Taking a vaccine is a not just a self-protection behaviour against a virus, but insofar as it reduces contagion and creates herd immunity, it is a pro-social behaviour. It reduces the chances of infecting others and minimises the risk of another wave of the pandemic, which would cause misery to so many. Taking the vaccine can be called a ‘win-win’ situation: engaging in one’s protection protects others. Hence it merits some form of promotion. The question of which vaccine is secondary and mostly irrelevant.
Yet, there are many out there who are still unsure whether to take the vaccine (the so-called ‘vaccine hesitant’), or who, more generally, happen to distrust medical decision-makers for all sorts of reasons. In a setting where effectively communicating knowledge is challenging, persuasion comes from the accumulation of previous knowledge, and building trust takes a long time, individuals are likely to pursue their own form of self-interest and go without taking the jab. In fact, today there is a petition in the UK parliament for the government not to roll out vaccine passports.
Yet, non-vaccination might be nonintentional, a form of procrastination (‘pushing critical decisions to the future’) or simply an additional expression of the universal preference for inaction which is known as ‘status quo bias’. People in the latter category might be sensitive to interventions to promote vaccine uptake. This includes the elimination of constraints to vaccination, namely frictions and transaction costs. However, when non-vaccination is intentional, a question that merits discussion is that of the legitimacy of making several benefits conditional on vaccination.
For this to be possible, one needs to be able to identify who has received the vaccine, something typically known as vaccine passports, which are proposed to be implemented in the EU from March 24. Below we discuss the conditions under which making certain benefits conditional on vaccine passports is acceptable, and what the advantages and potential consequences are.
When are vaccine passports discriminatory?
What we call a vaccine passports is just a digital certificate of vaccination, which some airlines or countries might require of travellers, but they can be used more widely in society, in any activity where the admission right is a business choice. However, how discriminatory are vaccine passports?
There are important technical issues at play, which the Royal Society has established. This includes, among other things: meeting benchmarks for COVID-19 immunity and dealing with differences in vaccines; some international standardisation; data security and portability; affordability; and meeting legal and ethical standards.
For vaccine passports to be fair, everyone should have had the chance of being vaccinated, at no major cost, or else passports become potentially discriminatory. First, some individuals will have to be excluded as they cannot be vaccinated due to allergies or pregnancy. Second, its immediate implementation would keep individuals in many lower income countries from travelling, as they might not get the jab until 2022. Not only people of power have used their influence to skip the queue, but in most countries older individuals would take priority against younger individuals—who have been prosocial and stayed at home, and now see that those who they have been protecting will be prioritised to travel. The exception of such argument is that people working for the health sector will also be prioritised, which provides for some compensation for their extra stress during the pandemic. However, in any event, discrimination would be only temporary whilst the vaccination rollout allows everyone to have the chance to take the jab.
What should vaccine passports piggyback on?
In addition to the discrimination of people who are willing but unable to take the vaccine, the use of passports should be limited to non-essential services. Hence, even when it comes to travelling, it should not be conditioned on travelling to work. And passports should not provide any special rights, else it can crowd out one of the most essential reasons people vaccinate: being pro-social towards others by helping contain the spread of the virus.
Who are the vaccine-resistant?
There have always been contrarian people in all societies, and their existence might be healthy, helping enrich our views of the world. Similarly, there are those who are so affected by a status quo bias that they oppose any form of change. In countries where herd immunity is likely to be reached even though some people might still not take the jab, such as the UK, conditioning certain benefits on vaccination might not be an efficient policy. However, data on vaccine attitudes suggests that many countries are far from reaching herd immunity in part due to the unwillingness of the population to vaccinate. Paradoxically, the population groups that are most at risk are those less willing to take the vaccine.
How do they change behaviour?
Vaccine passports can be used as an incentive to change behaviour. They not only provide some direct benefits, but they signal what society expects from individuals. They exemplify a social norm that individuals are expected to comply with. They are no different from other forms of conditioning used in a number of settings. Vaccination cards are typically required for children who are sent to childcare, school, and summer camp. These ensure that children do not put others at risk. Similarly, in some low income settings, cash transfers are conditional on beneficiaries vaccinating their children and, more generally, going through health check-ups.
Vaccination for yellow fever is required for travellers entering some countries already, so COVID-19 vaccines would simply be an addition to such requirements. Vaccination cards can be seen as a form of reward, and play the same role as blood donation cards in the UK. They signal compliance with a civil duty towards a community, very much like voting in an election when the costs of doing so are not large.
Assuming everyone has had the chance to take the jab, should we condition activities such as travelling and using leisure centres on taking the vaccine? Should it be used when individuals are hesitant, and marginal changes to what individuals can gain from taking the vaccine make a difference in the decision to vaccinate? Our behaviour is motivated by the consequences we might suffer—reinforcements and punishments. Examples of negative reinforcement include the “beep, beep, beep” until you fasten your seatbelt. Similarly, vaccine passports for certain activities act as a form of nuisance individuals must go through, like when one is fined and is reminded to pay.
Finally, it’s worth mentioning that recent YouGov data shows that 65% of the British people say they would support vaccine passports (‘a document that would theoretically allow vaccinated people to return to workplaces and bars, and even travel again, before those who haven’t had their shots’).
Joan Costa-Font
Joan Costa-Font is an associate professor (reader) at LSE’s department of health policy. He is an economist affiliated with CESIfo in Munich and IZA, Bonn. The core of his current research is on health economics.
This article was first published in LSE Business Review
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