It’s worth giving Covid-19 vaccine incentives a shot

The Morrison government is aiming for an 80 per cent fully vaccinated population by the end of the year. Picture: Gary Ramage

Australia is spending $8bn on its Covid-19 vaccination program, which is a pittance against the economic cost of lockdowns and damage to livelihoods and lives.

Yet having invested so much buying miracle drugs developed at warp speed, we need to find the best way - from messaging to logistical approaches - to get vaccines into arms.

Scott Morrison has outlined ambitious targets of fully vaccinating between 70 and 80 per cent of the eligible population, or 14.4 to 16.5 million people, to move into the next two phases of reopening the economy.

But to achieve them we’ll need more robust and bespoke incentives than the Prime Minister’s “freedom passes” or appeals to the “Australian way” to mop up the tail.

According to the battle plan of the National Covid-19 Vaccine Taskforce, revealed on Tuesday, the key incentives are personal freedoms, choice of vaccines, and ease of access, although there may be a place for financial enticements in targeting cohorts.

“This may include considering the role of gift vouchers and prize-drawers led by industry and business,” the campaign plan said, suggesting a liaison program with companies and the states to coordinate discounts and the like.

Labor’s proposal of a $300 cash payment to the fully vaccinated is expensive and a political wedge for a government that has presided over a haphazard rollout.

Morrison was savage in his denouncement of Labor’s idea on Tuesday claiming it was a “vote of no confidence” in Australians and that people would think there was something wrong with the vaccines.

Still cash carrots have precedents in other countries and some evidence to support them. Financial incentives are being rolled out around the globe to nudge acceptance of vaccines among the hesitant, including lottery tickets, donuts, concert and sporting tickets, even a “shot and a beer” in New Jersey.

New research from Oxford University has found Covid-19 vaccination messaging that highlights financial incentives is likely to have a bigger motivational impact on the unvaccinated than generic appeals that focus on health benefits.

As well, the experimental survey of unvaccinated Americans found people were significantly more likely to be motivated by messaging that highlights cash voucher incentives rather than lotteries, which are being used in the US and was raised last week in a study by the Grattan Institute.

One of the authors of the study on financial incentives, professor of health economics at Oxford University Philip Clarke, told The Australian: “In the US, the cash payment is generally around $US100 ($137), so that is was what we tested in our experiment”.

“It’s plausible that a higher payment, which is what is being discussed in Australia, would further increase uptake. Ideally one needs to conduct a similar experiment in Australia to see what works,” Professor Clarke said.

In the US, surveys show one-third of the unvaccinated would be more likely to get a shot if offered a cash payment, with half of Democrat voters responding that way.

Experts here have also promoted cash payments to shift behaviour. Health economist Anthony Scott from the Melbourne Institute has argued incentives can work “but the devil is in the detail”.

Professor Scott believes Labor’s $300 gambit, which translates to a budget cost of around $5bn to achieve 80 per cent coverage, is “expensive unless it is targeted”. He said it should work for those who are unsure “but probably won’t work for those who are unwilling”.

UNSW infectious disease social scientist Holly Seale doesn’t agree with Labor’s approach. “The horse has bolted with this kind of incentive,” Associate Professor Seale says, given over 40 per cent of the eligible population have received at least one vaccine dose.

“It’s better to focus on reimbursement, whether/how we proceed with a vaccine passport, and improving access,” she says.

Last November, Seale and colleagues in the Collaboration on Social Science and Immunisation group wrote a paper arguing well-crafted messages alone will not be sufficient.

“Vaccination behaviours are shaped by a multitude of factors such as access, cultural beliefs, community, a person’s identity and their norms, education, and socio-economic status, as well as by philosophical beliefs,” the COSSI authors said.

In advice provided to Morrison, the Behavioural Economics Team of the Australian Government (BETA) said larger financial incentives and lotteries generate attention but are “unlikely to drive vaccine uptake in Australia”.

What has worked, BETA advice shows, are personal freedom incentives. Last month, French President Emmanuel Macron announced a ban on the unvaccinated to visit public places.

Allowing vaccinated individuals to quarantine at home and easing domestic border restrictions are other measures on the table.

But researchers say given the outlay on vaccines to date and the potential payoff we need more data to get the most effective incentives.

“Unfortunately, we still have a very limited understanding of what motivates people to get vaccinated,” says Oxford’s Clarke. “Targeted research to find out what incentives and other policies work best should pay real dividends.”