Last month I made a video about increasingly bonkers author Naomi Wolf hosting an anti-vaccine potluck after being banned from Twitter. Well, I have a few important updates to that! First, the Juneteenth potluck and rally was, sadly, cancelled due to a “scheduling conflict.” I guess Wolf got a better offer to host an anti-time travel rally in a local San Francisco dog park.
But wait, that’s not all I wanted to update you on! In that same video I discussed an interesting new study on vaccine hesitancy, that found that in a survey, people were less likely to want to get a vaccine if it were mandated by the government, driven in part by a deep distrust of the government.
The researchers suggested that this is also due to a mandate crowding out feelings of social responsibility that would contribute to a more cohesive society. They thought that the results would be equally bad whether you examine the carrot or the stick — the stick being mandates that punish you for not getting a vaccine and the carrot being economic or other rewards for getting a vaccine. I was a bit skeptical of that, and said this:
“But here’s the thing — we know incentives work. Several US states including my own are now holding vaccine lotteries, paying out millions of dollars in prizes to people who get vaccinated. The trend started in Ohio, where they started handing out a million dollars per week and immediately saw the number of appointments jump 73%. And I could be wrong here, but I don’t think Ohio has seen any equal and opposite drop in social cohesion.
“So personally I don’t really buy the argument that a lack of intrinsic decision-making is the issue here, but I do buy the argument that for a certain subset of people, most of whom exist on a spectrum very nearby to paranoid anti-government kookballs, a government mandate runs the risk of further radicalizing them and pushing them into their extremist echo chambers.”
Well! It turns out, those early reports of the lottery increasing vaccinations may have been wrong! This week, doctors at Boston University published a letter in JAMA that found that Ohio’s lottery did NOT significantly increase vaccine uptake. There was, as reported at the time, a big (50 to 100%) jump in vaccinations the week following the lottery announcement, but the researchers wondered if maybe that was due to something other than the lottery. So, they compared Ohio’s increase to other states around the same time that did not have lotteries, and saw that the change in vaccination numbers was pretty similar in and out of Ohio. So why did more people suddenly and coincidentally want vaccines around the same time Ohio launched its lottery? Well, the researchers point out that at about the same time, the FDA expanded emergency use authorization for the Pfizer vaccine to allow it to be given to adolescents aged 12-15. This not only increases the total number of vaccines being given, but it also may have encouraged parents to get vaccinated who weren’t previously going to bother.
Does this mean the vaccine lotteries are a waste of time and money? Maybe! Maybe not. The study authors point out that they may not have enough data to detect small bumps that the lottery may have encouraged. But it is a pretty compelling argument that the money spent on lotteries may be better spent on different efforts to reach out to people who may not be vaccinated.
And why are they not getting vaccinated? Well, like I mentioned in that previous video there ARE a lot of people who distrust the government and/or the healthcare industry. Reaching them is going to be particularly tricky because, well, the American government hasn’t been particularly trustworthy of late, and the American healthcare industry is straight up garbage. The good news here is that surveys show that these people tend to be split into two camps: people who say they definitely will not get a vaccine and those who say they will wait and see if the vaccines work before they join in. The “definitely not” group is mostly White, while the “wait and see” group is much more likely to be Black and Hispanic, and those are the people we have a good chance to reach, especially once the vaccines get full FDA approval.
Unfortunately, access to vaccines is still not great, especially for that very group of Black and Hispanic people. Yes, the US has way more vaccines than we even need, and it’s now easy for someone like me to get vaccinated. I have a car, I work from home, I can afford to take a day or two off to get the shot and then lay low with any side effects.
But that’s not the case for many Americans. Getting to the pharmacy isn’t easy when you have to rely on public transportation that has been severely limited during the pandemic. Getting time off from an hourly minimum wage job where you’re considered “essential” is tough, and taking sick days is tougher. Kaiser Permanente found that people are more likely to want to get a vaccine when their employer encourages it and provides time off to get it. They also found more people, especially Black and Hispanic, were willing to get vaccinated at a mobile clinic that comes to their neighborhood.
All of this data taken together fits into what I’ve been preaching for more than a decade now — society is better, more educated, healthier, and less superstitious when their basic needs are provided for. When they have stability. Which is why if we had basic universal healthcare, reliable public transportation, and social safety nets, people would be more likely to trust their government, trust scientists, and care about their neighbors, and so they will be more likely and more able to do things like get vaccinated for the greater good.
And so now I’ve edited my opinion of that previous study’s conclusions — maybe it is true that neither the carrot nor the stick will fix the problem of low vaccination rates. While I can’t say whether or not their “crowding out” hypothesis is correct, I think I can agree that both the carrot and stick options are too little, too late, and that true beneficial change has to happen on a systemic level by satisfying people’s basic needs before we expect them to be good, upstanding citizens.