Sunday, February 14, 2021

Should We Pay People to Get Vaccinated for COVID-19?

I read recently that Kroger, who runs a grocery store chain, has joined with other retailers in paying employees who receive a COVID-19 vaccination.  The $100 payment should serve as an incentive for employees to roll up their sleeves.

There is an ongoing debate whether employers can or should mandate COVID-19 vaccinations for their employees.  The state of play now is that employers are encouraging, but not requiring vaccines, as mandating vaccines creates legal exposure for employers.  For example, if you require that an employee is vaccinated against the worker’s wishes, and a complication occurs, is the employer responsible?  Can an employee be disciplined or terminated for failure to vaccinate if there are no vaccines available within a reasonable distance?  And mandating vaccinations may be complicated when workers are unionized.

The right to refuse treatment is a bedrock medical ethical principle that I support.  For example, if I advise an individual with acute appendicitis to proceed with surgery, this patient has a right to decline, assuming that the patient is competent, and I have properly informed the patient of the risks and benefits of the reasonable options.

This right, along with all of our rights, is not absolute.  If refusing medical treatment has a public health dimension, then the issue becomes more complex.  And the terrain can be murky.  If a parent refuses to have his school age child vaccinated against communicable diseases, this right collides against the rights of other children and personnel in the school.   Indeed, it is for this very reason that school districts can require students to be vaccinated.   If a parent objects, then they are free to home school their youngster.

How much will you pay me to mask up?

This is why the failure to wear masks when advised to do so is not just a personal decision.  It puts other as risk.   I don’t object if someone chooses to become inebriated at home.  But it’s quite different if this individual decides to operate a motor vehicle on city streets. 

While no vaccine or medical treatment is 100% safe, and there may be unknown vaccine risks that will emerge later, I recently received the 2-shot Moderna series enthusiastically.  The only incentive I needed was my belief that I would be much less likely to become infected and to infect others.

If a hundred bucks is a necessary incentive, and a business has the will and resources to expend on this effort, then good for them.  We’re familiar with similar strategies, such as paying kids to do homework.

Should we also pay people to be honest or to be polite or to stop at red lights or to be on time for appointments or to observe speed limits?  What should the per diem reimbursement be for wearing a mask?

In other words, should we pay folks to do stuff that they should be doing for free?





Elliot Davidson said...

Interesting take and one with which I agree. With vaccine reluctance, we need to do all that we can to get to a critical mass of vaccinations to open up our society again. Be interested in your view of extrapolating this concept to preventing pregnancy. While this would be primarily a money saving endeavor there could be other benefits or negatives. Is it ethical to pay women for receiving an implantable contraceptive or either sex for permanent sterilization?

Unknown said...

Coercion versus persuasion is the issue. What a government does is generally coercion. The free market involves persuasion. There is a big difference; no violence with persuasion. The rights of any individual end where they interfere with the rights of another individual.
There really are no circumstances (or any “crisis”) which changes this dynamic. Liberty vs violence.

Peggy Finston MD said...

I think the premise of this question is problematic, even before we get to the human rights issue of enforced medical treatment.
Regardless of politics, the ambiguity around COVID vaccines and other restrictions have been endlessly exploited, upgraded and reported as fact. Even physicians who advise patients are not necessarily aware that there's no scientific evidence to support the effectiveness of masks to prevent COVID, whether indoor or outdoor. The damage of politicizing becomes obvious if one dares to question these restrictions. He or she is labelled a "conspiracy theorist" or a "Trumpite." That person's opinion is dismissed.
The Medical "experts" have called masks' effectiveness "common sense and refer to the material barrier of the mask. "Common sense" also predicts that the mask can hyperconcentrate the exhalation gases which may change the ph of throat and nose making that person more vulnerable to infection. In addition the mask might hyperconcentrate whatever virus is already present. I have post COVID syndrome with significant SOB and unable to tolerate the mask for more than 5 minutes before needing get "fresher air."
Also, these vaccines have been reported with approximate, but dazzling "95% and 83% effectiveness." Effectiveness of what, though? These RNA vaccines are not effective in the same way past vaccines have been effective, like polio. The new ones are enough different that even using the word "vaccine" is questionable but definitely useful for public acceptance. The new RNA messenger strands do not prevent a person from getting COVID nor prevent him from spreading this illness. That has not been made clear in the news coverage. The RNA vaccine is only intended to lessen the severity of the symptoms, if you already have contracted the virus.
The drug companies have not been willing to "share" their raw data to justify these numbers. I can't see how one could even determine them.
The bigger issue relates to adverse reactions. Since the vaccines are on-the-way to becoming mandatory, the hard-sell line has been "one size fits all" with only minimal side effects. Everyone but those with a history of anaphylactic shock from the same ingredients should take it. That excludes those with autoimmune and immune-compromising disorders, cancer treatments, etc. No data has been released to justify this conclusion. About 620 people have died from the vaccines to date and only about 200 were from anaphylactic reactions. I would expect an explanation about the other 400. Again, the drug companies have not, which may mean will not release further information. People getting the injection are not observed for the required 10 or 30 minutes. I can only wonder how careful the follow-up is for adverse reactions short of death.
We, as physicians, owe it to patients and ourselves, to read in between the lines and identify what information is missing. We can't afford to parrot mainstream press that has political agendas, even if we happen to agree with their opinions. Opinions are not facts.
Peggy Finston MD

Anonymous said...

Remember, at this point in time it has not been proven safe and effective by the FDA. It is approved only under an emergency use authorization. Industries often pay volunteers in drug trials. So, yes, everyone who received this novel treatment should receive financial compensation for assuming the risk inherent in the vast experiment in which they participated.

Michael Kirsch, M.D. said...

Excellent comments all!
I think the notion of paying for contraception is ethically problematic. It sounds similar to selling organs for transplant. Both lead to exploitation.
I have acknowledged that the vaccines were approved on an Emergency Use Authorization, which as the term suggests, is distinct from formal approval. But the interim evidence has been very favorable. I also acknowledge that the gov'd position on masks has been shifting since a year ago. But it is also true that nearly all public health experts recommend them even if there is not absolute proof of efficacy. Indeed, there have been much testing on various constructs of masks to determine which are more capable of filtering out droplets and aerosolized particles. Yes, the science is not perfect but decisions need to be made before proof of benefit emerges. And, while there may be some risks of masks in certain circumstances, as Peggy Finston, MD points out, I am not personally aware of a significant number of such cases. Peggy, I hope that 2021 brings you healing. I would query Dr. Finston if she credits masks or other measures for the extremely low levels of influenza infection.

Peggy Finston MD said...

Response To Michael:
Thank you for your thoughtful comments and wishes. As I mentioned, what are described as "effective vaccines" invite the public and professionals to imagine past successes with polio, and other attenuated DNA vaccines.
These products are different.
The reviews that praise the "vaccines" do not define what they mean by "effective." Effective commonly is assumed to be protective of both contracting and spreading the illness. Neither applies to these products. The statements about the safety of these products for everyone with any condition, sometimes even including anaphylaxis, are not being validated by what people are actually experiencing.
You don't need to believe me or anyone else. (I was shocked myself to learn this.) The truth is out there, it's just masked by misleading headlines and typical media hyperbole. (Look at the past 2-3 weeks of MedPage, STAT, JAMA, etc.). Last count about 640 deaths reported following the "vaccination," about 200 of them from anaphylaxis and the remaining deaths strangely not addressed or even acknowledged as something to find out about. Instead this drumbeat goes on, with the help of Bill Gates, another make-believe doctor. They are new champions of people's health and their own wealth. (Investments in Vaccine #3).

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