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Promoting vaccination uptake in Australia

Top economists in no rush to offer cash incentives for vaccination





Wes Mountain/The Conversation, CC BY-ND

Peter Martin, Crawford School of Public Policy, Australian National University

Australia’s top economists are reluctant to endorse the use of either cash incentives or lotteries to boost vaccination rates.

A survey of 60 leading Australian economists selected by the Economic Society has instead overwhelmingly endorsed a national advertising campaign (90%), vaccine passports for entry to high-risk settings such as flights, restaurants and major events (85%) and mandatory vaccination for high-risk occupations (81.7%).

Offered six options for boosting uptake once supply was in place and asked to pick as many as they liked, only 35% picked cash incentives and only 31.6% lotteries.

Many said advertising and vaccine passports should work on their own.

Others, such as Uwe Dulleck from the Queensland University of Technology, suggested that while cash and lotteries might also work, “maybe a little bit”, they were ethically no better than coercion.

The panel selected by the Economic Society includes leading experts in the fields of behavioural economics, welfare economics and economic modelling. Among them are a former and current member of the Reserve Bank board.





Read more:
Paying Australians $300 to get vaccinated would be value for money


 

Michael Knox of Morgans Financial said the most important thing for getting Australians vaccinated was “trust”.

Trust could be built through a national advertising campaign delivered via doctors and chemists as well as the media.



Others supported advertising in principle, but doubted the government’s ability to do it well.

The Australian government’s A$3.8 million “tacos and milkshake” campaign about sexual consent did not inspire confidence, said RMIT’s Leonora Risse.

The University of Sydney’s Stefanie Schurer said an easy and effective measure would be to simply reduce “transaction costs”. Many vaccinations don’t take place simply because they are difficult to arrange.

‘What’s in it for me?’

Former OECD director Adrian Blundell-Wignall said as a child in the 1950s, if you turned up on the day the polio or smallpox caravan was at school, you were either lined up and injected with a vaccine, or else given a lump of sugar with vaccine on it to swallow. “There was no debate, thank heaven.”

Underlying the reticence of two-thirds of those surveyed to endorse vaccine payments — along the lines of the $300 suggested by Labor or “VaxLotto” suggested by the Grattan Institute — was a concern that it would change the debate to “what’s in it for me?”.

Reserve Bank board member Ian Harper said “what’s in it for the rest of us” was at least as important.





Read more:
Why lotteries, doughnuts and beer aren't the right vaccination 'nudges'


 

Macquarie University’s Elisabetta Magnani said cash incentives could “validate mistrust”. The University of Sydney’s Susan Thorp was concerned they might set a precedent.

“Would people expect another cash incentive in future for COVID vaccination boosters or for flu shots or childhood diseases?” she asked.

‘My body, my choice’

Two of the 60 economists surveyed backed “no additional measures”. UNSW Sydney economist Gigi Foster said the choice should be an individual’s, made without social shaming, goading, moralising or outright coercion.

But others strongly disagreed with the prospect of no additional measures. The University of Melbourne’s Leslie Martin said while personal choice mattered, it “should not come at a cost to others”. And Stefanie Schurer said in a world where individual freedoms were already wildly curbed, vaccination mandates and passports did not seem off the charts:


A requirement for children to meet immunisation schedules has been attached to childcare payments since 1998 and for the Family Tax Benefit A supplement from 2012. Families can access their family-related Centrelink payments only if their child’s vaccination schedule is up-to-date. In 2015 exemption rules were tightened to make it harder for so-called conscientious objectors. States such as NSW have also introduced vaccination mandates for children to access childcare centres.

Several of the economists who supported cash payments and lotteries said they should be held in reserve and used only as a “last resort”.

The Grattan Institute’s Danielle Wood said even if they only shifted the dial a few percentage points, there was a big difference between getting 75% of people vaccinated and 80%.

Eighty per cent might be enough to get a re-opening of the economy to “stick” without the need for further lockdowns.


Detailed responses:

The Conversation

Peter Martin, Visiting Fellow, Crawford School of Public Policy, Australian National University

This article is republished from The Conversation under a Creative Commons license. Read the original article.


Responses (999)


 

peter abelson

Vaccine passports for higher-risk settings (eg. flights, restaurants, major events);National advertising campaigns;Mandatory vaccination for higher risk occupations

Covid is a public health issue. People who are vaccinated should be allowed to participate in business and society (with freedoms dependent on the social vaccination rate). Those who decline to get vaccinated and are prone to infect others with Covid should be required to adopt other safety actions.


 

Garry Barrett

Mandatory vaccination for higher risk occupations;Vaccine passports for higher-risk settings (eg. flights, restaurants, major events);National advertising campaigns;Cash incentives for vaccination;Lotteries with cash or prizes for the vaccinated

There is a positive social benefit with each person vaccinated. To encourage as high a rate of vaccination as possible, the govt should consider the spectrum of policy options available. To start, a clear and compelling information and communication campaign is needed. Further options including cash incentives or possible prizes merit consideration. Vaccine passports make very good sense for local business and, as is currently the case, will be required for international travel (when Australia moves to open up). A number of occupations are very high risk of exposure and spread - mandating vaccination for those occupations is a sensible public health measure.


 

Nicole Black

National advertising campaigns;Mandatory vaccination for higher risk occupations;Cash incentives for vaccination;Lotteries with cash or prizes for the vaccinated;Vaccine passports for higher-risk settings (eg. flights, restaurants, major events)


 

Harry Bloch

National advertising campaigns;Cash incentives for vaccination;Mandatory vaccination for higher risk occupations;Lotteries with cash or prizes for the vaccinated;Vaccine passports for higher-risk settings (eg. flights, restaurants, major events)

All of the listed options can help in persuading at least some people to get vaccinated, but the effects of each are likely to be small. Consistent messaging from governments concerning the public and private benefits from vaccination and from following public health advice on complying with public health orders would be even more useful. Of course, access to vaccines is the most important and making vaccination convenient and easy once the vaccines are available would help much more than buckets of cash and coercion.


