Carrot vs. stick: What can convince the unvaccinated?

·Senior Editor
·8-min read

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What’s happening

As the rate of COVID-19 cases continues to tick upward throughout the United States, some lawmakers, public health officials and opinion writers have started to express a new level of frustration with the millions of Americans who have not gotten the vaccine.

“Folks supposed to have common sense,” Alabama’s Republican Gov. Kay Ivey told reporters last week. “But it’s time to start blaming the unvaccinated folks, not the regular folks.” After peaking at more than 3 million doses administered per day in April, the daily vaccination rate in the U.S. has dropped to fewer than 600,000 per day. As of Wednesday, two-thirds of eligible Americans had received at least one dose. In polls, a majority of the remaining one-third who are unvaccinated consistently say they will never get the vaccine.

Throughout most of the rollout, the strategies to increase vaccination rates have focused on the power of persuasion. Testimonials from health officials about the life-saving protection and minimal risks of the vaccines — contrasted with warnings of the very real dangers of the coronavirus — have been ubiquitous for months. Governments and nonprofits have poured countless hours into outreach programs. Some states have even gone so far as to offer million-dollar giveaways and other freebies.

Recently, though, the tactic has shifted in some places to an approach that is centered less on the benefits of getting the vaccine and more on the penalties for refusing to do so. Over the past week, the long-discussed possibility of vaccine mandates became a reality for certain government workers and employees at a growing list of companies. Hundreds of bars in San Francisco this week also announced they would require patrons to show proof of vaccination or take a COVID test in what could be a first step toward more widespread vaccine requirements for customers of specific businesses.

Why there’s debate

Advocates for mandates and other coercive vaccine requirements say the U.S. has reached the limits of how far incentives go. While they concede that a certain percentage of Americans will never get the shot, they argue a lot of people would roll up their sleeves if being unvaccinated made daily life more difficult — whether it’s the threat of losing a job, the inability to shop or eat at certain businesses or even the inconvenience of having to take mitigation steps others don’t. As evidence, they point to France, where millions of people signed up for vaccinations in the days after President Emmanuel Macron announced that proof of vaccination would be required to access cafes, restaurants, trains and planes.

Supporters of this strategy say there simply isn’t time to wait for public health messages to incrementally put a dent in the size of the unvaccinated population when the Delta variant is spreading so rapidly. Also they cite the danger of a vaccine-resistant variant becoming increasingly possible the more the virus spreads.

Conservatives have expressed strong opposition to vaccine mandates, arguing that these violate personal freedom. And there are experts who say, from a practical standpoint, punishing people for being unvaccinated is a bad blueprint for convincing them to get the shot. Vocally defiant anti-vaccine voices often define the ranks of unvaccinated Americans, but polls show that reasons for avoiding the vaccine vary drastically. Many community organizers say programs that allow hesitant people to ask questions of trusted sources, take their concerns seriously and help them find the opportunity to get vaccinated would be much more convincing than arm-twisting.

Others point to a simple method that hasn’t been tried in earnest anywhere in the country: Paying people to get vaccinated. Offering cash, as President Biden proposed on Thursday, could be the most efficient way to determine who is persuadable and who is so entrenched in their views that nothing can change their minds, backers say.

What’s next

One factor outside of public policy that could influence vaccination rates is the virus itself. The number of doses administered nationwide has ticked up slightly over the past week, possibly in response to coverage of new outbreaks driven by the Delta variant. It’s too early to tell, however, whether that increase is the start of a trend.


Get tough

Coercion can work where persuasion has failed

“There are undoubtedly some hardcore groups and individuals who will never get vaccinated. But … many Americans are likely on the fence and not sure if a shot is necessary. Depriving them of the opportunities vaccinated people get to enjoy might be enough to convince them.” — Michael A. Cohen, MSNBC

The unvaccinated should have to pay a price for their decision

“This is madness. Stop making reasonable appeals to those who will not listen to reason. … It’s a waste of time. Start mandating that anyone who wants to travel on an airplane, train or bus, attend a concert or movie, eat at a restaurant, shop at a store, work in an office or visit any other indoor space show proof of vaccination or a negative coronavirus test.” — Max Boot, Washington Post

