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Should vaccination strategy switch from carrots to sticks?

By Vidal Seegobin

January 27, 2022

    A couple of weeks ago, our international research team conducted a global scan of what various countries, provinces, and states are doing to confront the wave of omicron infections. One emerging policy that we found that required its own, separate investigation is the increasing use of penalties to increase vaccination rates.

    By penalties we're talking about added costs and/or loss of activities and privileges. And in this context, they're applied to individuals who don't adhere to vaccination guidelines. A raft of jurisdictions from Austria to Quebec to Singapore are toying with the idea of making it more difficult for people to operate in society while unvaccinated.

    The first question to ask is: are penalties even needed? Well, unfortunately the data is clear that rewards don't meaningfully increase vaccination rates. Ohio introduced a lottery-based incentive to randomly pay vaccine recipients up to $1 million, but there is no evidence to prove this worked. And in Alberta, Canada where the provincial government introduced CAD$100 gift cards and entry into a lottery for people who received their jabs, the story is very much the same. So, at this juncture, I think it's fair to at least entertain the idea of penalties.

    Then the next question is: do penalties increase vaccination rates? If you look at why people are not being vaccinated it breaks down into either:

    1. "I'm worried about the associated risks with getting the shot" and/or
    2. "I don't trust the actors that are promoting these vaccines."

    For places like Quebec, Greece, and Austria, penalties do not address the fear of side effects. But they do reinforce the more conspiratorial theories behind the vaccine.

    So, they won't work, right? Well, two points to make on that front.

    The first is that an individual's cost benefit analysis is always updating. How much more important is the clinical risk than, say, going to restaurants or higher bills for Covid-19 treatment? We don't know what will work so I am in favor of trying a bundle of penalties both immediate and long-term to encourage vaccinations (Quebec is reporting a spike in vaccine appointments after its unvaccinated tax was announced).

    My second point is that these penalties are not about increasing vaccination rates (at least not entirely). Instead, they are signals to the majority population that "we see that you're making sacrifices and following the rules and we're not going to tolerate free riders." I think that's what Macron is doing. That's what happened with Novak Djokovic in Australia and that's what Legault in Quebec is doing.

    If I'm right and it's about political theater, then what I expect we'll see is a lot of noise and little implementation of these penalties for the unvaccinated since the major target audience are in fact the vaccinated.

    So, on the question of yes or no for vaccination penalties, I fall out on yes.

    The omicron scenario planning guide

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    For two years, the novel coronavirus has tested health care leaders. Staff are burned out, patients are confused, vaccination rates have stalled, and the future remains uncertain. As the highly transmissible omicron variant spreads among both vaccinated and unvaccinated groups, leaders must address its impact on capacity, staffing, and public health.

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