Commentary: Offer Compensation to Those Who Receive COVID-19 Vaccine When Available

A new opinion piece in the Journal of Medical Ethics suggests that governments should consider incentivizing people to receive the coronavirus disease 2019 (COVID-19) vaccine when it becomes available to achieve the required level of herd immunity, which could be up to 80% or more of the population. This would help to stamp out the infection and the incentive could either be a financial or “payment in kind,” such as being allowed to forego wearing a face mask in public, according to the paper.

The rising global death toll, in addition to the economic consequences of the pandemic, have led many calls to mandate a COVID-19 vaccination if and when a vaccine is approved. Although the vaccination should be voluntary, according to Professor Julian Savulescu, Oxford Uehiro Centre for Practical Ethics at the University of Oxford, there is a strong case for making any vaccination mandatory if 4 conditions are met, including:

• A grave threat to public health.
• The vaccine is safe and effective.
• The pros outweigh the cons of any suitable alternative.
• The level of coercion is proportionate.

There are mandatory vaccination policies already in place in different parts of the world; however, there are ethical issues if a mandatory approach were to be adopted, which is why an incentive should be considered to address this issue, according to Savulescu.

“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 wrote in the commentary.

On top of logistical issues to producing and administering a COVID-19 vaccine to the world’s population, universal coverage also faces the challenge of rising vaccine hesitancy.

“The problem is likely to be bigger for a new vaccine. For established vaccines, some countries have turned to mandatory vaccination schemes. In an ideal world, the vaccine would be proven to be 100% safe. But there will likely be some risk remaining, and there are risks that have not yet been identified,” Savulescu wrote.

Further, Savulescu added that any mandatory vaccination program would therefore need to make a value judgement about what level of safety and certainty are safe and certain enough.

“So, we cannot say whether a mandatory policy of COVID-19 vaccination is ethically justified until we can assess the nature of the vaccine, the gravity of the problem and the likely costs/benefit of alternatives,” Savulescu wrote.

Although “anti-vaxxers” may never be convinced to change their stance on the topic, an incentive may persuade others to get the immunization who may not have otherwise done so, according to Savulescu.

“The advantage of payment for risk is that people are choosing voluntarily to take it on. As long as we are accurate in conveying the limitations in our confidence about the risks and benefits of a vaccine, then it is up to individuals to judge whether they are worth payment,” he wrote.

Savulescu added that if a vaccine were deemed to be safe enough to offer on a voluntary basis without payment, it must be safe enough to incentivize with payment because the risks are reasonable.

“It may be that those who are poorer may be more inclined to take the money and the risk, but this applies to all risky or unpleasant jobs in a market economy. It is not necessarily exploitation if there are protections in place such as a minimum wage or a fair price is paid to take on risk,” he suggests.

As for incentives that take the form of “payment in kind,” Savulescu suggests the freedom to travel, not wear a mask in public places with a vaccination certificate, or not socially distance.

“Moreover, it would help ameliorate the risks the unvaccinated would pose to others,” he wrote.

REFERENCE

Pay people to get COVID-19 jab to ensure widespread coverage, says leading ethicist. BMJ. https://www.bmj.com/company/newsroom/pay-people-to-get-covid-19-jab-to-ensure-widespread-coverage-says-leading-ethicist/. Published November 5, 2020. Accessed November 6, 2020.