New York City officials are hoping a cash incentive to get the COVID-19 vaccine booster will help slow the impact of the omicron variant.
The Big Apple is offering $100 to people who receive the shot at city-run vaccine sites between now and the end of 2021, Mayor Bill de Blasio announced, calling it "the biggest booster incentive program" in the U.S.
"We want everyone, right now, as quickly as possible, to get those boosters," he said during a news conference on Tuesday.
"It's going to make you feel a lot safer, a lot better that you got the booster, and you'll have some more cash in your pocket at the same time."
There's been a lively debate over whether to pay people to get the jab ever since the COVID-19 vaccines started to become available in December of 2020. One year later, about 20% of U.S. adults are still not vaccinated and don't plan to be, according to a Gallup poll released in November 2021.
The reluctance of those holdouts to get the shot has led some high-profile voices to support a financial incentive. Pres. Biden urged state and local officials to offer $100 cash payments for COVID-19 vaccinations as the delta variant spread in the summer of 2021.
"People should get paid," wrote Stephen L. Carter, a professor of law at Yale University, in a column for Bloomberg Opinion in the fall of 2021. "Get a shot, get a check... Incentives work."
He suggested paying Americans $1,000 each to get vaccinated. Robert Litan, a senior fellow at the Brookings Institution, a nonprofit public policy organization in Washington, D.C., also supported paying at least $1,000 per person.
Former U.S. representative and presidential candidate John Delaney thought the amount should be $1,500 per person — calling it “a stimulus check & big vaccine incentive rolled into one” in a tweet last year.
Paying for vaccination may be “an ethically superior option” over making the shot mandatory, and could be “very cheap” when compared with the alternatives, according to a paper published in the Journal of Medical Ethics.
The pros and cons
There have been other examples of people getting compensated in a health setting such as being paid for donating plasma or taking part in medical studies. Many companies also offer financial incentives for employees who take part in wellness programs, including reducing health insurance premiums or funding a worker’s health care account.
Paying people to get a shot that’s likely to improve their health doesn’t necessarily raise ethical concerns, said Seema Shah, a bioethicist at Lurie Children's Hospital of Chicago.
“Paying people to take vaccines is worth considering in order to end the pandemic more quickly by protecting the population from COVID-19,” Shah told TODAY in 2020.
“When we worry about payment, it’s because the lure of money might entice people to make bad decisions. In this case, people would be paid to take vaccines that would benefit them and others, which has the potential to be a win-win.”
But other experts were opposed to offering money as an incentive to get immunized.
“People should understand that they are part of society. It's like paying people to stop at stop signs,” said Dr. Paul Offit, director of the Vaccine Education Center at Children's Hospital of Philadelphia.
Arthur Caplan, founder of the division of medical ethics at NYU School of Medicine, called it “a very bad idea.” He believed "anti-vaxxers" — people who are part of the anti-vaccination movement — would use any payment efforts to build more distrust.
“If you pay people to get vaccinated, the strong implication is it's not safe, there's something wrong, you have to use money to persuade them,” Caplan said.
“Historically, we've never paid anybody to vaccinate with routine vaccinations — we've always said they’re safe and they work, and that's why you should use them. You start rewarding them financially, I think many people may get nervous that they can't be safe, they can't work, there must be some reason you have to pay me to get it.”
In studies, participants who are paid spend more time examining the risks, suggesting that paying people to do something signals that something is risky or might not be good for them, Shah noted.
People who are paid to donate plasma or take part in studies are compensated because they don’t directly benefit, but people who get a highly-effective COVID-19 vaccine benefit by becoming protected from the disease, Caplan said.
In addition to cash, states have offered various incentives to attract vaccine holdouts — everything from complimentary amusement park tickets to free fishing licenses.
Some states also created "vaccine lotteries" that allowed vaccinated residents to become eligible to win a big cash prize. The results of those incentives were mixed, an investigation published in JAMA Network Open in Dec. 2021 found.
The lotteries were associated with increased vaccinations overall and in Ohio, Maryland, Oregon and Washington; but not in Arkansas, Kentucky and West Virginia.
The findings may be "relevant to the ongoing debate on how to persuade the millions of U.S. residents who are not yet vaccinated against COVID-19," the authors wrote.