Why Paying People to Be Vaccinated Could Backfire

Some economists and politicians have proposed offering financial incentives, but that risks sending an unintended message.

Western General Hospital in Edinburgh last week, when Britain began offering vaccination against the coronavirus.
Pool photo by Andrew Milligan, via Reuters

The approval of the first Covid-19 vaccine in the United States was hailed over the weekend as the beginning of the end of the pandemic. But the road between delivering the first doses and widespread vaccination at rates that will arrest the spread of coronavirus is far from straightforward. Besides the logistical challenges of distributing the vaccine, people must also be willing to take it. As recently as late November, 37 percent of Americans indicated they would not be.

Two prominent economists, N. Gregory Mankiw and Robert Litan, and the politicians John Delaney and Andrew Yang have proposed or supported paying Americans to receive the vaccine. At first glance, this seems like a reasonable idea; economics teaches us that people respond to incentives. But behavioral research suggests this strategy could backfire.

Humans don’t respond to incentives like rats pressing levers for food; they try to interpret what being offered payment means. In this case, the offer risks implying that the vaccine is not a thing of value.

Studies cited in a paper titled “Tom Sawyer and the Construction of Value” (referring to a famous section of the Mark Twain book in which Tom persuades his friends that whitewashing a fence is a desirable activity) have found that when people aren’t sure whether something is good or bad, the prospect of payment helps them decide, in the negative.

In one of the studies, a professor asked his students whether they would attend a reading of Walt Whitman’s “Leaves of Grass,” offering half of the students payment for attending the reading, while asking the other half if they would pay to attend. Those offered payment wound up reporting less interest in attending. For those unsure about being vaccinated, like those unsure about attending the poetry reading, paying will most likely send the message that this is something you would not want to do without compensation.

People are also likely to infer from payment that the vaccine could be risky. In our research with Kevin Volpp and Alex London, we found that people naturally assume that payments signal risk. In a series of experiments, we described clinical trials that offered different payment amounts for participating in a study that involved an unfamiliar testing procedure. We found that people believed that a study’s riskiness was greater when the payment was higher, even though the descriptions of the study procedures were otherwise identical. Paying people to be vaccinated might, similarly, lead them to infer that it is riskier than they would otherwise assume.

Data thus far suggest that the early Covid-19 vaccine candidates from Pfizer and Moderna are safe and effective — evidence that has already led to emergency approval of the Pfizer candidate. Although direct payments for vaccination might increase uptake for some people in the short term, the effects just described might ultimately lead to exactly the opposite of the intended effects, especially for those uncertain about whether the risks of vaccination exceed the benefits.

In addition to making the vaccine seem riskier, payments might also make people less likely to get vaccinated for the selfless goal of helping others. Research shows that paying people to take altruistic actions often backfires. In one study, Israeli high school students who collected for charity on a particular day of the year collected less money when they were paid a small commission.

The paper reporting the study, titled “Pay Enough or Don’t Pay at All,” argued that the amount paid was too little to motivate the students, but enough to raise questions about the motives of students who collected a lot of money, both in the minds of people observing those students, and possibly even on the part of student collectors themselves. That same logic would suggest that paying people to get vaccinated could diminish the motivation of those who are altruistically motivated, or who would like to appear so.

A more promising approach might be to make desired activities, such as travel, contingent on vaccination. The Australian airline Qantas reports that it and other airlines are considering making vaccination a requirement for international air travel. If a vaccination becomes associated with enjoyable outcomes, such as travel and access to large public events, vaccination itself will become positively valued. When people perceive the various benefits of vaccination, skepticism is likely to evaporate, at least for some.

In the end, the circumstances surrounding the rollout of the vaccine may shape attitudes toward it. Given the complexities of producing and distributing the vaccine, it is almost sure to be scarce for months. The silver lining to this is that much research in marketing has shown that scarcity can be a huge stimulator of demand. Seeing others eager to be vaccinated — waiting desperately to get to the front of the line — could make people more likely to see value in the vaccine and to want it themselves.

George Loewenstein is the Herbert A. Simon Professor of economics and psychology at Carnegie Mellon University. Cynthia Cryder is an associate professor of marketing at Olin Business School, Washington University in St. Louis.

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