 

Adrian Blundell-Wignall

Vaccine passports for higher-risk settings (eg. flights, restaurants, major events);Mandatory vaccination for higher risk occupations

In France, where i spend much of my time, it is clear that the Passe Sanitaire (a certificate with information about the bearer?s COVID vaccination status) has had by far the biggest effect in stimulating uptake of the vaccine, along with mandatory vaccination for occupations the require facing the public. It is discouraging that we don't seem to be able to take these decision quickly and without debate. As a child at school in the 50s, if you turned up at school on the day the polio or smallpox caravan was there you were lined up and injected or took you lump of sugar with the vaccine. There was no debate, thank heaven. The more we flip flop and vacillate on this, the greater the chance of new variants and more sickness. We need better leadership on this.


 

Alison Booth

Mandatory vaccination for higher risk occupations;Vaccine passports for higher-risk settings (eg. flights, restaurants, major events)

We will soon have an ample supply of vaccines. Since we need to consider the social good as well as that of the individual, I would advise implementing the following as soon as possible. (i) Vaccine passports for higher risk settings (people can always choose not to visit these higher risk settings if they don't want to be vaccinated). My guess is that the vast proportion of the population would be happy with this. (ii), mandatory vaccination for higher risk occupations (health, quarantine workers and the like) There are interesting issues for other workers of high mobil ? eg plumbers who work across multiple locations, taxi drivers etc. If there were vaccine passports, potential users could request to view the vaccine passport of such workers. One can imagine getting into a cab in which the driver displays not only has his/her cab driver licence but also his/her vaccine passport.


 

Jeff Borland

Mandatory vaccination for higher risk occupations;Cash incentives for vaccination;Vaccine passports for higher-risk settings (eg. flights, restaurants, major events);National advertising campaigns

Cash incentives and advertising both seem to have the potential to speed up vaccination (of course, with both policies, getting the details right will determine whether the policies are effectiv ? compare for example the Commonwealth ads with the much more effective ads done by the Victorian Council of Social Service. Other items in the list would seem to be better decided on using the expertise of epidemiologists ? but I have ticked mandatory vaccination for high risk occupations and vaccine passports on the basis that, in the short run while we are still bringing COVID under control and learning about it, it is best to adopt an approach that is as controlling as possible.


 

Robert Breunig

Lotteries with cash or prizes for the vaccinated;Vaccine passports for higher-risk settings (eg. flights, restaurants, major events)

I would make vaccine passports optional for those venues that wanted to use them. Consumers could then choose between those venues requiring vaccine passports and those who don't. One could consider lotteries which have been successful in other places. I'm also comfortable with no other measures. Once there is sufficient supply, the government could simply announce that in three months everything will be open again. That will provide an incentive for people to get vaccinated. Will some people free ride?. Yes. Will this impose excess costs on the health system? Yes. One response might be to deny health care services to the non-vaccinated; another might be to get rid of the national health care system. I support neither of those; we don't deny service to obese people, for example. There are real trade-offs between health, well-being and freedom that need to be weighed up. Reasonable people can disagree about the weights to give these things.


 

Markus Brueckner

Mandatory vaccination for higher risk occupations;Cash incentives for vaccination;Vaccine passports for higher-risk settings (eg. flights, restaurants, major events);National advertising campaigns


 

Matthew Butlin

National advertising campaigns;Mandatory vaccination for higher risk occupations;Vaccine passports for higher-risk settings (eg. flights, restaurants, major events)


 

Lisa Cameron

Cash incentives for vaccination;National advertising campaigns;Vaccine passports for higher-risk settings (eg. flights, restaurants, major events);Mandatory vaccination for higher risk occupations;Lotteries with cash or prizes for the vaccinated

We need a national advertising campaign to make the case for getting vaccinated. The lack of action on this front is difficult to justify given that vaccination rate remain well below 100% even in the older age groups (where supply is not an issue). Incentives for vaccination (cash incentives or a lottery) and penalties for not getting vaccinated (inability to travel, go out for dinner etc) can both play an important role in motivating people to get the jab. In high risk occupations, mandating vaccinations is reasonable as not being vaccinated in these occupation constitutes a significant risk to the health, wellbeing and livelihoods of your fellow members of society.


 

Fabrizio Carmignani

National advertising campaigns;Cash incentives for vaccination;Mandatory vaccination for higher risk occupations

Vaccine hesitancy has been a problem to a large extent caused by confusing communication (both domestically and internationally). A clear, widespread campaign that addresses hesitancy is therefore necessary. Mandatory vaccinations for higher risk occupations is a measure that should be (in fact: should have been) taken irrespective of any consideration regarding boosting demand. I realise that ethical issues have been raised against mandatory vaccinations, and there is some literature suggesting that this type of non-voluntary interventions can backfire, but given the experience of the last 18 months, it seems that vaccinating people in high-risk occupations is likely to have a significant payoff in terms of preventing further spread. Finally, the question of how cash incentives (or lotteries) affect the incentive to be vaccinated is debated in the literature, with evidence that the effect could go either way. On balance, however, both theoretical and empirical arguments suggest that cash transfers should effectively help (see for instance https://www.medrxiv.org/content/10.1101/2021.07.26.21250865v1) and for this reason I include them in the list of desirable policies.


 

Bruce Chapman

National advertising campaigns;Mandatory vaccination for higher risk occupations


 

Ken Clements

Mandatory vaccination for higher risk occupations;Vaccine passports for higher-risk settings (eg. flights, restaurants, major events);National advertising campaigns;Cash incentives for vaccination;Lotteries with cash or prizes for the vaccinated


 

Deborah Cobb-Clark

Lotteries with cash or prizes for the vaccinated;Vaccine passports for higher-risk settings (eg. flights, restaurants, major events);Mandatory vaccination for higher risk occupations;National advertising campaigns


 

Lin Crase

Vaccine passports for higher-risk settings (eg. flights, restaurants, major events);National advertising campaigns;Lotteries with cash or prizes for the vaccinated;Mandatory vaccination for higher risk occupations


 

Gabriela D'Souza

Lotteries with cash or prizes for the vaccinated;Vaccine passports for higher-risk settings (eg. flights, restaurants, major events);Cash incentives for vaccination;National advertising campaigns;Mandatory vaccination for higher risk occupations

I don't think it's possible to understate just how crucial it is that we get as many people vaccinated as possible. In an ideal world, we wouldn't have to force people to get vaccinated but when so many lives and livelihoods are at stake with the likelihood of repeated lockdowns in the future looming large, I don't think we have much of a choice. I assume by high risk occupations we are referring to people who work with at-risk populations. Financial incentives seem like a no-brainer to me whether that be lotteries or cash incentives. Vaccine passports also make sense, and will give people a sense of the benefits that will accrue to the vaccinated (freedom to travel domestically, freedom from hotel quarantine, etc). Other things that also need to be considered are widely available rapid antigen tests. The transition out of COVID-zero will be very difficult without them.


