Today's Opinions, Tomorrow's Reality 

The Carrot and the Stick

By David G. Young

Washington, DC, April 20, 2021 --  

Now is the time to pressure vaccine-hesitant Americans to change their minds. An appeal to selfish interests can go a long way toward serving the common good.

Barely a year after coronavirus cases filled hospitals in New York City, an amazing thing has happened -- over half of American adults have received their first shots of vaccine against the disease1 Yet while this milestone indicates an immense triumph, it also signals the beginning to a new phase for which the country is woefully unprepared.

Vaccinating half the population is nowhere close to enough. No vaccine provides perfect protection and the last six months have seen the emergence of new strains that reduce the efficacy of vaccines designed for the variant that first appeared in Wuhan China 16 months ago. The herd immunity needed to stop the spread in the general population requires that the vast majority be either vaccinated or have recovered from an active infection.

And there is the problem -- America has nearly burned though all its eager early adopters of the vaccine. Most of those who remain are those hesitant to receive it. And American officials have shared no plan for cajoling the long tail of nervous, misguided, ill-informed, and ideologically obstinate Americans to get with the program.

Fortunately, there is a proven way to accomplish this: simply require vaccines for group activities. Such a suggestion will certainly provoke outrage amongst many Americans. It conjures up notions of repressive government, lost privacy and odd-ball conspiracies about what is really in that shot.

But this is hardly a new idea. For most of the last 50 years, public school districts in the Unites States have required parents to show proof that children had been vaccinated against a wide variety of diseases to attend class: smallpox, measles, mumps and rubella are all viral diseases conquered not in small part by these vaccination requirements. What's more, there was no fancy vaccine passport app needed to show this proof -- a doctor's certificate with the patient name was good enough.

And while there were always a few fringe Americans who fought against these vaccination requirements -- religious zealots, hippies, nature freaks as well as the delusionally paranoid -- the vast majority went along and society went on without them.

Similarly, travel to tropical countries has long required proof of tropical disease vaccination (typically yellow fever) in order to be admitted at the border. My passport cover contains a well-worn yellow card with logos of the U.S. Centers for Disease Control and Prevention and the World Health Organization showing a hand written dated signatures of the doctor or nurse inoculating me against yellow fever and other diseases. I had to show this form to the public health officer at the border when visiting Southeast Asia, South America and East Africa. It's really not that big of a deal.

This simple, established system must be expanded from international travel to many group activities within the United States: schools, domestic airline flights, restaurants, bars, gyms, and even churches. A coordinated reopening campaign linking vaccination with the ability to engage in many activities of daily life will go a long way toward nudging millions of hesitant Americans to go ahead and get vaccinated.

This may sound a lot like the concept of "vaccine passports", but it isn't really anything fancy or new. There is absolutely no need for a special ID card or mobile phone app. The United States already allows a wide variety of forms of identification to be used for proof of identity -- the same broad standard can be used to offer proof of vaccination.

Israel is one of the early countries to introduce a system to require vaccination for these same kinds of group activities with its "Green Pass" program. Despite sizable vaccine hesitant communities amongst Orthodox Jews and younger Israelis, the country managed to get roughly 80 percent of its adult population2 outside the Palestinian territories to get their first inoculation -- not in small part because of the rule that returning to the pleasures of daily life required it.

If nothing is done, there is no way America can achieve that same rate of success. A Gallup Poll released last month found that 26 percent of Americans do not plan to get vaccinated3. If America fails to change many of these people's minds, the dream of herd immunity will be impossible to achieve, unless the bulk of the vaccine hesitant fall victim to natural infection.

The good news is that the vaccine hesitant are far from a monolith. A second poll from the Kaiser Family Foundation, also conducted in March, defined the vaccine hesitant as three distinct groups. Although 13 percent said they were "definitely not getting the vaccine," 7 percent said "probably not" and another 17 percent were said they would "wait and see".3 If America can successfully convince all but 13 percent of the population to get vaccinated, it will have a good shot at reaching the herd immunity that could edge the country back to something we recognize as normal.

Achieving the above means using both a carrot and stick to reach the 7 to 24 percent of Americans who are vaccine hesitant but not beyond convincing. Want to go to a bar? Sing in the church choir? Fly across the country? Work out at the gym? Well, then you better get that vaccination. Look at all your friends who have gotten vaccinated and what a great time they hare having!

America is a free country where people are at liberty to decline. But those people will have to look forward to sitting at home alone -- or at least being stuck at a house party filled with their pig-headed science-denying compatriots.

Yes, such an effort would encounter lots of opposition from local leaders, especially in Republican-governed states. But witness the success that regional supermarket chains have had at enforcing mask mandates inside grocery stores even where there is an absence of state and local rules requiring them. Forget government mandates -- a quiet partnership between American health leaders, the Biden administration, and private businesses can go a long way toward achieving this system. The goal need not be strict enforcement nor perfect compliance -- it just has to be good enough to nudge hesitant Americans to agree to get that first shot.


1. Associated Press, Half of US Adults Have Received at Least One COVID-19 Shot, April 18, 2021

2. The Times of Israel, Vaccination Stagnation: Only About 6,000 Israelis a Day Now Getting First Shots, April 1, 2021

3. Gallup, Satisfaction With U.S. Vaccine Rollout Surges to 68%, March 30, 2021

4. Kaiser Health News, Covid Vaccine Hesitancy Drops Among All Americans, New Survey Shows, March 30, 2021