A lot of people would choose the vaccine if their job was on the line

“Well, it’s time to make the ‘I ain’t getting vaccinated!’ crowd pull their weight for a change — and requiring them to get a shot if they want to get to work sounds like a pretty good start to me.” — Roger Brown, Herald-Tribune (Florida)

Businesses that require vaccinations are exercising their own freedom

“Let me concede a right for people to be unenlightened. Yet about all that right means is that you are not going to face criminal penalties for avoiding a needle pushed into your arm. At the same time, private businesses have a right to fire you or not to hire you if you don’t get shots.” — Jay Ambrose, Miami Herald

There are ways to guide people without mandates

“Nudges — ways to influence people’s choices without forbidding any option — are proven to work. One kind of nudge is what we call routine offering. That is, everyone in a given setting — whether it’s a school, workplace, or hospital — is scheduled to receive a COVID-19 vaccine. Most people would get the jab if their peers were all being vaccinated. People could opt out, but not easily.” — Lawrence O. Gostin and Scott C. Ratzan, STAT

Mandates will protect those who can’t be vaccinated

“A surge in the virus puts at risk all of our brothers and sisters with weakened immune systems. People with genetic disorders. People dealing with illnesses like cancer. People with ailments ranging from Lupus to rheumatoid arthritis to Type 1 diabetes. Very young children, who cannot yet be vaccinated, are at risk. And their parents. Their brothers and sisters. Their grandparents.” — EJ Montini, Arizona Republic

Social pressure can make a big difference

“The time for analyzing why these human petri dishes have chosen to ignore the medical science that could save them, and us, is over. We need a different strategy. I propose shunning. … Things should get personal, too: People should require friends to be vaccinated to attend the barbecues and birthday parties they host. Friends don’t let friends spread the coronavirus.” — Michael J. Stern, USA Today

Provide support

Mandates or not, reaching herd immunity will require convincing a lot of people

“Persuasion is going to play a big role in boosting vaccination, a reality that’s easy to ignore when the health of the community is at stake.” — Paul Thornton, Los Angeles Times

Mandates won’t address the reasons the most vulnerable people aren’t vaccinated

“A lot of vaccine information isn’t common knowledge. Not everyone has access to Google. This illustrates preexisting fault lines in our health care system, where resources — including credible information — don’t get to everyone. The information gap is driving the vaccination gap. And language that blames ‘the unvaccinated’ misses that critical point.” — Public health advocate Rhea Boyd to Atlantic

Unvaccinated people need support, not derision

“If we continue to think of the vaccine hesitant as misinformed only, we remain blind to other reasons preventing uptake. And if we misunderstand these reasons, not only will we fail to reach certain segments of the unvaccinated, we will not recognize that a few essential public policy-based support efforts could go a long way to ensuring an enduring, equitable recovery.” — EJ Sobo, San Diego Union-Tribune

Giving people money for getting vaccinated would be the most effective strategy

“Is there a way to substantially expand vaccinations in the narrow window of the next six months without going in for heavy-handed, possibly counterproductive interventions? To me the only major idea that seems worth considering is the simplest one: We could start paying people to take a vaccine.” — Ross Douthat, New York Times

Shaming unvaccinated people is counterproductive

“Shaming of the unvaccinated is common but hardly productive. … Nothing is achieved by squelching debate, railing against Fox News playing to its worried viewers, or pretending that we know more about the long-term efficacy or safety of the vaccines, approved for emergency use, than actually is the case. Better to evangelize for the vaccine [than] to insult the hesitant.” — Editorial, Chicago Tribune

Many unvaccinated are victims of misinformation and social pressure

“I actually hold a certain kind of empathy for everyday people who might get sick because they are so tangled up in their politics and their beliefs right now, who’ve convinced themselves that not wearing a mask or getting a vaccine says something to their friends and neighbors that they’re part of ‘the right crowd.’” — Will Bunch, Philadelphia Inquirer

Unless people feel respected, they won’t be willing to listen

“Proponents of the vaccine are unwilling or unable to understand the thinking of vaccine skeptics — or even admit that skeptics may be thinking at all. Their attempts to answer skepticism or understand it end up poisoned by condescension, and end up reinforcing it.” — Michael Brendan Dougherty, National Review

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