More than a third (37%) of the population is still leery of getting a COVID-19 vaccine, according to Kaiser Health News.
Among the vaccine hesitant / resistant, 17% want to wait and see how the vaccines do, 13% insist they will definitely not be getting the shot, and 7% do not want to get vaccinated but will if they are required.
Those wanting to wait and see have decreased from 39% of the population to 17% since December 2020, while the percentages of people who will only get the vaccine if required and those who definitely will not participate have stayed roughly the same.
Therefore, some government agencies and private employers are debating COVID-19 vaccination mandates, while others are attempting to use incentives to encourage employees to get vaccinated.
American Airlines, Amtrak, McDonalds and Trade Joe’s are offering employees free time off, while Kroger is giving employees $100 if they show proof of vaccination.
The most innovative offer is in New Jersey. Gov. Phil Murphy recently announced a program where people who get vaccinated can get a free beer from one of 13 area breweries.
Getting free stuff for participating in a health clinic initiative is nothing new.
My closet is filled with T-shirts from the American Red Cross. Many employers have wellness programs, which give significant discounts on health insurance premiums.
There have been three historic methods for motivating people to focus on their health.
The first is an appeal to morality.
We should get the COVID-19 vaccine simply because it is the right thing to do. Evidence shows that it significantly protects the person getting the vaccine plus it helps to protect the community and build herd immunity.
This is the same argument we use when encouraging health care workers to get an annual flu shot. It is a safety issue for the individual and a public health benefit.
The second approach is to create rules or mandates.
It is common for employers to insist that employees receive specific vaccines. For example, most hospitals require staff to get a flu vaccine or fulfill other requirements like wearing masks and other PPE.
This is the same method used in public schools. Children are required to receive specific vaccines in order to maintain enrollment.
Exceptions are made for medical, religious and other reasons in many states, but these require signed doctor’s explanations or sworn affidavits from the individual seeking an exemption.
The third method of motivating people is through rewards or incentives.
Here, individuals are incentivized to make a health care choice in exchange for a reward.
I participate in my employer’s wellness program and receive a significant discount on my insurance plan. To be honest, I do not work out or go running because I like it. I want the discount.
I also have a device in my car from my automobile insurance company that watches how I drive and then I get a discount accordingly.
Incentive programs are tricky.
They can sometimes work magic to encourage the undecided to participate. Yet, they are not really effective at changing the minds of those who have made a clear decision.
In the case of COVID-19, incentive programs will do very little to convince the 13% who flat out refuse to be vaccinated.
The 7% who claim they will get the vaccine if required probably will only be motivated by an employer mandate. This is unlikely to happen on a large scale outside of health care or education.
Most of the 17% who want to wait and see probably will be vaccinated in the next few months anyway. We could speed up the process with an incentive, but there are still people who clearly want a vaccine and have not been able to get one yet.
On the negative side, an incentive program might put employers in a bind by potentially creating a precedent that people should be paid to take care of themselves.
Early adopters of the vaccines will want to know why they did not get an incentive. They did the right thing for the right reason and now they are losing out.
These late adopters had to be paid to get on board, so the next time there is a public health emergency, many could be tempted to wait and see how good the incentives are before committing.
On the other hand, mandates and programs that penalize employees for non-compliance tend to be more effective but create resentment in employees.
People do not like to be told what to do, even if it is for their best interest. Employees will only put up with so many mandates before they seek employment elsewhere.
In industries already facing problems filling positions, mandates are risky.
This is probably not worth the risk, as the 17% who want to wait and see will most likely be vaccinated in time.
They are like late adaptors of new technology. Once a majority of the population is vaccinated, they will agree to vaccination. It is counterproductive to fight this natural process.
Therefore, we are left with an appeal to morality.
Vaccinations are good. They protect the individual’s health and they protect the community.
Legislating or paying for morality has always had mixed results. Encouraging people to do the right thing has always been noble and created better citizens.
It is time we make a shift from letting policymakers and government officials do the talking. We need to speak directly to friends and family about their need to get a vaccine, appealing to their sense of right and wrong.
People who want to wait and see need to be reminded they are not getting vaccinated for the state, they are doing it for their friends and neighbors. It’s a moral issue at this point.
Senior Staff Chaplain and Clinical Ethicist at the Baptist Health Medical Center in Little Rock, Arkansas.
