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Dr. Zorba Paster: Reward people who get COVID-19 vaccine to ensure herd immunity
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Dr. Zorba Paster: Reward people who get COVID-19 vaccine to ensure herd immunity

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Time for an important question: Will you get the COVID-19 shot when it comes out?

Will you be the first one to roll up your sleeve, or the last? Or not at all? If our government says it’s safe, will you trust the data?

These are not small questions but big ones, which is why a recent article in the British Medical Journal interested me so much. The headline was intriguing: “Pay people to get the COVID shot.”

Now, hold on a minute — pay people go get the shot? Where is personal responsibility here? Do we really have to put money in people’s hands to get enough folks on board for herd immunity?

To reach herd immunity, where enough people have antibodies so the virus can’t propagate, more than 80% of the population needs to have antibodies. That just might mean we have to incentivize people to get immunized.

Let me digress a moment to back in the day when we didn’t have to wear masks. I was the medical director of our local nursing home for, get this, 40 years. Yes, folks, I am that old. Hard for me to believe that, too.

So, we wanted to have everyone who worked there get a flu shot. About 20% of the workers didn’t want to get a shot. We tried to convince them it was important, but many of them held their ground — no shot.

The administrator and the owner of the nursing home (it was not a large corporate entity) could have just said no shot means no job, but they didn’t want to do that. These were good, hardworking people who liked their job and kept the nursing home going.

What to do? Remember, this was pre-COVID times. Influenza is most contagious just before you have symptoms. So, like COVID-19, you can’t depend on symptoms to determine when you’re infectious.

We decided that as soon as influenza was reported in the state of Wisconsin in autumn, everyone in the nursing home who was not immunized would have to wear a mask until influenza left the state in the spring.

Now, as you know, masks are not natural, not something anyone in their right mind really wants to wear. So guess what happened? We went from 80% influenza immunization compliance to 100%. The incentive of not having to wear a mask worked.

Back to this “pay to get your shot” scenario. Public health experts say getting the COVID vaccine should be required if certain conditions are met such as when something is a grave threat to public health, the vaccine is safe and effective, the pros outweigh the cons and there is no suitable alternative.

We have done that with other things including outlawing smoking in public, mandating seat belts — incentivizing that by giving a ticket if you don’t buckle up.

So what sort of incentive or coercion should be used? Should it be like a parking ticket or a tax break? And how would people react? Keep in mind the BMJ is not an American journal but out of the U.K. — different country, different culture. Their doctors are wondering whether giving a cash payment for getting COVID immunization is the way to go. They agree that making it mandatory is not the way to go. I can just imagine what that would be like in the U.S. Nope, not in our country.

Safety is a very important issue. We used an oral Sabin polio vaccine for years — it was a live attenuated virus that was easy to administer and worked better than the Salk vaccine. But one in a million kids got polio from the vaccine. Eventually, there was no “wild” polio in the U.S., so we went back to the older Salk “killed virus” vaccine. One in a million cases from the vaccine was no longer acceptable as the epidemic waned.

The incentive might be like that in our local nursing home — if you get your shot, you don’t have to wear a mask, you can travel on an airplane (ah … I remember air travel), you can go to a rock concert, you can go to theaters because you have your COVID Card. That would be an interesting incentive.

My spin: An incentive to get the shot wouldn’t have to be money or avoiding a ticket, but being rewarded by getting to do the things we like to do — travel, restaurants, friends and family. People who get the vaccine could be issued a COVID “shot card” to show they’ve had it. It might be like having a valid ID to get a drink.

Interesting thought, isn’t it? Stay well.

This column provides general health information. Always consult your personal health care provider about concerns. No ongoing relationship of any sort is implied or offered by Dr. Paster to people submitting questions. Any opinions expressed by Dr. Paster in his columns are personal and are not meant to represent or reflect the views of SSM Health.

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