To Reward or Punish? The U.S. Changes Tone on COVID-19 Vaccines

As hospital beds across the U.S. remain occupied by largely unvaccinated patients infected with the delta COVID-19 variant, governments and employers alike are reconsidering their approach to encouraging vaccinations. The days of flashing a vaccination card for token incentives like free beer, lottery tickets or donuts may soon be coming to an end. Instead, governments and private companies are complementing (or swapping out entirely) their incentives with punishment. Meanwhile, families and businesses are facing the prospect of more venues closing just when schools are ready to reopen.

Offering carrots to reach herd immunity and stop COVID-19

The messaging of encouraging COVID-19 vaccinations has evolved quite a bit since the first doses were administered back in December 2020. Early adopters were offered little in the way of financial incentives, but rather given assurance that they were protecting themselves and others from the virus that’s taken the lives of more than 600,000 people in the U.S. As the number of vaccine doses available outpaced the number of people willing to get the shots, state governments began rolling out creative programs to entice people who were on the fence. Campaigns like Ohio’s Vax-a-Million and Washington’s Shot of a Lifetime offered million-dollar grand prizes as well as smaller prizes like tickets to sporting events or game consoles. Businesses joined the party too, offering incentives ranging from grocery store gift cards to complimentary packages at Hustler Clubs valued at $5,000.

The latest messaging is the most severe to date. U.S. President Joe Biden announced in late July that the roughly 4 million workers in the federal government would be required to sign forms proving they’ve been vaccinated. Unvaccinated federal workers would be subject to stricter COVID-19 compliance rules, including mask mandates and weekly testing. New York City’s mayor, Bill de Blasio, issued a similar mandate for all city or contracted workers, though he upped the ante for New Yorkers. By August 16, those wishing to attend a performance, eat indoors or work out at a gym must provide proof of at least one dose of the vaccine.

The government’s latest announcement could serve as a model for private businesses, though the government has said it will foot the bill for the weekly COVID-19 tests, a potentially costly investment for businesses.

(Tina Casey has brilliantly covered COVID-19 vaccine responses: Read her latest work on corporate leaders losing patience and the healthcare industry’s influence on upping vaccination rates.)

More companies are wielding a stick

Some companies are going a step further, like CNN and the National Football League, which have each terminated unvaccinated employees. CNN fired three of its unvaccinated workers after they came into the office. The companies’ president, Jeff Zucker, issued a memo which stated the vaccine is required for those reporting in the field, working with fellow employees or going into the office.

The Minnesota Vikings made headlines after firing an offensive coach for refusing to get the COVID-19 vaccine, complying with new NFL guidelines requiring Tier 1 staff including front-office executives, trainers, scouts and coaches to receive the vaccine. Perhaps more worrisome for NFL fans and franchises, a game that needs to be rescheduled due to a COVID-19 outbreak caused by an unvaccinated player or staff member will be forfeited by the infected team. This is a considerable punishment and break from the puzzle piecing that went into rescheduling the 15-plus games delayed during the 2020 season due to COVID-19.

Notably, Tyson Foods joined the growing list of employers requiring its staff to receive the vaccine, representing one of the first frontline companies to announce such a policy for its workers. Fewer than half of the 120,000 workers employed by Tyson Foods are vaccinated, and the union representing Tyson employees has rebuked the company for instituting such a mandate despite the vaccines having only emergency approval from the Food and Drug Administration.

There hasn’t been a universal shift away from incentives. Vanguard announced a $1,000 payment for proof of vaccination. Aviation giants Delta, United and American Airlines are all offering additional paid leave for vaccinated employees. (United is now requiring all of its employees to be vaccinated, and Delta is not hiring unvaccinated candidates.) Paid time off to get the vaccine has become an increasingly popular (and smart) approach, as companies like Walmart hope to negate the tough choice hourly workers have to make between getting the vaccine or receiving more hours at work.

So what works, the carrot or the stick?

In the next five years, the number of case studies to be published about the efficacy of COVID-19 vaccine campaigns is likely to exceed the shelf space currently available in all of the U.S. public libraries. Most of what works and what doesn’t is speculative and will need to be contextualized. An incentive-based program in Arkansas may yield different results than the same program run in Oregon.

The last few months have shown intriguing initial responses of incentives for the unvaccinated population, but they lack the momentum to sustain any scalable success. Ohio’s Vax-a-Million campaign, for example, did correspond with an uptick in vaccination rates, but at a rate on par with other states not offering lottery programs.

Including lucrative incentives may also be setting companies and state governments up for a difficult not-so-distant future response. As it’s become increasingly understood that the vaccines are likely not one-offs, those who responded well to the incentives may expect the same rewards when the time for a booster shot arrives. If the states and companies refuse similarly competitive incentives, how will iffy vaxxers react?

The now-popular strategy of balancing incentives and punitive measures is likely to yield the best results. People innately respond differently to rewards and punishments, so why choose one or the other? At this unprecedented time, companies and governments find themselves authors of their own rulebook. And credit must be given to companies and governments for developing creative incentives or taking gutsy stands to try and increase vaccination rates among their employees or constituents.

Image credit: Mick Haupt/Unsplash