 

Kevin Davis

Vaccine passports for higher-risk settings (eg. flights, restaurants, major events);Lotteries with cash or prizes for the vaccinated;Cash incentives for vaccination;National advertising campaigns

One issue is how to ?frame? any cash incentives (including lotteries), particularly given Morrison?s response to Labour that offering cash is insulting etc. But there is a social benefit from vaccinations, like an externality, in the form of lower health costs etc so providing an incentive has merit. Possibly a scheme like a temporary partial rebate of the Medibank levy, which is directly tied to vaccination would emphasise that link ? but since the reward from that is delayed (till end of year tax time) it would probably be less effective than immediate cash in the pocket. An issue with vaccine passports, which have some merit is the question of who determines what settings they are required for - government or a private operator of a facility.


 

Brian Dollery

National advertising campaigns;Mandatory vaccination for higher risk occupations;Vaccine passports for higher-risk settings (eg. flights, restaurants, major events)


 

Uwe Dulleck

Vaccine passports for higher-risk settings (eg. flights, restaurants, major events)

The main policy to "solve" the vaccination problem is to have a clear policy regarding a way back to normal life. Once supply is no longer a constraint, a clear timeline until restrictions are lifted would help to let people make the choice whether they want to take health risks or not. Vaccine passports for say international travel and really high risk events or situations can be added ? if data points towards high risks of running out of hospital capacity. The pandemic and the space it takes in the news should ensure that most people that choose no to get vaccinated do have a good idea about the health risk ? and letting them make this decision themselves, but saying there will be no further restrictions for others (lock downs) to protect the unvaccinated ? this is now treated like a normal infectious disease, will get vaccination rates where they should be and it does not hold the majority hostage to a small group. Would cash or other incentives (lotteries) work - yes, maybe a little bt ? but would that be ethically better than a form of coercion? Do we need more advertising ? I think the news provide free advertising and the people who don't engage with that information may not be reached by a campaign either. If at all, making access to the vaccines even easier (taking it to the people) could help to reach some that actually want to get vaccinated but struggle with the 'how'.


 

Chris Edmond

Cash incentives for vaccination;National advertising campaigns;Mandatory vaccination for higher risk occupations;Vaccine passports for higher-risk settings (eg. flights, restaurants, major events);Lotteries with cash or prizes for the vaccinated


 

Craig Emerson

National advertising campaigns;Vaccine passports for higher-risk settings (eg. flights, restaurants, major events);Mandatory vaccination for higher risk occupations

The Grim Reaper AIDS campaign was very effective in the early 1990s. A faltering COVID-19 campaign showing a distressed young woman with an assisted breathing apparatus was inaccurate and was abandoned owing to lack of vaccine supply. A new campaign would need to be medically realistic and multilingual. Vaccine passports will be necessary if inter-state travel is to be opened up; high-vaccination states will not accept visitors from low-vaccination states. Mandatory vaccination should apply to high-risk occupations such as health care, aged care and disability care.


 

ALLAN FELS

Mandatory vaccination for higher risk occupations;Vaccine passports for higher-risk settings (eg. flights, restaurants, major events);National advertising campaigns


 

Gigi Foster

No additional measures

The choice of whether to be vaccinated should be an individual's, in consultation with his or her GP, based on the expected benefits and risks for that person of that vaccine compared to the expected harms of the illness that the vaccine protects against. The vaccines are a valuable component of our arsenal against covid, but the present environment in which decisions about whether to have the vaccine are occurring is heavy with social shaming, goading, moralizing, and in some cases outright coercion ? as evidenced in the alternative answers to this question, which speak of vaccine mandates, cash prizes, and other strong incentives. In such an environment, free and unhindered consent for a medical procedure cannot be given. The "incentives" we have seen governments, businesses, and schools already implement to try to twist people's arms into getting the vaccine set a dangerous precedent. Further politicization of what should be a personal health decision would take us further down the path trodden by the Nazi scientists who ran medical experiments on non-consenting people. If the vaccine were so beneficial relative to the disease ? for example, if we were dealing with the highly deadly disease of smallpox, and its dangerous but highly effective vaccine ? then people would voluntarily get vaccinated even with no "incentives". What has happened to "my body, my choice"?


 

John Freebairn

Mandatory vaccination for higher risk occupations;Vaccine passports for higher-risk settings (eg. flights, restaurants, major events);National advertising campaigns

Vaccination to reduce the effects of COVID-19 provides private benefits and external benefits. External benefits include lower rates of transmission to other members of society and less call on public funded health services. Higher transmission rates with risks to employees and customers happen with the high risk occupations and settings. Information is important for both private decisions and for government intervention. I question expenditure on additional cash incentives and lotteries. Provision of free vaccination is a subsidy already. It seems 70% plus are happy to comply with no further subsidy, and government have many other higher priority fund claims.


 

Renee Fry-McKibbin

Vaccine passports for higher-risk settings (eg. flights, restaurants, major events);Lotteries with cash or prizes for the vaccinated;Cash incentives for vaccination;National advertising campaigns;Mandatory vaccination for higher risk occupations

All of the options listed have been successful in other countries to some extent so it would be sensible to consider some combination of the list above. Making vaccines easier to access in local communities would also be a good idea especially in areas where people do not necessarily have private transportation and where there are language barriers.


 

Lata Gangadharan

Cash incentives for vaccination;Vaccine passports for higher-risk settings (eg. flights, restaurants, major events);Lotteries with cash or prizes for the vaccinated;National advertising campaigns

Once supply issues are resolved, if we still see low vaccination rates, then disseminating information about the benefits of vaccination not just for oneself but also for others is important. Vaccination is really a public good. We haven't seen much of an information campaign in Australia. Methods that use persuasion rather than coercion would be more effective. This is where incentives come in: both monetary and non-monetary. Non-monetary measures such as social information, nudges etc should not be dismissed. These have the potential to be more effective than the monetary ones in this case. Though I can see a case for vaccination being mandatory for high risk occupations, mandatory policies are often not effective and can sometimes backfire, so one should be cautious about using them. Also some exceptions will need to be made even if the policy is mandatory, and this creates opportunities for inequalities, corruption and rent seeking.


