Should People Be Paid for Getting the COVID-19 Vaccine?

To date, more than 19 million COVID-19 vaccine shots have been administered in the U.S. with more to be disseminated in the coming months. Although herd immunity may seem far off, some experts argue that it could be achieved if people were paid cash incentives to take the vaccine.

Two prominent economists, N. Gregory Mankiw and Robert Litan, as well as the politicians John Delaney and Andrew Yang, have proposed or supported paying people in the U.S. to get vaccinated.

In a recent paper published on January 6 in JAMA, authors Emily A. Largent, JD, PhD, RN, and Franklin G. Miller, PhD, take a closer look at some of these proposals.

They argue that these policies may not be feasible proposals. They cite four main reasons as to why these payments shouldn't be pursued as policy:

1. People have a moral duty to be vaccinated.
2. Paying a large sum as an incentive to overcome vaccine hesitancy and promote vaccine uptake may not be a wise investment of dollars.
3. Monetary incentive raises ethical questions.
4. COVID-19 vaccine hesitancy stems from rapid development of vaccines and dissemination. It is unclear whether a financial incentive would overcome people’s existing fears and concerns over the COVID-19 vaccines.

Overcoming Vaccine Hesitancy

Delaney, a former congressman from Maryland and 2020 Democratic presidential candidate suggested paying every adult $1,500 if they provide proof of vaccination. If everyone in the U.S. took advantage of the program, it would cost $383 billion, making vaccination payment a costly endeavor.

Payment for vaccination has also been supported by Litan, a nonresident senior fellow at the Brookings Institution who served during the Clinton administration. Litan suggests paying an initial $200 when individuals accept vaccination and another conditional payment of $800 once a national vaccine threshold is reached. Litan’s proposal would cost an estimate of $275 billion.

From a moral standpoint, Miller, a professor of medical ethics at Weill Cornell Medical College, is already opposed to these proposals. “I believe there is a duty to become vaccinated against the coronavirus to protect themselves and others,” Miller tells Verywell. “Typically, when people have a duty to something, then they are not offered payment as an incentive.” 

But beyond morals, he argues that paying a large sum to overcome vaccine hesitancy and promote uptake is not a “prudent investment.”

Miller says it might be a reasonable policy if it were necessary to achieve herd immunity. But paying people to get vaccinated is often unnecessary. “Most people are likely to be eager to get vaccinated," Miller says. "It would be a substantial waste of money to offer to pay $1,000 to every adult who chooses to be vaccinated."

Although payment would not likely help people overcome vaccine hesitancy, Nolan Kline, PhD, MPH, assistant professor of anthropology at Rollins College, tells Verywell that payments would help alleviate financial burden and cover indirect costs associated with vaccination. “What it could do is help cover any costs with getting the vaccine that might contribute to delaying vaccination, such as losing wages because of having to take time off work, or having to pay for transportation to a vaccination site,” Kline says. 

Coercion and Ethics

Overall, a monetary incentive for vaccination might do more harm than good. Because the money can impact a person’s decision to receive the vaccine, it can be perceived as coercion, raising ethical concerns. “It’s possible that providing an incentive could have an unintended consequence of amplifying vaccine hesitancy since some who already do not trust the vaccine might further feel it’s unsafe if people are being paid to get it,” Kline says. 

This concern is illuminated in Black, Brown, and low-income communities, who have been disproportionately impacted by the pandemic, economically and health-wise. “Those who are in poverty or financially stressed may feel that they have no choice but to get vaccinated in order to receive this payment,” Miller says. 

Because some of the COVID-19 vaccine hesitancy stems from the quick approval and dissemination of the Pfizer and Moderna vaccines, Miller states it is unclear if a cash incentive would even help people overcome their apprehensions. 

Vaccine History in the U.S. 

Vaccination in the U.S. has never been smooth-sailing. When smallpox became a public health threat, Massachusetts passed a vaccination law that mandated vaccines in 1902. This issue was not taken lightly, especially by one of the state’s residents, Henning Jacobson. He argued that the law violated his liberty and took the case to the Supreme Court in 1905. That case is referred to as Jacobson v. Massachusetts. 

The Supreme Court determined that liberty—as mentioned in the Constitution—is not a free pass to be liberated from restraint at all times. “The court determined that states had the power and responsibility to protect the health and wellbeing of the population, but culturally, this question has persisted as both a legal and moral question,” Kline says.

Although the state won the right to protect the health of the people, the case brought up moral and ethical questions about requiring a vaccine mandate. Today, these issues continue to manifest in forms of vaccine resistance and misinformation. 

Still, it is unclear whether payment for vaccination would become a part of the federal government or state’s COVID-19 plan, but the option is not off the table. 

“Overall, we should think about how to reduce those barriers, and we can think about this as an opportunity to consider how economic inequality shapes poor health,” Kline says.

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.