Jackpots for Vacc Shots - Part I
Here we propose a novel incentive device for COVID-19 vaccination — a very peculiar lottery. A lottery with no tickets, no registration database, no need for government funding, enabling legislation or regulation, ZERO per-capita operating costs, and no need for active individual buy-in.
Two notes of urgency:
While writing this (and learning the ropes at Substack publishing), we learned a close friend’s middle-aged daughter — one of those who never got around to it — is at death’s door.
We also came across national treasure Norm Ornstein’s May 4 tweet proposing a $10M vaccination lottery. The Twitter version of his plan is not exactly clear. It’s not exactly right either. But it’s not entirely wrong, and it has spurred interest. Read on, as we take up that broad notion and sharpen it into a working tool.
Odds are you, dear reader, are already vaccinated. You scrambled to take your shot as earnestly as you dug for reliable news when the COVID first hit the fan.
Now that vaccine is abundant, there are fewer enthusiastic recipients left. Immunization faces steeper hills and stronger headwinds.
Aggressive variants are crowding out “classic” COVID, the maths have changed, and the threshold of herd immunity is getting higher — arguably out of our reach. But that’s a reason to try harder, not to
Most vaccine hold-outs today — maybe 9 out of 10 —are not militant objectors. They’re laggards They never got around to it, never rethought an early wait-and-see attitude, didn’t think it’s their problem, or maybe they did care … but just not enough.
There are several kinds of laggards, and several ideas about how to move them. Incentives were tossed around last year — and largely dismissed — before we had today’s intel on vaccines, variants and viewpoints. Suddenly, they’re back.
In late 2020, entrepreneurial-minded presidential hopefuls Delaney and Yang proposed rewards of $1,000 to $1,500 — up to $380B in cash payments. A bulldozer, as tools of influence go, and a bootless one at that1.
At the plastic spork end of the tool shed are free doughnuts (a sweet marketing ploy), hot dogs (won’t cut the mustard), “a Shot and a Beer” (a drop in the bucket).
Mid-range models (maybe the lawn tractor equivalent) include WV Gov. Justice’s $100 Savings Bond idea ($27.5M plus operational costs, covering ages 16-35), and similar amounts in cash grants or gift cards for students, employees, public recipients or friends who get others to the clinic. Surveys suggest these rewards would move some laggards — but surveys tell us what people say, not what they do.
The best tool for the job might be a lever, not a bulldozer. For good or ill, lotteries2 can exert enormous motivational leverage.
Let’s try giving one randomly-selected vaccine recipient3 a life-altering one MILLION dollars4. Repeat as necessary, and see who takes notice. It’s a somewhat blind bet, but we can afford to take chances experimentally to move laggards off the dime.
This “Golden Ticket” scheme might sound complicated, but it’s just unfamiliar. Diffuse incentives — the kind that spread rewards evenly across an eligible population — require more moving parts, and are more vulnerable to fraud.
It’s immensely scalable, and orders of magnitude more cost-effective. Excluding promotional expense (which depends on the target market), $10M out of pocket covers 5 or more jackpot cycles for one city, one county, or one whole country. That’s chump change for any number of foundations, interested businesses, even high net worth individuals.
Let’s back up these unbelievable claims with a few concrete details. [Additional issues, objections, cavils and quibbles will be dealt with in Part II.]
How do we select prospective winners? It’s a three-step process with two random drawings.
Select one small US Census unit – a Tract or Block Group — at random. Weight each unit’s odds of selection by stated population.
Dispatch an on-the-ground contact team to canvass the area and build as complete a list of current residents as possible.
Select one name at random from this list. This is our finalist, but not yet our prize-winner.
How do we confirm the lucky finalist as a prize-winner?
If they don’t respond to the door, the phone, the mail, social media or any other means of contact, they’re out of luck. We start over in a new Census unit.
If they admit they’re not vaccinated, they’re out of luck.
If they claim they’re vaccinated, we’re getting warmer — but still must confirm their residence and vacc status.
We examine records to confirm their identity (no last-minute vaccinated stands-in’s), and confirm they reside in the targeted area (no last-minute interlopers when the contact team shows up to canvass the area).
Finally, the acid test: a blood draw and serologic assay5, to distinguish mature vaccine-driven immunity from survivor immunity, antibody infusions, or yesterday’s hasty jab. Only then do we have a confirmed winner.
How does the winner get paid? Let the prize package include a quantum of professional support. Make sure the recipient is properly banked, advised, and testate.
Then, unlike typical lotteries6 where a “million dollar” winner ends up $400K to the good, let’s make our $1M winner $1M richer. A $1.5M lump sum will suffice for most people in most states — but we can customize to individual cases. And at the $1M scale, there’s little need to annuitize 30-year payouts.
That’s the nutshell version. There are fine points where it’s not perfectly fair7, and cases where it could go horribly wrong8, but at worst case it’ll move some hold-outs to get vaccinated — and to do it sooner rather than later. The sooner your shot takes effect, the more chances you have to win ... and we never discriminate against early adopters, as many plans would.
Incentive systems attract close scrutiny from practical economists and philosophical ethicists, and properly so. Reward systems are a breeding ground for moral hazards and paradoxical effects. In Part II we’ll take up imperfections, objections, cavils and quibbles. As an appetizer, consider Oxford philosophy Prof. Julian Savulescu’s extended argument in BMJ’s Journal of Medical Ethics to the effect that mandatory vaccination and strong coercive measures are fully justified by accepted ethical standards, … but incentives are better!
We’ll also take a look at different slices of the laggard pie, what reasons restrain them, and how they might respond.
Like other diffuse “horizontal” proposals (spreading rewards evenly across the affected population) the Delaney plan budgeted the cost of incentive payments themselves, but made no operational provision for transacting with a quarter-million individuals. Nor did it have an answer for vaccination cards lost or counterfeited. It could never have worked.
Most proposals in this class would cut costs — and defeat themselves — by rewarding only new vaccine recipients, or conditioning payment on achieving a collective vaccination target, or restricting participation by age or status.
Lotteries helped finance voyages to the New World, colonial infrastructure, and parts of at least 6 of the 8 Ivy League campuses. From the numbers rackets to Powerball to dot-com stock options, ordinary people have long known how ordinary people respond to long odds of large gains. In recent times, behavioral economists have begun to get a handle on the underlying theory.
Not the commercial antibody tests (narrow, hit-or-miss), but all-out multiplex assay. Results for some subjects may still be equivocal, and some dutifully vaccinated but immuno-compromised subjects will not develop sufficient response. Policy guideline: When in doubt, give ‘em the money.
Big name lotteries take out 39% off the top as a “cash value” discount. They also take federal withholding, usually 24%, but a “million dollar” winner will face an effective federal income tax liability in the 30% ballpark — not counting their loss on preexisting income that gets bumped into the 37% bracket. Additional taxes vary by state and locality.
Census counts aren’t perfect, and they’re even less perfect for downscale and minority demographics. Residence may work against students, military, snowbirds. Immune-compromised individuals may not show adequate immune response. It’s not perfectly fair, but it’s as fair as possible.
For instance, the prize might find our winner in the throes of divorce, addiction, or dementia.