The Alternate Storyline of the US Vaccine Rollout
The Biden Administration recently admitted that although we’ll come close, the US vaccination rate will not reach the administration’s goal of 70% by July 4th. Over the past few months, demand for the vaccine has dried up, and some state governments, like Ohio, are literally paying people to get the vaccine alongside a slew of other incentives initiated by the public and private sectors alike. Everything from Krispy Kreme donuts to free cruise vacations is on the table to convince the hesitant to get vaccinated, but are they working?
Unfortunately, recent data suggests that most of these incentives have had little effect on the overall vaccine rollout.
Given what we know from behavioral science, the general failure of carrot incentives is not all that surprising. Studies on loss aversion, past stick incentive campaigns, and FOMO show that humans perceive losses as a greater motivator than gains.
What if the US had taken a different approach — an approach that accounted for flaws in human judgment? How different would the vaccination process have looked? Would Biden have met or even exceeded his target goal?
Let’s rewind the clock.
It’s February 2021. Joe Biden was recently inaugurated as President of the United States after promising a more involved national response to the pandemic during his campaign. The Pfizer-BioNTech and Moderna mRNA vaccines have been approved by the FDA for emergency authorization, both showing outstanding efficacy rates in preventing severe illness following clinical trials. The race to get vaccines into arms is officially on.
There are two paradigm policy alternatives that I believe would have tremendously impacted the rollout of vaccines in America:
- Vaccine Passports
- Utilization of market forces
Vaccine passports were a topic introduced relatively early on as dialogue on international travel began to open up around the world. The main idea is that verification of vaccination is required for entry or participation. When vaccine supply was more scarce and access to doses was limited to certain subsections of the population, there was a great deal of controversy around vaccine passports. Some viewed them as a discriminatory policy, against those unable and those who choose not to be vaccinated.
Clearly, there were issues with equity and fairness due to the exclusivity of being vaccinated at the start. When the equal opportunity to get the vaccine fails to exist, passports are not an effective option. However, since all adults over the age of 16 (and eventually children older than 12) were given the green light to receive vaccines, the dynamic has completely shifted. What was once a challenge of meeting high demand has flipped completely to an issue of increasing low demand.
Vaccine passports are effective both at preventing the spread of the disease AND encouraging people to get vaccinated because they draw borders around the safe, COVID-free (for the most part) locations in our communities. Want to eat at your favorite restaurant again? Get vaccinated. Hoping to see your favorite baseball team play this summer? Get vaccinated. Looking to take the trip you’ve been planning in quarantine the past year? Get vaccinated.
Essentially, vaccine passports are a one-way ticket back to pre-pandemic life, and it’s hard to think of a stronger motivator than returning to the events, places, activities we all love and have been deprived of for over a year. By taking away or blocking these things conditional on simply getting a vaccine, the value of getting the vaccine skyrockets. Currently, there is no valid method of determining who is and isn’t vaccinated, opening activities, events, and locations to unvaccinated individuals as well. This environment provides little incentive for those who haven’t been vaccinated to do so because they are already enjoying privileges that should be reserved for solely the vaccinated population. So basically all the unvaccinated concert-goers and public non-maskers are that one kid in the group project that does nothing but still walks away with an A.
Now, let’s talk market incentives. Imagine if when Biden had announced his July 4th vaccination goal of 70% he said, “Everyone is welcome to a free vaccine until July 4th. After that, we will begin donating our entire vaccine supply to the COVAX program, and if you’d like to receive a vaccine after the 4th, you will be required to pay a small fee.”
I have a hunch that this version would have performed much more effectively because the language of the announcement implies entitlement and ownership of the vaccine. In a study done by the Behavior Change For Good initiative at UPenn’s Wharton School, results showed that the most effective messaging technique in convincing people to schedule appointments and get the vaccine incorporated the same qualities.
The threat of losing something that someone feels attached to or feels they have ownership of plays on our loss-averse nature. Loss aversion causes us to weigh the cost of losing something to be far higher than gaining something of equivalent value. In this alternate reality, the fear of missing out and losing out both play a speculatively greater role in convincing unvaccinated individuals to get their shot(s) than any incentive would.
Although both of these ideas are relatively unrealistic, I hope this thought experiment exposed the effectiveness (and polarizing nature) of stick approaches to public health policy.
