Pay people to have coronavirus vaccine to achieve herd immunity, urges ethicist

An ethicist has suggested people should be paid to have a coronavirus vaccine if an effective jab is developed.

Scientists all over the world are working on an immunisation programme that could help stem the pandemic, potentially freeing people from the constraints of face coverings, social distancing and home working.

Exposing someone to a harmless amount of the virus would help them develop an immune response against it, warding off an infection if it were to be encountered.

If a sufficient number of people get vaccinated, an infection cannot take hold in a community, which is known as herd immunity.

Around 80% of people are thought to be required to have a coronavirus jab to achieve this, with vaccinations not being compulsory in the UK.

Read more: Living with young children linked to reduced risk of dying with coronavirus

Professor Julian Savulescu from the University of Oxford has therefore suggested people be financially incentivised to have the vaccine, or offered a “payment in kind”, like being allowed to forgo a face covering if they carry a “vaccination certificate”.

Not everyone agrees, however, with another expert warning such a move would “set a very dangerous precedent”.

“To be maximally effective, particularly in protecting the most vulnerable in the population, vaccination would need to achieve herd immunity,” Professor Savulescu wrote in the Journal of Medical Ethics.

“The exact percentage of the population that would need to be immune for herd immunity to be reached depends on various factors, but current estimates range up to 82%.”

Not everyone can get vaccinated, for example people whose immune systems are suppressed by chemotherapy. These individuals therefore rely on others to have jabs to create herd immunity.

“Vaccines are some of the safest and most effective interventions we have, and have achieved incredible successes,” wrote Professor Savulescu.

“We no longer face diseases that killed our ancestors, but vaccine hesitancy is on the rise even for well-established vaccinations.

“The problem is likely to be bigger for a new vaccine. For established vaccines, some countries have turned to mandatory vaccination schemes.”

Read more: Immune response six months after overcoming mild coronavirus

The global coronavirus death toll has exceeded 1.2 million, with the pandemic also having far reaching consequences on the economy and people’s mental health.

Some have therefore called for a coronavirus vaccine, if and when one becomes available, to be made mandatory.

Professor Savulescu believes jabs should be voluntary in general, however, “there is a strong case for making any vaccination mandatory (or compulsory) if four conditions are met”.

These conditions are “a grave threat to public health, the vaccine is safe and effective, the pros outweigh the cons of any suitable alternative, and the level of coercion is proportionate”.

While “coercion” may sound off-putting, Professor Savulescu pointed out people have historically been conscripted to serve their country.

“We often analogise the pandemic to a war: we are fighting the virus,” he wrote.

“If people can be sent to war against their will, in certain circumstances some levels of coercion are justified in the war on the virus.”

Australia also has the “no jab, no pay” scheme, which withholds child benefits if a youngster is not vaccinated.

Watch: Can you catch coronavirus twice?

Any mandatory vaccine would ideally first be proven to be “100% safe”, however, “a 0% risk option is very unlikely”.

“We cannot say whether a mandatory policy of COVID-19 [the disease caused by the coronavirus] vaccination is ethically justified until we can assess the nature of the vaccine, the gravity of the problem and the likely costs/benefit of alternatives,” wrote Professor Savulescu.

Staunch anti-vaxxers may never be convinced to have a jab, however, incentivising immunisation may persuade those who are more on the fence.

Read more: App could detect asymptomatic coronavirus

“As long as we are accurate in conveying the limitations in our confidence about the risks and benefits of a vaccine, then it is up to individuals to judge whether they are worth payment,” wrote Professor Savulescu.

“If a person chooses that option, it is because they believe that, overall, their life will go better with it, in this case, with the vaccination and the payment.

“It may be that those who are poorer may be more inclined to take the money and the risk, but this applies to all risky or unpleasant jobs in a market economy.

“It is not necessarily exploitation if there are protections in place such as a minimum wage or a fair price is paid to take on risk.”

While paying people to have a coronavirus vaccine may sound expensive amid the UK’s faltering economy, Professor Savulescu stressed the move could save money in the long term.

“The cost of the UK’s furlough scheme is estimated to reach £60bn [$78.4bn] by its [original] planned end in October, and the economic shut down is likely to cost many billions more,” he wrote.

“It would make economic sense to pay people quite a lot to incentivise them to vaccinate sooner rather than later; which, for example, would speed up their full return to work.”

Incentives could also take the form of “payment in kind”.

“One attractive benefit would be the freedom to travel, to not wear a mask in public places if you carried a vaccination certificate and not to socially distance,” wrote Professor Savulescu.

“Moreover, it would help ameliorate the risks the unvaccinated would pose to others.”

Read more: Social distancing leading to surge in dengue cases in Thailand

Not everyone agrees with Professor Savulescu, however.

“Paying people to get vaccinated would set a very dangerous precedent,” said Professor Keith Neal from the University of Nottingham.

“If we did this, people will expect it for other vaccines and also social media falsehoods would have a field day suggesting it can’t be safe if that’s what you need to be paid to have it.

“Using vaccines as immunity passports would be worthless as the vaccine may occasionally not protect and the system could be open to forgeries, much the same as under 18s borrow ID for alcohol.

“We have never had mandatory vaccination and are not going to start with a new vaccine.”

With any coronavirus vaccine assumed to be voluntary, Professor Neal expects demand to exceed the speed of which a jab can be produced and delivered.

“The idea to pay people to get a vaccine is ill thought out and potentially counter-productive,” he said.

“The money will be much better spent in other parts of the NHS or providing vaccine to low-income countries to prevent possible re-introduction into the UK.”

Watch: What is long COVID?