The approval of the first Covid-19 vaccine in the United States was hailed over the weekend as the beginning of the end of the pandemic. But the road between delivering the first doses and widespread vaccination at rates that will arrest the spread of coronavirus is far from straightforward. Besides the logistical challenges of distributing the vaccine, people must also be willing to take it. A new survey has found that more than a quarter of Americans are hesistant.
Two prominent economists, N. Gregory Mankiw and Robert Litan, and the politicians John Delaney and Andrew Yang have proposed or supported paying Americans to receive the vaccine. At first glance, this seems like a reasonable idea; economics teaches us that people respond to incentives. But behavioral research suggests this strategy could backfire.
Humans don’t respond to incentives like rats pressing levers for food; they try to interpret what being offered payment means. In this case, the offer risks implying that the vaccine is not a thing of value.
Studies cited in a paper titled “Tom Sawyer and the Construction of Value” (referring to a famous section of the Mark Twain book in which Tom persuades his friends that whitewashing a fence is a desirable activity) have found that when people aren’t sure whether something is good or bad, the prospect of payment helps them decide, in the negative.
In one of the studies, a professor asked his students whether they would attend a reading of Walt Whitman’s “Leaves of Grass,” offering half of the students payment for attending the reading, while asking the other half if they would pay to attend. Those offered payment wound up reporting less interest in attending. For those unsure about being vaccinated, like those unsure about attending the poetry reading, paying will most likely send the message that this is something you would not want to do without compensation.
People are also likely to infer from payment that the vaccine could be risky. In our research with Kevin Volpp and Alex London, we found that people naturally assume that payments signal risk. In a series of experiments, we described clinical trials that offered different payment amounts for participating in a study that involved an unfamiliar testing procedure. We found that people believed that a study’s riskiness was greater when the payment was higher, even though the descriptions of the study procedures were otherwise identical. Paying people to be vaccinated might, similarly, lead them to infer that it is riskier than they would otherwise assume.
With distribution of a coronavirus vaccine beginning in the U.S., here are answers to some questions you may be wondering about:
- If I live in the U.S., when can I get the vaccine? While the exact order of vaccine recipients may vary by state, most will likely put medical workers and residents of long-term care facilities first. If you want to understand how this decision is getting made, this article will help.
- When can I return to normal life after being vaccinated? Life will return to normal only when society as a whole gains enough protection against the coronavirus. Once countries authorize a vaccine, they’ll only be able to vaccinate a few percent of their citizens at most in the first couple months. The unvaccinated majority will still remain vulnerable to getting infected. A growing number of coronavirus vaccines are showing robust protection against becoming sick. But it’s also possible for people to spread the virus without even knowing they’re infected because they experience only mild symptoms or none at all. Scientists don’t yet know if the vaccines also block the transmission of the coronavirus. So for the time being, even vaccinated people will need to wear masks, avoid indoor crowds, and so on. Once enough people get vaccinated, it will become very difficult for the coronavirus to find vulnerable people to infect. Depending on how quickly we as a society achieve that goal, life might start approaching something like normal by the fall 2021.
- If I’ve been vaccinated, do I still need to wear a mask? Yes, but not forever. Here’s why. The coronavirus vaccines are injected deep into the muscles and stimulate the immune system to produce antibodies. This appears to be enough protection to keep the vaccinated person from getting ill. But what’s not clear is whether it’s possible for the virus to bloom in the nose — and be sneezed or breathed out to infect others — even as antibodies elsewhere in the body have mobilized to prevent the vaccinated person from getting sick. The vaccine clinical trials were designed to determine whether vaccinated people are protected from illness — not to find out whether they could still spread the coronavirus. Based on studies of flu vaccine and even patients infected with Covid-19, researchers have reason to be hopeful that vaccinated people won’t spread the virus, but more research is needed. In the meantime, everyone — even vaccinated people — will need to think of themselves as possible silent spreaders and keep wearing a mask. Read more here.
- Will it hurt? What are the side effects? The Pfizer and BioNTech vaccine is delivered as a shot in the arm, like other typical vaccines. The injection into your arm won’t feel different than any other vaccine, but the rate of short-lived side effects does appear higher than a flu shot. Tens of thousands of people have already received the vaccines, and none of them have reported any serious health problems. The side effects, which can resemble the symptoms of Covid-19, last about a day and appear more likely after the second dose. Early reports from vaccine trials suggest some people might need to take a day off from work because they feel lousy after receiving the second dose. In the Pfizer study, about half developed fatigue. Other side effects occurred in at least 25 to 33 percent of patients, sometimes more, including headaches, chills and muscle pain. While these experiences aren’t pleasant, they are a good sign that your own immune system is mounting a potent response to the vaccine that will provide long-lasting immunity.
- Will mRNA vaccines change my genes? No. The vaccines from Moderna and Pfizer use a genetic molecule to prime the immune system. That molecule, known as mRNA, is eventually destroyed by the body. The mRNA is packaged in an oily bubble that can fuse to a cell, allowing the molecule to slip in. The cell uses the mRNA to make proteins from the coronavirus, which can stimulate the immune system. At any moment, each of our cells may contain hundreds of thousands of mRNA molecules, which they produce in order to make proteins of their own. Once those proteins are made, our cells then shred the mRNA with special enzymes. The mRNA molecules our cells make can only survive a matter of minutes. The mRNA in vaccines is engineered to withstand the cell’s enzymes a bit longer, so that the cells can make extra virus proteins and prompt a stronger immune response. But the mRNA can only last for a few days at most before they are destroyed.
Data thus far suggest that the early Covid-19 vaccine candidates from Pfizer and Moderna are safe and effective — evidence that has already led to emergency approval of the Pfizer candidate. Although direct payments for vaccination might increase uptake for some people in the short term, the effects just described might ultimately lead to exactly the opposite of the intended effects, especially for those uncertain about whether the risks of vaccination exceed the benefits.
In addition to making the vaccine seem riskier, payments might also make people less likely to get vaccinated for the selfless goal of helping others. Research shows that paying people to take altruistic actions often backfires. In one study, Israeli high school students who collected for charity on a particular day of the year collected less money when they were paid a small commission.
The paper reporting the study, titled “Pay Enough or Don’t Pay at All,” argued that the amount paid was too little to motivate the students, but enough to raise questions about the motives of students who collected a lot of money, both in the minds of people observing those students, and possibly even on the part of student collectors themselves. That same logic would suggest that paying people to get vaccinated could diminish the motivation of those who are altruistically motivated, or who would like to appear so.
A more promising approach might be to make desired activities, such as travel, contingent on vaccination. The Australian airline Qantas reports that it and other airlines are considering making vaccination a requirement for international air travel. If a vaccination becomes associated with enjoyable outcomes, such as travel and access to large public events, vaccination itself will become positively valued. When people perceive the various benefits of vaccination, skepticism is likely to evaporate, at least for some.
In the end, the circumstances surrounding the rollout of the vaccine may shape attitudes toward it. Given the complexities of producing and distributing the vaccine, it is almost sure to be scarce for months. The silver lining to this is that much research in marketing has shown that scarcity can be a huge stimulator of demand. Seeing others eager to be vaccinated — waiting desperately to get to the front of the line — could make people more likely to see value in the vaccine and to want it themselves.
George Loewenstein is the Herbert A. Simon Professor of economics and psychology at Carnegie Mellon University. Cynthia Cryder is an associate professor of marketing at Olin Business School, Washington University in St. Louis.