Over the next couple of months, other countries will probably surpass the U.S. on rates of COVID-19 vaccination. The reason is not lack of supply, but vaccine hesitancy. How can more Americans be persuaded to get their shots? Insights from behavioral economics can help.
The U.S. as a whole is approaching having 40% of the population fully vaccinated, but the proportion varies widely from state to state. Almost half of people in Maine have had their shots, but only about 30% in Georgia, Tennessee, Louisiana and Wyoming.
About a quarter of Americans say they don’t want to get vaccinated. That share has declined slightly over the past six months, but it’s higher than in most other countries. In almost every developed economy except France, the share of people who would get vaccinated if offered the chance is 10 to 20 percentage points higher than in the U.S. So as vaccines become increasingly available worldwide, the vaccination rate in the U.S. stands to lag.
Now, the “superforecasters” participating in the Good Judgment Project associated with the University of Pennsylvania are skeptical that the U.S. will reach herd immunity anytime soon. Less than 20% of them think that at least 265 million Americans (80% of the population) will be vaccinated before March 1 of next year. Experts such as former Food and Drug Administration Commissioner Scott Gottlieb are concerned that not many more than half of Americans will get vaccinated.
This problem may be disguised for a while, as the summer mitigates the effects of the virus. The worry is the country will remain well below the level of herd immunity when the respiratory-disease season returns in the fall and winter. What can be done?
Behavioral economics may provide some ideas. Katy Milkman of the University of Pennsylvania has written a fabulous new book describing her pioneering work in the field, including on how to boost vaccination rates. Given the benefits of achieving herd immunity, it is essential to try a wide variety of approaches.
The easiest steps are often remarkably simple. For example, Milkman and others suggest sending text messages to let people know that a vaccine has been reserved for them. That has been shown to be effective in one experiment with Penn Medicine and the Geisinger Health System and another with Walmart.
Those experiments were conducted with the flu vaccine, but the insight may carry over to COVID-19. As Milkman’s colleague Alison Buttenheim has explained, letting people know that a vaccine has been reserved for them may provoke a sense of loss if they don’t get it, along with a sense of obligation to the person who set aside the dose.
Another approach is to have trusted voices encourage vaccination. The government has been trying this with various well-known organizations and personalities. But as Zeke Emanuel, another University of Pennsylvania professor, has emphasized, the most trusted recommendations would come from people’s own physicians.
One thing that would help is to expand vaccine distribution through doctors’ offices, streamlining the process for patients. That would be much easier if vaccines did not require ultracold storage, and new evidence suggests they might not, even the mRNA kind.
A third approach is to highlight activities that only vaccinated people can enjoy. The recently revised guidelines from the Centers for Disease Control and Prevention provide a vivid illustration: Vaccinated people have been advised it’s safe to go maskless and to refrain from distancing and testing.
Finally, it’s worth experimenting with financial incentives — though if they’re not done carefully, these can backfire. One recent experiment shows that paying people $20 to get the COVID-19 vaccine reduces demand compared with no financial incentive, while compensation above $100 helps boost demand. It may be particularly effective to combine generous compensation with the reservation approach. However, this study measured only what people said they would do, not what they actually did.
A more extreme idea is the lottery prize, which has been shown to encourage a variety of behaviors. Ohio now offers $1 million prizes in lotteries for people who have received a COVID-19 vaccine and, for teenagers, a full scholarship to a state university. I bet the prize need not be that high: Anyone willing to get vaccinated to have a chance to win $1 million probably also would be attracted to, say, a $100,000 prize, and then the state could afford many more prizes (and advertise more winners).
None of these approaches is a panacea, but all are worth trying over the summer. When fall arrives, we’ll all be better off if the superforecasters turn out to be wrong.
Peter R. Orszag is a Bloomberg Opinion columnist. He was director of the Office of Management and Budget from 2009 to 2010 and director of the Congressional Budget Office from 2007 to 2008.
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