Incentivise people to get Covid-19 vaccine, expert suggests

Governments should consider incentivising people to get a Covid-19 vaccine in order to achieve the required level of herd immunity, an expert has said.

The incentive could be either financial or payment in kind, such as being allowed to not wear a facemask in public, the University of Oxford ethicist suggests.

Given the rising global death toll and the far reaching health and economic consequences of the pandemic, there have been calls to mandate Covid-19 vaccination, if and when a jab is approved, according to Professor Julian Savulescu at the Oxford Uehiro Centre for Practical Ethics.

Writing an opinion piece in the Journal of Medical Ethics he argues that though vaccination should be voluntary generally, there is a strong case for making any vaccination mandatory if four conditions are met.

These consist of: when there is a grave threat to public health, the vaccine is safe and effective, the pros outweigh the cons of any suitable alternative and the level of coercion is proportionate.

Prof Savulescu said there are examples of coercion for the public good, including conscription during wartime, taxes and the wearing of seat belts.

He adds that mandatory vaccination policies are already in place in different parts of the world.

But there are ethical issues with a mandatory approach so if voluntary vaccination proves insufficient – incentivisation should be considered, he suggested.

A certain level of uptake will be required to make any vaccination programme really effective and quell the relentless surge of the pandemic.

Prof Savulescu said: “To be maximally effective, particularly in protecting the most vulnerable in the population, vaccination would need to achieve herd immunity.”

The exact percentage of the population that would need to be immune for herd immunity to be reached depends on various factors but current estimates range up to 82%, he added.

He said: “Any mandatory vaccination programme would therefore need to make a value judgement about what level of safety and what level of certainty are safe and certain enough.

“Of course, it would need to be very high, but a 0% risk option is very unlikely.”

Prof Savulescu also argues that until the nature of any Covid-19 vaccine can be assessed, along with the gravity of the problem and the likely costs/benefit of alternatives, it is not possible to say whether a mandatory vaccination policy is ethically justified.

“However, another way of looking at this is that those at low risk are being asked to do a job which entails some risk, albeit a very low one.

“So they should be paid for the risk they are taking for the sake of providing a public good,” Professor Savulescu suggests.

But he points out that payment is not necessarily about coercion, saying: “If a person chooses that option, it is because they believe that, overall, their life will go better with it, in this case, with the vaccination and the payment.

“It is true that the value of the option might exercise force over our rational capacities, but that is no different from offering a lot of money to attract a favoured job applicant.”

However, other experts have disagreed with the view, saying it could be dangerous to incentivise vaccination.

Adam Finn, professor of paediatrics, University of Bristol, said: “The proposal to make immunisation mandatory and the approach preferred by the author to offer financial incentivisation to people to accept the vaccines runs counter to the normal approach taken in the UK which is to offer vaccines free on the NHS and for people to take them voluntarily.”

While Keith Neal, emeritus professor of the epidemiology of infectious diseases, University of Nottingham, said: “Paying people to get vaccinated would set a very dangerous precedent.  The main benefit of vaccination is to protect yourself.

“Any herd immunity from vaccines is a bonus for those unable to be vaccinated.”

He added:  “The idea to pay people to get a vaccine is ill-thought out and potentially counterproductive.

“The money will be much better spent in other parts of the NHS or providing vaccines to low income countries to prevent possible reintroduction into the UK.”

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