 

Ian Harper

National advertising campaigns;Mandatory vaccination for higher risk occupations;Vaccine passports for higher-risk settings (eg. flights, restaurants, major events)

Offering cash incentives and prizes emphasises the ?what?s in it for me? dimension of vaccination whereas the ?what?s in it for the rest of us? dimension is at least as important. In other words, vaccination is a public good. Like other public goods, a measure of compulsion can be justified to ameliorate the free rider problem, especially where the individual might ride free but at the expense of the onlookers. Even so, I?d attach the compulsion to the activity rather than the individual. ?If you want to engage in this activity, then you must comply with these standards? is not an unfamiliar refrain across many occupations and activities where external costs potentially accompany private benefits. So it is with activities and occupations where the risk of transmission from or infection of unvaccinated participants is greatest.


 

RICHARD HOLDEN

Mandatory vaccination for higher risk occupations;Vaccine passports for higher-risk settings (eg. flights, restaurants, major events);Cash incentives for vaccination;Lotteries with cash or prizes for the vaccinated;National advertising campaigns

We only have one effective tool to make life as close to what it was pre pandemic long term ? vaccinations. There is a large and clear negative externality to folks not being vaccinated. Business and government internalize such externalities all the time. For vaccinations we have no-jab-no-pay, vaccination requirements for school attendance and more. We need to think creatively to get vaccination rates as high as possible.


 

Guyonne Kalb

Vaccine passports for higher-risk settings (eg. flights, restaurants, major events);Mandatory vaccination for higher risk occupations;National advertising campaigns

What I like about vaccine passports is that they are likely to make higher-risk settings like flights, eating out and events safer (and therefore possible) while at the same time encouraging people to be vaccinated. Of course, there need to be exemptions for people who cannot be vaccinated for medical reasons, but in my view it is important to keep the number of exemptions relatively limited, otherwise it will not work. A national advertising campaign is important and should focus on providing people with relevant information regarding the risks of being unvaccinated and the very small risks of vaccination. More attention could be given to what we are losing out on by our low vaccination rate. Opening up borders is not just important for social reasons given the many migrants in Australia, but also for economic reasons, with tourism and international students being major contributors to our economy. In addition, skilled migration into Australia is as good as non-existent at the moment, and there is already a brain-drain happening due to existing migrants choosing to return to their home country as the border closure continues. Mandatory vaccination for higher risk occupations are likely to be relatively limited and so would not contribute substantially to encouraging overall vaccination rates, but it is very important to keep workers and those they come in contact with as safe as possible.


 

Michael Keane

Vaccine passports for higher-risk settings (eg. flights, restaurants, major events);National advertising campaigns;Mandatory vaccination for higher risk occupations

Labour has called for a $300 cash payment to everyone who gets vaccinated by December 1st. Lotteries that only the vaccinated can participate in are another type of cash incentive. It seems a bit premature to conclude that lack of take-up of vaccination is a major problem when in fact the lack of supply has been (and remains) the real problem. The idea that we need to offer incentives to achieve a high vaccination rate is based on the unknown hypothetical that once adequate supply is available a substantial number of people will resist getting vaccinated. If it is true that a substantial number of people do not want vaccination, I am not aware of any empirical evidence showing that cash incentives would induce them. Perhaps most of those people have very strong feelings on the matter, so that a cash incentive would have minimal effect. There is no way to know this a priori (and economists certainly have no special insight into this question). Obviously we ought to run a simple discrete choice experiment to test how effective cash incentives might be before implementing any such policy.


 

Michael Keating

Mandatory vaccination for higher risk occupations;Vaccine passports for higher-risk settings (eg. flights, restaurants, major events);National advertising campaigns

While I favour both mandatory vaccination and vaccine passports (in due course) these measures will not be appropriate while there is a shortage of vaccination slots. I also think it is too early to decide on whether or not, incentives are needed. They may be appropriate later on if it proves difficult to encourage sufficient numbers to come forward for vaccination.


 

Geoffrey Kingston

National advertising campaigns;Mandatory vaccination for higher risk occupations;Vaccine passports for higher-risk settings (eg. flights, restaurants, major events)

We certainly need stronger incentives for people to get vaccinated, Are seeing successful implementation of vaccine passports in various Northern Hemisphere locations. QR coding needs to be a feature. Am not sure about cash incentives but am not opposed either.


 

Michael KNOX

National advertising campaigns

Australia appears to have the target of of having 80% of the population fully vaccinated. For this to be achieved it is necessary to develop a high degree of national trust in the vaccine . This would best be done by a national advertising campaign through doctors and chemists as well as media . Mandating vaccinations or requiring domestic Australian passports would imply that there is some thing wrong with the vaccine that people have to be forced to take it. The public must trust the Covid vaccine at least as much as it now trusts the Flu vaccine or the other vaccines that many travellers already receive when they are going overseas.


 

Emily Lancsar

Mandatory vaccination for higher risk occupations;Vaccine passports for higher-risk settings (eg. flights, restaurants, major events);National advertising campaigns

Incentives to vaccinate are all about tipping the balance in the trade off individuals make between the costs and benefits of vaccination. For different groups, the benefits could be considered purely from individual and/or from perspectives of family, society etc. Which incentives (intrinsic or extrinsic) increases the benefits (or reduces the costs) will be different for different groups, so a portfolio of incentives may make sense over time. Starting with National advertising campaigns - again with a portfolio of ads with different messages/target groups in mind ? e.g. the rise of cases in children may also lead those who may not vaccinate for themselves to consider vaccination to cocoon their and other?s children. Another key consideration is externalities ?both positive and negative. Mandatory vaccination for higher risk occupations can help internalise both positive and negative externalities. Vaccine passports for higher-risk settings (e.g. flights, restaurants, major events) can help increase the cost of not vaccinating (or benefits of vaccinating) in individual?s cost-benefit calculation and likely useful in targeting those currently unwilling to vaccinate. Universal cash payments are not needed but targeted payments could be considered down the track to encourage those willing but not yet vaccinated, although there would be an equity consideration in paying some but not others. In all of this, research to understand the general public?s preferences in relation to COVID-19 vaccination is essential, including understanding preferences of different groups and different forms of hesitancy ? something our team at ANU and others are currently working on.


