In many countries, COVID vaccination has been viewed as a race, with the finishing line being double vaccination of a high proportion of the population. Unfortunately, those countries who were initially successful face the challenge of a runner that has reached what they thought was the finishing line being told to run on, as more vaccinations are required.
Africa faces a different challenge. Despite the success of a handful of countries, with just 9% of the continent’s total population fully vaccinated, the race has yet to commence.
In response to the emergence of omicron, many countries are now offering “booster” vaccinations. It is uncertain whether additional COVID vaccinations will be needed in future, but governments should be prepared for a situation where ongoing vaccination cycles are required to suppress COVID for many years.
Alongside the development of vaccines that are effective against emerging variants, a major challenge will be getting people regularly vaccinated. Flu vaccination provides a guide to the possible scale of this challenge. Take the US, where the Centers for Disease Control and Prevention recommends almost universal flu vaccination every season, yet only half the population follow these guidelines. Beneath this average lies large racial and geographic disparities.
Many governments have dabbled with incentives such as cash, shopping vouchers and lotteries to increase vaccination uptake, but largely as one-off initiatives. A key component of an effective long-term COVID vaccination strategy is likely to involve vaccine incentives, in the form of either carrots or sticks.
Much can be learned from the experience of countries that have linked family welfare payments to childhood vaccination status. Australia has done so for over two decades, and it has been credited with raising vaccination rates to among the highest in the world.
A key aspect of COVID vaccination is that the magnitude of its benefits to individuals and to society vary widely. For the young, the chance of severe illness from COVID is small, but the likelihood of transmission is greater due to higher levels of contact from education, work and socialising. Conversely, the personal benefits to the elderly of being vaccinated are high, but societal benefits outside institutional settings, such as nursing homes, are relatively low.
An economic rationale for carrot-type incentives is that vaccination is a way of rewarding the societal benefit it generates. Another approach is to penalise those who are unvaccinated using stick-based incentives, such as mandatory vaccination or requiring the unvaccinated to pay an additional “health tax”, as has recently been proposed in Quebec, Canada. While fines and penalties are less costly to government than incentive payments, they can be polarising. Recent moves by the Austrian government to make COVID vaccination compulsory have brought thousands onto the streets in public demonstrations.
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