Countering Vaccine Hesitancy: Give Megabucks not just Beer Money

To date, 14.2 percent of the total Australian population, or 3.7 million people, have been fully vaccinated and 31.7 per cent (8.1 million) have received a first dose.[1]

This is an abysmal take-up of what was, just over a year ago, the silver-bullet everyone was waiting for. The reason is that an unexpectedly large number of the population is either hesitant, or downright resistant, to taking a COVID-19 vaccine, especially the AstraZeneca vaccine.

Many academic studies have been conducted to understand the reasons behind this phenomenon. Taken together, the existing literature indicates that there are likely to be several psychological dispositions that traverse personality, cognitive styles, emotion, beliefs, trust, and socio-political attitudes that distinguish those who are hesitant or resistant to a COVID-19 vaccine from those who are accepting.[2]

A study undertaken at the Australian National University (ANU) measured vaccine intention by asking: “If a safe and effective vaccine for COVID-19 is developed, would you…” with four response categories. The answers alongside the weighted percentage of respondents were: (a) Definitely not (5.5 per cent); (b) Probably not (7.2 per cent); (c) Probably (28.7 per cent), and (d) Definitely (58.5 per cent).

Consistent with previous literature on vaccine acceptability, the ANU study defined those who are definitely not going to get the vaccine as ‘vaccine resistant’. High levels of hesitancy was defined as those who would probably not get vaccinated, while low levels of hesitancy to be vaccinated was mainly because of the uncertainty if the vaccine would be safe and effective.[3]

Clearly, safety was a major concern of those who were hesitant.

Numerous proposals to improve voluntary uptake of COVID-19 vaccines have been advanced. These proposals are often focused on fostering public trust in the vaccine approval process, removing practical barriers to vaccination, and promoting vaccine acceptance through community engagement, identification of trusted leaders, and public health messaging.

Marketing and advertising experts believe that public health officials could use advertising theory to achieve herd immunity to COVID-19. Whilst efforts to date have been focused on vaccine distribution, marketers believe that addressing how people think and feel about getting the vaccine could convince sceptics to vaccinate. Another perspective is that community leaders and local health workers can also play a key role in tackling vaccine-related fear and misinformation; and that incentives from states, cities and employers could help get sceptics through the door of local vaccination centres.[4] Some countries, and employers such as Google and Facebook, have also considered mandating vaccinations.[5]

Recently, however, several individuals from across the political spectrum have proposed paying cash incentives for COVID-19 vaccination.

The Grattan Institute, an Australian public policy think tank, suggests ways the federal government could encourage immunisation as more COVID-19 doses arrive in Australia. One suggestion for the country to begin to shift away from lockdowns and economically damaging restrictions on travel and business ­- and move towards COVID-normal in 2022 – is to have a weekly, million-dollar lottery and proof of vaccination for travel and to attend sport or music festivals.[6]

John Delaney, a former congressman from Maryland, USA, and a 2020 Democratic presidential candidate, has suggested paying every individual in the US who provides proof of vaccination $1500 via check or direct deposit. If every adult took advantage of this program, the estimated cost would be approximately $383 billion. Delaney contends that his plan is “worth the cost” because it would save lives, provide “relief to struggling Americans [and]…accelerate the reopening of the economy.” And just this week, President Joe Biden proposed that all states in the USA should offer US$100 to each person as an incentive to get vaccinated.

Paying people to get vaccinated against COVID-19 might be a reasonable policy if it were necessary to achieve herd immunity. Yet payment-for-vaccination proposals are not only unnecessary, but come with significant moral and ethical issues.

Some have argued that people have a moral duty to be vaccinated, including a duty to promote their own health, a duty to others to promote the community benefit of vaccination, and a duty to society for individuals to do their fair share in putting a stop to the pandemic. Being vaccinated in order to receive a $1000 or $1500 incentive robs the act of moral significance. However, it is morally appropriate to offer payment to people who are vaccinated to reimburse reasonable vaccine-related expenses or as a form of compensation for the time and effort expended to become vaccinated, analogous to the modest payment offered to citizens summoned for jury duty. Such payments may even be morally imperative if they are necessary to overcome barriers to vaccination.[7]

Whilst money is a motivator, how much is enough to counter vaccine hesitancy? The incentives already given by many countries indicates that just giving the equivalent of  “Beer Money” is not enough to cut through the noise around vaccine hesitancy.

In this article it is proposed that there is a much more effective way of overcoming vaccine hesitancy, and at a much cheaper cost. This is by providing megabucks of money targeted at the one issue that is most prevalent in people’s minds, i.e., can the vaccine kill them?

In economics, there is a valuation method called ‘Contingent Valuation’; which is a method of estimating the value that a person places on a good. The approach asks people to directly report their ‘willingness to pay’ to obtain a specified good, or ‘willingness to accept’ to give up a good, rather than a third-party inferring them from observed behaviours in regular marketplaces.

Monetary incentives or influences within health decisions are not new concepts. Examples of monetary drivers include withholding of medical services due to lack of health insurance, as in the USA; or conversely excessive testing and treatments for futile or unnecessary conditions in those who can simply afford to pay for it. In the extreme circumstances we find ourselves in, Governments may need to consider extreme measures, including the contingent valuation approach on human lives (Ratnatunga, 2020).