 

Guay Lim

Vaccine passports for higher-risk settings (eg. flights, restaurants, major events);National advertising campaigns;Mandatory vaccination for higher risk occupations


 

Elisabetta Magnani

National advertising campaigns;Vaccine passports for higher-risk settings (eg. flights, restaurants, major events)

Despite having historically experienced very high vaccination rates, Australia is now facing a significant and growing anti-vax movement. These events, combined with the rapid spread of highly infectious variants of the virus threaten Australia's response to the COVID-19 pandemic. In addressing the need for a high vaccination rate, public health policies aim to strike a balance between individual rights and community needs. In some cases, achieving a high vaccination rate may need to rely on existing laws, which many States and Territories already have in place--for example, South Australia?s Work Health and Safety Act. These laws require staff in specific workplaces to be vaccinated against diseases like influenza, hepatitis A and B, and now COVID-19. More generally, addressing obstacles to achieving high vaccination rates requires an understanding and respect for various social and cultural perspectives on vaccination. The growth of the anti-vax movement in Australia has been explained by a variety of factors, including misinformation spread by social media as well as some TV stations and newspapers. In this sense, the growth of vaccination hesitancy and resistance forces an evaluation of the services provided by public/private information and media systems. The situation also highlights the need to regulate social media platforms and the media?s ability to spread misinformation. Importantly, misinformation breeds vaccination hesitancy and resistance. For some individuals and communities, suspicion and apprehension with respect to the COVID-19 vaccination may be best understood in a social and historical context of inequality and mistrust with respect to political leadership. Addressing these issues require more than paying people to get vaccinated. Rather it starts from a recognition of the problem and from reflection on how we got here and how to restore social cohesion by addressing the key sources of the problem. Vaccine hesitancy and resistance do not happen in a vacuum. We know from past campaigns encouraging vaccination for children, that vaccination hesitancy tends to cluster in regions. Furthermore, low vaccination rates are also associated with low confidence in the efficacy of the vaccine or its risk. Vaccine confidence is often a degree in a spectrum ranging from absolute to nil. A recent study by Edwards et al. (2021) based on a large nationally representative survey of Australians? vaccination intentions indicates that 13% of the Australian population may experience or be about to experience high levels of hesitancy or resistance to vaccination. Individuals who live in disadvantaged areas, those who tend to have more populist views or have higher levels of religiosity or lower levels of household income, and those individuals who display less confidence in their state or territory government, are less likely to get vaccinated. As pointed out in the study by Edwards et al., a targeted public health campaign directed to address these groups? beliefs and concerns is required. These groups need to receive the information they need, so to be reassured and confident of their decision to vaccinate. Any public communication campaign should emphasize that delaying vaccination is a threat to both individuals? and public health, and it may lead to extended lockdown, which threatens livelihoods. What we need to avoid is a public conversation that becomes aggressive and labels individuals and groups in false binary categories (e.g., responsible/irresponsible, pro/anti-social). In this context, measures aimed to increase the personal (monetary) advantage of vaccination decisions are unlikely to be effective. We already know about the limited effectiveness of monetary incentives from domestic and international research. In fact, I believe that given the broader challenges that the COVID-19 pandemic has unveiled, monetary incentives including lotteries, could be harmful. In displaying a lack of ability/willingness to properly address individuals? and communities? concerns, monetary incentives could validate mistrust with respect to collective institutions. Ultimately, crises don?t happen in a vacuum. The crisis triggered by this pandemic is an opportunity to start addressing the challenges that Australia is facing, primarily inequality, mistrust in our political system and erosion of the quality of our social fabric.


 

Tony Makin

National advertising campaigns

Cash incentives are inequitable, as those already vaccinated would miss out. They would also add hundreds of millions more to the budget deficit and hence to already historically high public debt, worsening future economic growth.


 

Leslie Martin

National advertising campaigns;Lotteries with cash or prizes for the vaccinated;Vaccine passports for higher-risk settings (eg. flights, restaurants, major events);Mandatory vaccination for higher risk occupations

My decision to vaccinate involves both private and external costs and benefits. The unvaccinated are much more likely to be vectors of transmission (being both more likely to catch covid and more likely to transmit it if they catch it) and may reduce the level of hospital care available to others if that resource becomes congested. Personal choice is important, but should not come at a cost to others. I support vaccine passports: those who opt out should only be allowed to enter public spaces without causing disproportionate harm to others, i.e. with mask and face shield if indoors. Adults who choose to be unvaccinated, when vaccines are widely available, should also sign over their right to priority access to hospital care should they contact covid when the system is at capacity. It doesn't make sense to give access to the unvaccinated above others who have made decisions that put more weight on the safety of their community. To what extent should there be exceptions? According to the CDC, there are very few medical reasons to not get vaccinated. The personal risk of blood pressure complications (AstraZeneca) and Myocarditis/Pericarditis (Pfizer) is very low, and likely to drop as we gain experience protecting a very large already-vaccinated wealthy population. And although vaccines are less effective on the immunosuppressed, it is not a live vaccine and there is no evidence of harm. If anything, the private benefits of protection are likely to be higher for the immunocompromised. People with allergies to some vaccine components (Polyethylene Glycol ? Pfizer or Polysorbate 80 ? AstraZeneca) have other vaccines available. Of course, carrots can accompany or proceed sticks. Catchy advertising campaigns and prize lotteries are relatively low cost and potentially high benefit.


 

Margaret McKenzie

National advertising campaigns

Paid vaccination leave for all workers, especially for casual workers is an essential measure, because worry about losing pay is a major barrier to getting vaccinated. Unions have won this right in workplaces covering 1.6 million workers, but we now need to include it in the National Employment Standards to cover all workers. A dramatically scaled-up national education campaign and other forms of employer support such as onsite vaccinations are also important.


 

Warwick McKibbin

Mandatory vaccination for higher risk occupations;Vaccine passports for higher-risk settings (eg. flights, restaurants, major events)

While individuals currently have the right not to be vaccinated, they do not have the right to infect others. If a person does not want to be vaccinated (apart from because of legitimate health issues) then they should be excluded from any social interaction that will spread the virus. If high levels of vaccination are not achieved then there is a case for cash incentives that are income contingent.


