Carrots and sticks can promote vaccination

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Faced with the worldwide spread of Delta, a coronavirus variant twice as infectious as the original strain that started the pandemic 18 months ago, governments around the developed world are considering a growing range of carrot-and-stick measures to persuade the hesitant to get vaccinated.

Some action is necessary, with infection rates soaring again but vaccine supplies also increasing in developed countries. Yet there are no simple answers about whether to exclude the unjabbed from the worlds of work and leisure by requiring vaccination certificates — or how generously to reward people for getting vaccinated, with incentives ranging from lottery tickets to cash rewards.

Surveys in several countries show that hardline approaches to encourage jabs are popular with the public and the evidence suggests that they succeed in driving up vaccination rates, at least in the short term. A powerful example was French president Emmanuel Macron’s July 12 announcement that vaccination would be mandatory for health workers and required for visits to entertainment and eating venues. An additional 1.7m French people had signed up for vaccination by the end of the following day.

But authorities should also consider the downsides of compulsion. One is the risk of deepening the political and social divisions over Covid, between a vaccine-friendly majority and a vocal minority who oppose mandatory vaccination for reasons ranging from safety concerns to libertarian objections to compulsory medical treatments. Thousands have demonstrated in Paris against Macron’s moves.

Care is also needed as in many countries the people most reluctant to be vaccinated are in black and minority ethic groups, who already suffer from discrimination. Making life more difficult for the unjabbed will exacerbate existing unfairness in society.

Mandating jabs as a condition of employment is justified in jobs involving extensive contact with people who are vulnerable to infection. Health workers and care home staff should be vaccinated. For other employees, such as teachers, police, retail and hospitality workers, the argument is more finely balanced. Last week President Joe Biden came up with sensible proposals for US federal workers: either be fully vaccinated or wear a mask on the job and submit to regular testing.

Vaccination certificates have a long history in international travel, and it is entirely reasonable to resurrect them for Covid, though agreement is needed on their format and on which vaccines are covered. Unjabbed travellers should not be excluded from flights but should face stringent tests.

In the leisure and entertainment sectors, varying political and social circumstances mean vaccination requirements will differ around the world. Some countries may mandate certificates for entry into crowded venues, while others leave businesses free to implement their own policies.

When it comes to carrots, Biden’s suggestion that states offer $100 rewards to those who accept a vaccine is ill-judged. While small incentives such as lottery tickets, food and travel vouchers may be appropriate, significant cash gifts risk annoying those who had earlier volunteered for vaccination for no such reward. The gimmick also gives vaccine sceptics the false impression the government is bribing people to undergo an unsafe procedure.

While carrots and sticks can help to drive up vaccination rates, particularly among young people, authorities should not overestimate their power. Information, education and persuasion still have a vital role to play.