't feel comfortable making the decision one way or another until they see the evidence."

Susan Bailey, President AMA

So, here's the question on your COVID-19 Final Exam: Should we pay to Jab?

A. No. It won't work – because those who are genuinely concerned over safety can't be bought.

B.  No. It sends the wrong message; commingling the practice used to recruit volunteers for clinical trials testing "experimental vaccines," with FDA deemed safe vaccines,

C.  No. The money will go to religious objectors who will claim their religious rights are being violated, and they need to be treated equally– even though they will refuse vaccination.

D. No. If we have to pay people to take actions that will save their kids or parents, the country has more significant problems than a COVID-19 vaccination program.

E. All of the above.


[1] A more recent Gallup Poll puts the number at 58%

[2] Only three religions officially can be said to prohibit vaccines: Christian Science, Jehovah's Witnesses, and the Dutch Reformed Church. After our publication, we were contacted by Mr. Robert Hendriks, US spokesperson for Jehovah's Witnesses. He indicated that the official position of the Jehovah's Witness Church is that vaccination is acceptable. We thank him for the clarification of their position.

[3] Jacobson v. Massachusetts, 197 US 11 (1905), a Supreme Court case upholding the authority to enforce compulsory vaccination laws.

Source: Pandemic Preparedness in the Workplace and the Americans with Disabilities Act Equal Employment Opportunity Commission