 

Flavio Menezes

National advertising campaigns;Vaccine passports for higher-risk settings (eg. flights, restaurants, major events);Mandatory vaccination for higher risk occupations

Vaccine passports and mandatory vaccination are a no-brainer. These are standard responses to externalities. For example, travelers arriving in Australia from countries where there is yellow fever need to be vaccinated or face quarantine. There may be benefits in introducing targeted financial incentives, but passports and mandatory vaccination will go a long way in ensuring a higher vaccination take-up.


 

James Morley

Mandatory vaccination for higher risk occupations;Vaccine passports for higher-risk settings (eg. flights, restaurants, major events);Cash incentives for vaccination;National advertising campaigns


 

A Abigail Payne

Vaccine passports for higher-risk settings (eg. flights, restaurants, major events);National advertising campaigns;Mandatory vaccination for higher risk occupations

Anything is better than nothing. A critical challenge is lack of consistent information and positive messaging. But also -- there is much information of what works and what does not work from other countries. This is a not a unique issue to Australia.


 

Alison Preston

Mandatory vaccination for higher risk occupations;Vaccine passports for higher-risk settings (eg. flights, restaurants, major events);National advertising campaigns

Not in favour of cash / prize incentives. The majority will 'do the right thing' and get vaccinated and, as we keep hearing, the likelihood is we will need boosters which, if we go down the cash incentive path may see this turn out to be a costly and unnecessary policy. I do favour mandatory vaccination for 'higher risk' occupations, although, of course, it will come down to what we mean by 'higher risk'.


 

John Quiggin

Vaccine passports for higher-risk settings (eg. flights, restaurants, major events);Cash incentives for vaccination;Lotteries with cash or prizes for the vaccinated;Mandatory vaccination for higher risk occupations

Not enough. We need Green Pass as in Europe and mandatory vaccination or weekly testing for everyone who works with other people. Given uselessness of current advertising campaign I haven't checked this option.


 

Mala Raghavan

Vaccine passports for higher-risk settings (eg. flights, restaurants, major events);Mandatory vaccination for higher risk occupations;National advertising campaigns

I believe mandatory vaccination is needed for high-risk occupations such as the health care and hospitality sectors. For the matter, people in any occupation that has direct contact or exposure with the masses should vaccinate. It is essential, the workers are protected and do not pose risks especially to the vulnerable members of society. Resistance to vaccinating is generally due to lack of information and misinformation, or due to the tedious nature of the vaccination process. To achieve sufficient vaccination coverage, it is, therefore, necessary to understand the reasons for the lackadaisical behaviour. A clear national advertising campaign should be complemented with some softer advertising campaigns and actions targeted at specific groups. For example, in areas or communities of high resistance, we need to identify: (i) a respected local hero as ?vaccine ambassador? (ii) popular local businesses and or community groups as ?influencers? who can promote and spread the benefits of vaccinating as opposed to not vaccinating.


 

Sue Richardson

Vaccine passports for higher-risk settings (eg. flights, restaurants, major events);National advertising campaigns

The first thing that should be done is to make access to the vaccine widely accessible--it must be easy to get from a place where people are comfortable to be. Then we should take active steps to increase vaccination rates. Advertising campaigns need to be clever and engaging, especially for younger people. Give the topic to the Gruen Project! Use the evidence. Many strategies have been tried in other countries and we should study these carefully to see what we can learn from them. Appeal to the greater good, not just to one's own safety. Ads need to be tailored to the different demographics and reasons for reluctance to get vaccinated.


 

Leonora Risse

National advertising campaigns;Vaccine passports for higher-risk settings (eg. flights, restaurants, major events)

Behavioural economics shows us that the design of the decision-making environment ("choice architecture") can steer people towards choices that would be best for society overall (in this case, having a vaccination), with necessarily resorting to mandates or overt enticements like cash incentives. Lotteries and cash incentives have appeal, but can come with potential costs. For a start, an element of good public policy is that you shouldn't be paying people for something they were planning to do anyway. Secondly, lotteries and cash incentives are a popular feature of US culture, but it's not clear that this resonates well in Australian culture. Unlike in the US, we don't pay people for their blood or organ donations. Instead, we have nurtured a culture where such acts are done out of goodwill, altruism, moral duty and other intrinsic values. There is a risk that attaching a financial payoff to a vaccination will distort this sense of intrinsic value and potentially deter this innately-motivated cohort. Activating intrinsic motivation is important long-term sustainability for the vaccination program ? cash rewards will condition people to keep expecting a payment each time we need to roll out booster shots. Also the concept of lotteries is also precariously linked to the issue of gambling, and could be considered insensitive to the harm and suffering that gambling causes many Australian households. Moreover, there is weak evidence that financial incentives will change the minds of Australians who are vaccine hesitant/resistant. Research by the Melbourne Institute found that, at most, 16% of people who were currently unwilling or unsure about getting vaccinated could be swayed by a cash payment (https://findanexpert.unimelb.edu.au/news/25780-our-survey-results-show-incentives-aren't-enough-to-reach-a-80-vaccination-rate) Vaccination passports could conceivably work as an incentive as well as an information device. However, the Melbourne Institute research also found that placing social restrictions of non-vaccinated people (such as banning attendance at large events and travel) would still not be enough to sway up to 56% of those who were unwilling or unsure about getting vaccinated. There is also an equity issue here. Vaccination passports can't come into effect until all members of the community have been offered their opportunity to be fully vaccinated, otherwise we are unfairly allowing freedoms to some while denying them to others. Nevertheless, vaccination passports could have their strongest impact by setting the "social norm" - the default behaviour that is expected for a well-functioning society, which might incentivise people to shift their behaviour over time once they see this as the norm. The 'No Jab, No Play' vaccination scheme for children is an example of a successful vaccination program that has helped set childhood vaccinations as the norm. Mandatory vaccinations for high risk occupations is an important factor for consideration, but it should not be used for the purpose of boosting demand for vaccinations. If mandates are enacted, it should be for genuine public health and safety reasons. National advertising campaigns have the potential to activate intrinsic motivations, such as a patriotic spirit. However, this government's track record on advertising campaigns is not convincing (especially after the tacos and milkshakes debacle). Outsourcing the advertising mission to community groups, who have greater capacity to tailor the messaging to their particular demographic, cultural, industry or geographical cohort, is likely be more effective. Research shows that the interventions that have been found to be successful in shifting people's intrinsic attitudes and behaviours are those where the message is delivered by someone that they genuinely trust, admire, respect and relate to. A tailored advertising approach can make better use of the power of local role models, ambassadors, leaders of the local communities and social peers to convey the vaccination message in a more meaningful way across different cohorts of society. Behavioural economics tells us that, to nudge people's choices, policy needs to be designed in a way that makes it easier to opt-in, and more onerous to opt-out. Once a sufficient supply of vaccines is secured, vaccination take-up can be improved by making "opting in" the default. This means that everyone is automatically registered for a vaccination, saving people the time and effort of chasing information. While we keep hearing that "vaccinations are our ticket out of the pandemic", we must not lose sight of the other critical investments that are needed to contain the spread of the virus, namely the construction, operation and staffing of purpose-built quarantine facilities. If your tap is dripping, you don't just let it keep dripping and mop up the puddles - the more efficient solution is go to the source of the leakage and tighten the tap. Proper quarantine facilities targets the source of the virus upstream.