Clearly, all the research indicates that the number one reason for vaccine hesitancy, especially of the AstraZeneca vaccine, is that the vaccination will result in developing a blood-clot which will eventually kill them. The question is, “How much would they be willing to accept to take this risk?”

Would a ‘Million Dollars’ that goes to their next of kin should they die as a direct result of the vaccination be sufficient compensation?

Whilst a layperson can ask someone directly what monetary compensation he or she is ‘willing’ to accept to give up their life, they cannot legally be part of any action that implements that offer – should it be accepted. However, these values are being regularly indirectly inferred from their willingness to pay for a life insurance policy. Here the policyholder is giving a value as to how much they need to be compensated if they lost it, involuntarily. One could argue that death due to complications from the COVID-19 vaccination could be classified as ‘involuntary’.

Though there are a plethora of legal, ethical and moral implications that would need to be addressed in estimating the actual amount of the monetary compensation, the management accounting numbers are extremely simple to calculate.

As of 20 May 2021, Australia had recorded 21 confirmed cases of blood clots following administration of 2.1 million doses (10 cases per million). As Australia’s population is approx. 26 million, this is approximately 260 cases of possible blood clots. In the UK, of 21.2 million doses of AstraZeneca given by April 14^th, 2021, there were 168 cases of blood clots. That is approximately 8 cases per million, or 0.0008%. Most of the cases were of clots in the brain. Of these 168 cases in the UK, there were 32 resultant deaths (19%). These statistics are not indicative of every country. For example, by April 9th, 2021, Germany had a higher ratio of clots to dosage: there, 31 people developed blood clots out of 2.7 million doses (11 per million).[8]

Taking the UK statistics and doubling it, even if 40% of Australia’s possible 260 confirmed cases of blood clots result in deaths, that is about 104 deaths. The Federal government could give affected families $1 million each, for a total cost of $104 million.

Victoria’s recent lockdown cost about $100 million a day in lost economic activity, according to the Victorian Treasury. NSW’s current lockdown will cost about $140 million a day, according to AMP. The total cost of current lockdowns affecting Sydney, Darwin, Brisbane and Perth will therefore be in the billions.[9]

Whilst it is correct that the causal links between AstraZeneca and the blood clotting side effects are still under investigation, and there currently are no hard statistics about which demographics are most likely to be affected, the numbers tell the story, i.e., death due to vaccination is a very rare event. In contrast, death due to no vaccination is extremely common. In recent weeks, one piece of data has gotten a lot of attention: 99.5% of all the people dying from COVID-19 in the U.S. are unvaccinated.[10]

The Australian Federal Government could even give families of those who die of the vaccine $10 million each and come out well in front. It is megabucks, not lotteries or beers that will overcome vaccine hesitancy.

It is surprising that such a solution has not been proposed before. Am I missing something?

Prof. Janek Ratnatunga

CEO, ICMA Australia

The opinions in this article reflect those of the author and not necessarily that of the organisation or its executive.

[1] Rachel Clun and David Crowe (2021), “Leaders seek fine balance of economy, jab targets”, The Age, July 29, pp. 1-4.

[2] Jamie Murphy, et.al. (2021), “Psychological characteristics associated with COVID-19 vaccine hesitancy and resistance in Ireland and the United Kingdom”, Nature Communications, 12 (29). https://www.nature.com/articles/s41467-020-20226-9.

[3] Ben Edwards, Nicholas Biddle, Matthew Gray & Kate Sollis (2021), “COVID-19 vaccine hesitancy and resistance: Correlates in a nationally representative longitudinal survey of the Australian population”, Pone, March 24, https://doi.org/10.1371/journal.pone.0248892.

[4] Ofer Mintz, Rohit Deshpandé & Imran S. Currim (2021), “3 tactics to overcome COVID-19 vaccine hesitancy’, World Economic Forum, June 28. https://www.weforum.org/agenda/2021/06/3-tactics-to-overcome-covid-19-vaccine-hesitancy/.

[5] Cara Walters (2021), “Google staff vaccination mandate hits roadblock”, The Age, p.5.

[6] Rachel Clun (2021), “$ 1m lottery urging to vaccinate”, The Age, July 29, pp. 4.

[7] Emily A. Largent & Franklin G. Miller (2021), “Problems with Paying People to Be Vaccinated Against COVID-19”, JAMA, January 6. https://jamanetwork.com/journals/jama/fullarticle/2775005

[8] Deborah Devis (2021), “AstraZeneca and blood clots: by the numbers”, Cosmos, 28 April. https://cosmosmagazine.com/health/medicine/astrazeneca-vaccine-blood-clots-statistics-percentage/.

[9] Patrick Abraham, Laxman Bablani, Natalie Carvalho & Tony Blakely (2021), Yes, lockdowns are costly. But the alternatives are worse, The Conversation, July 1. https://theconversation.com/yes-lockdowns-are-costly-but-the-alternatives-are-worse-163572.

[10] Rodney E. Rohde & Ryan McNamara (2021), “US is split between the vaccinated and unvaccinated – and deaths and hospitalizations reflect this divide”, The Conversation, July 22.