WASHINGTON — In late March, Krispy Kreme made an offer: Any customer showing a coronavirus vaccination card would receive a free doughnut.
Some celebrated the move as the kind of public health nudge that could hasten vaccine uptake, but Dr. Leana Wen was not among those cheerleaders. The former Baltimore public health commissioner, who has become a prominent media commentator on the pandemic, took to Twitter to criticize Krispy Kreme. “Every incentive helps & free donuts may help move the needle,” she said. “However, donuts are a treat that's not good for health if eaten every day.”
Twitter being Twitter, Wen was swiftly denounced as a scold, with Cosmopolitan magazine going so far as to accuse her of “inciting fatphobia.” In the end, nearly 1.5 million people took advantage of the promotion, Krispy Kreme recently announced.
And that was only the start. Since then, states have offered a variety of incentives to get people vaccinated. Long gone are the days when “vaccine hunters” stalked the entryways to supermarkets at closing time, hoping there would be doses to spare. Increasingly, the goal is to vaccinate people who have been less than eager to get the shot, either because they’ve been subject to misinformation or for some other reason, such as mistrust of the medical establishment or, simply, a lack of will. In early May, President Biden came close to saying that some of the still-unvaccinated were just lazy.
According to the Centers for Disease Control and Prevention, 63 percent of Americans are either fully or partially vaccinated. That has caused infection rates to plummet in recent weeks, but thousands of people are still contracting the coronavirus daily. Millions more need to be vaccinated to eradicate community spread. Hence the plethora of giveaways, all meant to close gaps that the coronavirus could potentially exploit.
Increasingly, states are adopting a whatever-it-takes approach to drive people to vaccination sites. One of the first early successes was Ohio, whose Vax-a-Million contest made a 22-year-old woman very rich. West Virginia, another state early to the incentive idea, offered residents $100 savings bonds. That hasn’t proved enough, however, with Gov. Jim Justice announcing that the state will hold a vaccine-related raffle on Father’s Day that will include guns, trucks and cash.
Not gun licenses, mind you. Actual guns. Which one could then presumably use in Maine, which is offering free hunting and fishing licenses as an incentive (it is unclear if any enterprising Americans have tried to claim incentives in multiple states).
Vaccination is supposed to be a virtuous act, with every shot conferring a greater protection to the community as whole, not just to the recipient alone. So it’s more than a little ironic that the appeal has come to be largely driven by some of our favorite vices. The question is whether that kind of appeal makes sense in what is already a public health emergency, one that has a significant psychological component.
“It's possible that some individuals might revive a bad habit as a result of these initiatives (e.g., a former gambling addict might start gambling again); so if one could think of equally effective policies without those risks, they would be preferable,” said Emrys Westacott, a philosopher who has written about the history of human vices. He added that “this may be one of those occasions where the community good outweighs individual concerns.”
That may explain why the rigorously abstemious President Biden, whose son Hunter just published a book chronicling his fight with substance abuse, was recently hawking beer from the White House.
“Get a shot and have a beer,” the president said in announcing a partnership with Anheuser-Busch. The behemoth brewer said earlier this week that if Biden’s goal of having 70 percent of adults at least partially vaccinated by July 4 is met, every American will get a free beer.
If you live in Illinois, getting vaccinated can earn you two beers, one from Anheuser-Busch and one from a new state-level program. A vaccination clinic at the Kennedy Center in Washington, D.C., offered sweeping views of the Potomac River and, more to the point, a free beer from the Solace Brewing Company.
“I do not think giving people guns for a vaccine is a good idea at all due to the implications for public health of gun violence,” said Dr. Monica Gandhi, an infectious disease expert at the University of California, San Francisco. “I do think giving out incentives like food or beer is actually a good idea; this works in HIV medicine (giving incentives for taking pills) and has been used in medicine for ages.”
Still, all this could come across as a little self-indulgent, considering that many parts of the world have been desperate to access vaccine doses. As of early May, there were some countries that hadn’t had a single citizen vaccinated. And others, like India, have undergone surges that killed thousands daily. In the United States, meanwhile, doses are going unused. "People should be offered a vaccine,” Johns Hopkins surgical oncologist Dr. Marty Makary said on Fox News earlier this week, “and if they choose not to get it at this point, we should send those vaccines overseas."
There is also the question of whether the incentives actually work. “It’s hard for me to believe that someone would be motivated to get vaccinated just so they could get a Krispy Kreme doughnut or two,” Doug Storey, a professor of health communication at Johns Hopkins, said last month.
Storey suggested that financial incentives could work but stressed the importance of outreach to people who have something “nagging at them,” such as a worry that vaccines are not safe. In the same White House remarks that saw him hawking beer, Biden announced a partnership with barbershops in the African American community, called “Shots at the Shop.” That program is premised on the notion that trust, not freebies, is what will ultimately help get people vaccinated.
Of course, no state is relying on giveaways alone as a solution to its vaccination challenges. Rather, giving people free stuff is just one more means to get them to do the right thing, if the prospect of returning to a pre-pandemic normal is not enough on its own.
Plus, those giveaways inject a little esprit de corps into what can be an unpleasant or inconvenient process. “I'm basically a fan of anything that makes it fun,” said Brown University economist Emily Oster, who has written extensively on the pandemic.
“Fun” is usually not a word associated with New York Mayor Bill de Blasio, but he was clearly enjoying himself during a recent press conference that had the notorious gym rat eating a burger and fries as he announced that Shake Shack, the wildly popular haute fast food chain, would be offering burgers and fries for the vaccinated.
“If this is appealing to you, just think of this as you think of vaccination,” de Blasio said.
“Mmmm ... vaccination.”
Then there was the company ScanMyPhotos, which offered free photo scanning services for people who got vaccinated. A press release sought to distinguish the company’s giveaway as more virtuous than others. “Unlike free donuts or beer, the free photo scanning incentive will become a storytelling heirloom keepsake for families,” it read.
As one public health professional told Yahoo News, all such giveaways “aren't going to be that effective as incentives as much as they are effective as marketing ploys for the companies,” whether those companies are selling beer or digital photos.
“What will make a difference is requirements,” she said. And while states have urged vaccinations, they have shied away from mandating them. For now, they're hoping that cash and booze will do the trick.
Cover thumbnail photo illustration: Yahoo News; photos: Scott Olson/Getty Images, Getty Images (6)
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