 

Rana Roy

Cash incentives for vaccination;Lotteries with cash or prizes for the vaccinated;National advertising campaigns

The carrot is always preferable to the stick. And there is abundant evidence - see for example the latest issue of The Economist - that carrots such as cash incentives, lotteries, and advertising campaigns, are indeed effective in increasing the take-up of vaccination. As for more coercive measures such as "mandatory vaccinations" and "vaccine passports", the problem is this. The "leaders" of the "western democracies" have already presided over the preventable deaths of far too many. OECD countries make up a majority of the top 20 countries ranked by deaths per million (though, thankfully, Australia is not in this group). And this is in part a result of their own actions and non-actions: their flat-footed response at the start of the pandemic; their late and limited use of lockdowns; their too-early withdrawal of fiscal support; their repeated flirtations with the suggestion to "Let the bodies pile up high!"; and their continuous political point-scoring which has greatly undermined in the public's mind the message that this moment really is an emergency and not business-as-usual. So, I say to our prime minister, and to all the "leaders" of the "western democracies" - in the words that the then-Treasurer Scott Morrison once used in addressing Australia's banks - "They already dont' like you very much!" So, step lightly. Use the carrot, not the stick.


 

Stefanie Schurer

National advertising campaigns;Mandatory vaccination for higher risk occupations;Lotteries with cash or prizes for the vaccinated;Vaccine passports for higher-risk settings (eg. flights, restaurants, major events)

Mandates, passports, more fun and less fear In a world, where individual freedoms are already wildly curbed, vaccination mandates and passports are not an unreasonable or infeasible strategy to boost vaccination rates. This strategy in combination with a variety of softer-touch interventions and fun campaigns to reduce fear will help us re-establish our beloved mobility freedoms. Here are some ideas that also make economic sense. The demand for Covid19 vaccination is a complex matter. Standard economic demand theory breaks down in this context as individuals do not pay a price for the vaccine (although supply is price dependent). Thus, a typical price tool in the government?s tool box to boost demand ? price ceilings ? are of no relevance here. Strategies to increase the quantity of vaccines demanded must therefore involve non-price interventions. I personally consider interventions that shape the expectations, believes and preferences of the yet-to-be vaccinated population as the key starting point. Another important consideration are interventions that reduce transaction costs for people yet-to-be vaccinated. And of course, mandates are critical in a setting where individual decision-making can have major costs to society. Generating 100% vaccination uptake from people who are expected to be affected by the Covid19 outbreak (or any other infectious disease of great public health concern) is impossible. Consider for example the so-called MMR1 vaccination to prevent the spread of highly contagious childhood diseases. Australia has a vaccination coverage for five-year olds of 95% today, a coverage deemed necessary to achieve herd immunity for eg the highly infectious measles. This number wasn't always that high. Australia achieved this coverage through implicit mandates. A requirement for children to meet immunisation schedules has been attached to childcare payments since 1998 and for the FTB-A supplement from 2012. Families can access their family-related Centrelink payments only if their child?s vaccination schedule is up to date. In 2015 exemption rules were tightened to make it harder for so-called ?conscientious objectors?. Some states have also introduced vaccination mandates for children to access child-care centres (eg NSW in 2014). So, federal and state legislation can provide for such targeted mandates. Some may argue that immunisation mandates are too invasive, that they would be restricting individual freedoms too much: the freedom over one?s own body and its integrity. However, in a world where individual freedoms -- local, domestic, and international mobility -- are already radically and continuously restricted, mandates don?t appear to be off the charts. I support mandating vaccination of high-risk workers if relevant medical exemptions are provided for. A recent opinion piece in the Medical Journal of Australia argues that this is legally possible: "The federal government has limited but available powers to enact compulsory vaccination for high-risk workers under the Biosecurity Act, and while there is variation among states and territories, compulsory vaccination is allowed for in Victoria and WA and could be enabled via passage of specific legislation elsewhere" (see https://www.mja.com.au/journal/2021/215/1/medico-legal-considerations-mandatory-covid-19-vaccination-high-risk-workers). Note, the Australian Government announced end of June 2021 that COVID-19 vaccinations would be made mandatory for residential aged care workers. All workers in aged care will be required to receive their first dose of the vaccine by September this year. Some states and territories have also issued public health orders mandating vaccination for certain industries or workers. For example, Queensland has a public health order in place mandating vaccination for health service employees who are likely to encounter and treat people with COVID-19. I personally support such measures during an epidemic, although I would never opt for such policies under normal circumstances. In addition, the Government can and should use more standard tools from the economist's toolbox. As a guiding principle for any intervention, life should be made easier for people who are vaccinated, and more difficult for people who are not. This will create the right incentives for unvaccinated people to reconsider their choices. It is for this reason that I personally support vaccination passports that grant access to large public events (e.g. access to concerts, stadiums, lectures ect) and most importantly domestic and international travel. The European Union has introduced such requirement to re-establish basic individual freedoms (no quarantine is required if a negative Covid test is presented). Some would even go so far to make them compulsory to access restaurants. France is currently battling with such ideas. I am personally less in favour of paying cash incentives to highly-reluctant vaccine uptakers. I am not generally opposed to cash incentives. They have proven useful in other public health campaigns. For instance, financial incentives are effective to reduce the incidence of smoking during pregnancy or to increase the willingness to attend school during adolescence to reach a critical education threshold. The main problem with cash incentives is that they cannot be targeted in the context of Covid19. For instance, if the government considered in the public debate a cash transfer of let?s say 300$, people may wait with vaccination until the Government will start paying the cash incentive. That would delay vaccination rollout. Thus, I am opposed to such cash incentives. I am more in favour of paying incentives to general practitioners to ensure that their registered patients are up to date with Covid vaccination and provide the relevant information. Let them call up their registered patients and lure them into their practice for the jab. It's possibly one of the very few examples where supplier-induced demand is a good thing. Australia has experience with such initiatives. The 2015 budget earmarked $26.4 million over four years to improve immunisation coverage rates, particularly in children and adolescents. The Government intended to make an incentive payment to doctors and other immunisation providers when they identify a child who is overdue for vaccination and call them in for a catch up, fund an awareness campaign to promote immunisation and address parents' concerns regarding immunisation and; expand the existing National Human Papillomavirus Vaccination Program Register to include all adolescent vaccinations delivered in schools under the NIP. So, we have already a lot of experience with such incentives. This brings me to talk about softer-touch interventions. A big-win lottery could be helpful to put a positive vibe and some fun on the whole vaccination rollout. This lottery should be combined with a funky national advertising campaign that communicates simple and clear messages about the effectiveness of vaccines. The government could hire sports and entertainment celebrities to speak out. It could be combined with a fun competition that encourages citizens to provide their own solutions to the vaccine hesitancy problem. The government could offer prizes for the three most innovative and practical ideas to boost vaccination rates. Instead of being numbed by fear, Australians should feel empowered through the vaccine rollout. Here are some ideas how philantropic organisations have incentivised crowdsourcing of ideas to create better neighbourhoods: https://ssir.org/articles/entry/six_ways_contests_improve_philanthropy Last but not least, I propose that the state governments bring vaccination clinics closer to the homes of people. I want to see vaccination trucks (like those blood donation trucks) drive through neighbourhoods. During a pandemic, reasonable people will avoid public places. They will not want to go to their GP practice where they may catch Covid19 or other diseases. As we will continue to be in lockdown for some extended time, vaccination trucks should be driving through neighbourhoods now and knock on people?s doors. My neighbour told me she could get the Astra Zeneca jab any day from her GP, but she is wary of going to the GP and doesn't want to spend the time travelling. Thus, I suggest the Government should help reduce these transaction costs. Mobile vaccination trucks will achieve higher vaccination rates.


