Part I proposed an oddly-constructed lottery with potentially remarkable properties as a COVID-19 vaccination incentive.1
Part II examines hold-outs and laggards, and the reasons some might respond to such incentives. Part III takes up a range of objections — to incentives in general, and lottery incentives in particular.
Why aren’t more of us vaccinated already? 200 different viruses induce the “common cold”, and as many different factors induce “vaccine hesitancy”. Drawing on untold hours counseling hold-outs in person and on social media, Dr. Daniel Fagbuyi knows that each reluctant subject must identify and understand their “Why” before they can move (or be moved) past it
In short, different Who’s have different Why’s.
Who are our Who’s, what are their Why’s, and which What-If or But will move each Who to take a shot? Every unvaccinated Who in Whoville is infatuated with some beguiling Why over there in Whyville. How many Who’s will kiss their Whyville crushes good-bye for a shot at a million bucks?
It shouldn’t have been this hard … just ask Fauci2 Are we not the human race — the damned species that met the damned deadly smallpox virus and vaccinated it to planet-wide extinction?
We must study harder, learn our lessons, and step up our game.
Pose the right options, and surveys yield some answers. Listen thoughtfully, one-to-one, for other clues.3 Cross-check larger data sets, and we pick up hints of pretext — of conveniently mutable surface excuses for deep, stubborn, unspoken reasons.4
What kind of reasons? Complex reasons. Are we not the human race — the only damned species whose members could ever claim “the damned COVID is fake” and simultaneously insist “the damned COVID is Made in China” … even as they croak their final good-byes?
Few of the unvaccinated are committed anti-vaxx movement “lifers”. Most aren’t conspiracy nuts or hard-core ideologues. Survey results are maddeningly inconsistent, but many — possibly most — intend to get their shots but haven’t got it done.
Some laggards are physically limited or digitally disadvantaged. Some live under the long shadow of Tuskegee, or red state social pressure, or in news deserts or medical deserts. Some put their faith in God, or yoga, or yogurt, or hydroxychloroquine. Some hold out to express solidarity with Trump (who nearly died of it, and followed good advice to get vaccinated later on top of his presumed survivor immunity).
Some know (or think) they had COVID and lived. Others didn’t catch it in 2020 and assume they won’t in 2021 either. There are young invincibles, well-informed skeptics, habitual procrastinators, ODD cases5 who reflexively push back. There are folks who think it’s too much fuss and bother … who racked up resentments against masks and closures and lockdowns, and whose adverse attitudes spilled over to vaccines when they became available. And millions who struck a “wait and see” pose when that might have been reasonable, but haven’t re-examined it lately.
There are folks whose ears are closed because of the obstacles they met in earnest efforts to get vaccinated. And there are those who argued it til they turned blue, and would really rather die than admit the nagging in-laws were right.
We can’t resolve every case on the multifaceted spectrum of vaccine hesitancy, but we can apply combinations of access, information, motivation, and empathetic counsel to improve outcomes.
Improve access. It’s just not good enough yet. Let every perplexed and hard-pressed laggard get vaccinated on the spur of the moment, whenever interest peaks and nothing else interferes.
Educate and inform. Find and fill individual knowledge gaps and counter disinformation, mostly by listening before answering, one-to-one, question by question, with a compendium of credibly-sourced answers at hand. In mass communications, put the facts in the lede. Quit giving falsehoods top billing.6
Motivate more effectively. Ditch the death pitch. If it worked, it would have worked by now, wouldn’t it? Emphasize the residual downside of survivable and “silent” COVID: compromised lungs, kidneys, hearts … and minds7. Marginal disabilities take young healthy specimens out of the running for all kinds of success in the prime of life, and rob them of reserves they’ll need as the years add up. Protect yourself, protect your family, protect your community.
Now, where does a million-dollar lottery come in?
About half of us play state lotteries, and the average American spends $1,000 a year!8 Some — even some of the attitudinally opposed — will take the free shot for its own sake, for fun, or for FOMO.
For the millions idling in wait-and-see mode, it will grab attention and lead some to re-weigh the pro’s and con’s, but with more current information. Some of those will decide it’s time to make the move.
At any given time, millions seem stuck atop the broad, flat, equivocal cusp of a value function, stranded status quo in decisional no-man’s land. They might need a NUDGE9, and might very well respond favorably.In the language of behavioral economics, “nudges” can be conveniences, default options, or de minimis incentives that alter behavior without changing an underlying value proposition.
For those facing practical, logistical hurdles, the lottery might be nudge enough to bum a ride to a clinic, or impose on a friend to help set an appointment.
Nudges aside, behavioral economics sheds light on lottery decisions, under subject headings like prospect theory and positional goods. Even a badly-priced lottery ticket may give the buyer better real-world odds of jumping to a higher-rung on the economic ladder, compared to putting that dollar in the bank. In our case, the lottery is free and players come out ahead even when they “lose”.
Monetary incentives — and lotteries in particular — have their critics. Oh, boy, do they ever! Part III will take up a range of objections — some potentially meritorious issues the particulars of our proposal are design to circumvent, and other complaints we hold in lower regard.
Vaccination incentive lotteries have been suggested before, notably by Robert Litan and by Norm Ornstein, but left operational details undefined. Gov. DeWine recently announced a lottery in Ohio, with details due 5/18/2021 and a first $1M drawing 5/26/2021. See “In Ohio, a Shot in the Dark”.
Google finds 1,630,000 results for Fauci+never+imagined.
Derek Thompson, The Atlantic, “What Are They Thinking?”
Kathleen Hall Jamieson advises, “Don’t negate. Displace.”
See Thaler and Sunstein, NUDGE: Improving Decisions About Health, Wealth, and Happiness