I’m not usually a fan of lotteries — they’re a tax on people who are bad at math, my math teacher once joked. But unlike a lottery, which requires buying a ticket, entry into the COVID-19 vaccination sweepstakes is automatic and free for everyone who gets the vaccine.
Here’s why I’m in favor of them.
People get vaccinated for two reasons: to protect themselves and to protect others.
The first reason is selfish, and it’s enough for lots of people. I’m an infectious diseases specialist, and I’m over 50, so for me, self-protection was reason aplenty. I got the vaccine as soon as I could, as did virtually every other doctor.
But the second reason is not selfish — in fact, it’s altruistic.
Some people who haven’t been vaccinated yet are true conspiracy theorists. But many more aren’t so much afraid, as they just don’t see the benefit. They believe their personal risk of catching a bad case of COVID-19 is low, and let’s assume they’re right.
For those folks, the main reason they would get vaccinated is because they feel a duty to protect others. They are getting a shot, with its possible side effects, because they want to help our community achieve herd immunity and they don’t want to risk spreading it to others if they were to catch a mild or asymptomatic case.
But, let’s face it, not everyone feels a strong enough sense of duty to protect others to get them off the fence and into a vaccination clinic.
Protecting others is sometimes called an ‘externality’ in the decision to get a vaccine, because it’s an ‘external’ benefit — one that goes to someone other than the person being vaccinated.
The idea of a financial incentive — such as a shot at winning a million dollars — is to turn that external benefit into an internal benefit. It’s to reward people for the benefit they’re providing to others by getting vaccinated.
Entry into a sweepstakes is just one form of financial incentive, of course, and you might think it would be better to use another. For example, why not pay everyone who gets vaccinated $5?
That’s not a bad idea, and it would work for some people. But for others, the chance to win a million dollars will be more of a motivator. Lotteries are popular because lots of people will eagerly trade a sure $5 for a possible million.
Plus, there’s already evidence the sweepstakes idea works. Ohio started the first statewide COVID-19 vaccine sweepstakes, and in its first week vaccinations rose 55% for people 20 to 49 and an incredible 94% among teenagers!
Some have objected to using financial incentives to encourage vaccination if they are coercive, but a single entry into a sweepstakes is hardly coercive. Besides, coercion usually suggests someone is being threatened, not rewarded, into doing something they don’t want to do.
A more important objection is that a sweepstakes doesn’t address certain underlying reasons why some people aren’t getting vaccinated, like mistrust of the health care system or trouble getting time off from work. Setting up a sweepstakes must not cause us to ignore these other issues.
Finally, maybe the idea of a sweepstakes just doesn’t appeal to you. Fair enough, but it does appeal to some who’ve been on the fence. Achieving herd immunity is hard, and one approach won’t work for everyone. But herd immunity is our ticket out of this pandemic, just like it was for diphtheria, polio and smallpox — each of which was once a worldwide scourge. We need to work all angles to get people vaccinated.
Dr. Matthew Wynia is a professor at the University of Colorado School of Medicine and Colorado School of Public Health and director of CU’s Center for Bioethics and Humanities, located on the CU Anschutz Medical Campus.
This article originally appeared The Denver Gazette as part of a point/counterpoint opinion editorial.
November 16, 2023