 

Jeffrey Sheen

No additional measures


 

Susan Thorp

Vaccine passports for higher-risk settings (eg. flights, restaurants, major events);National advertising campaigns;Mandatory vaccination for higher risk occupations

Cash incentives might encourage people who are avoiding a vaccination because of inconvenience or discomfort to take the jab more quickly but cash from a government is unlikely to change the minds of those who are really hesitant. It would also possibly set a precedent. Would people expect another cash incentive in future for COVID vaccination boosters or for flu shots or childhood diseases?


 

Julie Toth

Vaccine passports for higher-risk settings (eg. flights, restaurants, major events);National advertising campaigns;Mandatory vaccination for higher risk occupations

Vaccine 'hesitancy' receives far too much attention in the media. Vaccine frustration is a bigger problem. That is, the frustration of wanting vaccination but unable to get it. when vaccines are genuinely available to everyone (easily and rapidly) and if Government information is provided clearly and directly, we are very likely to see vaccination rates rise to required levels. Even after vaccinations rise, COVID will be with us for many years and so vaccinations will probably become mandatory over time for certain occupations and activities (e.g. aged care workers and for international air travel), just as they are for other common diseases.


 

joaquin vespignani

Vaccine passports for higher-risk settings (eg. flights, restaurants, major events);Mandatory vaccination for higher risk occupations;National advertising campaigns

With more than 2.3 billion vaccines (from different brands) already applied (worldwide), and no evidence of important side effects, there is no good reason to be unvaccinated in a truly global pandemic. People who choose not to be vaccinated are adding an enormous social and economic cost to the rest of the Australian and the global communities. Therefore, policies which restrict the circulation of the virus should be burdened mostly by unvaccinated people.


 

Danielle Wood

Cash incentives for vaccination;Lotteries with cash or prizes for the vaccinated;Mandatory vaccination for higher risk occupations;National advertising campaigns;Vaccine passports for higher-risk settings (eg. flights, restaurants, major events)

We need to throw everything and the kitchen sink at the challenge of getting Australians vaccinated because of the costs of falling short on vaccinations are huge. Grattan's modelling presented in its Race to 80 Report (https://grattan.edu.au/report/race-to-80/) suggests that after 80 per cent of the population is vaccinated, including 95 per cent of over 70-year-olds, living with COVID in the community will be manageable. Serious cases are not likely to overwhelm the health system. Even if Delta turns out to be more infectious than we expect, the health outcomes will be only a bit worse than a bad flu season. If transmissibility is in line with expectations, fewer will die from COVID than from the flu. But abandoning the ?Zero COVID? strategy at lower levels of vaccine coverage is a different matter. Even at 75 per cent, there are plausible scenarios where case numbers grow too quickly, ICU capacity is exceeded, and death numbers are high. Such an approach risks sending us back into long lockdowns. 80 per cent delivers much greater confidence in re-opening. So getting to 80 has huge payoffs, and almost any intervention that helps rather than hinders will fly over any cost-benefit hurdle. Survey data suggests only around 10% of the Australian population are opposed to getting a vaccination. Another 35% or so are open to it but waiting. Initial advertising campaigns should target the moveable middle and the reasons for their hesitancy. Convenience is also really important - it needs to be as easy as possible to get a vaccine once supply is no longer constrained (GPs, pharmacists, mass vaccination centers, schools, pop-up clinics...). After that we should move to financial incentives (cash payments, lotteries or both). Even if they only shift the dial a few percentage points there is a big difference between getting to 75% and getting to 80% vaccination in the certainty that re-opening will 'stick' and we won't need lock downs to mange the health fall out. In other words, the expected economic benefits are massive. If we do cash payments they need to be large enough to work (there is some evidence that small cash payments can be counterproductive). We should also embrace temporary vaccine passports for higher risk settings like restaurants, large events and domestic flights. Yes, it's a impingement on liberty but compared to the impingement under lockdowns it's small. Domestic passports are also a useful public health measure because we are likely to be opening before herd immunity is reached.