• Prasanna Adhikari

Can rules and incentives change the rate of COVID-19 vaccination at a workplace?


More than six months after a savior, the COVID-19 vaccine, arrived, the goal of saving every life through vaccination remains very elusive. Why is it that, while some people rolled up their sleeves and lined up at vaccination sites, others stayed away from it? And. more importantly, what can possibly be done to get more people to receive their shots?


Vaccination is not the only personal health and safety choice we make in our life. Buckling up while driving is also a personal choice we make every day. According to the latest data NHTSA, in all of 2017, 2,549 lives could have been saved had they been wearing seat belts. It is fair to assume that the numbers are not very different for 2020. Compare this with about 8000 people who died due to COVID-19 in just one month in July 2021. The overwhelming majority of them were not vaccinated and would not have died had they been vaccinated. NHTSA estimates that, in the same period, seat belts saved about 14,995 lives. In contrast, vaccination is attributed to have saved thousands life during the recent surge of Delta variant. If were to summarize these numbers, the likelihood of dying due to COVID-19 if unvaccinated is much higher than the likelihood of dying in a car accident if we do not wear a seat belt. Still, 90% of Americans (according to NHTSA) are willing to put up with the daily inconvenience of wearing a seat belt while less than 50% are willing to get a single shot of a COVID-19 vaccine. Why is that?


One reason is, we are terrible at estimating risks, but that's a topic of discussion for another article. The focus of this article is group behavior and one place where we can look for an answer in Conformity by Harvard behavioral psychologist Cass Sunstein.


As the name of the book implies, it explores is how our opinions and decisions conform to the opinions and decisions of those around us. Most of what we think about almost anything - including vaccines, is not because of our first-hand knowledge but of what we learn from what others say and do. Although we hear much about personal choices in terms of our vaccination choice, there is very little that is truly personal in the choices we make. Most of our choices and our decisions are influenced by other people.


Cass Sunstein points out that there are two important influences on individual beliefs and behavior. The first, informational influence, is the influence of the information conveyed to us by the words or the actions of other people. We use their statements and actions as the source of information to help us make our own decision. As Sunstein puts it, "when your friend or your neighbor believes in certain things, you might well take their beliefs as evidence of what you should believe". Jack may not have first-hand information on vaccination but because the friends he trusts are vaccine skeptics, so is he. What Jack may not realize is that his trustworthy friends likely made their choices using the same rationale as he did, and without the benefit of first-hand information.


The second influence, reputational influences, is what Cass Sunstein describes as, "the pervasive human desire to have and retain the good opinion of others." When many in our close circles believe in something, we have an innate tendency to agree even though we may have an opinion to the contrary. Even though Jill may have an inclination to get the vaccination, she would rather not dissent and instead be in agreement with the decision of her family members who vehemently oppose vaccination.

If informational and reputational influence can sway people’s beliefs in one direction, one cannot stop but wonder if we can leverage these influences to sway them in a different direction?


One such possibility is by using what Sunstein referred to as the "expressive function of law". He points out how some laws change people's behavior, even though such laws are never enforced. Examples include seat-belt and public smoking laws. These laws are hardly enforced but are heavily followed. According to Sunstein, laws provide an informational influence about the "right thing to do". It also helps those under reputational influences follow their belief under the cover of the law.


I am not suggesting by any means that we should make vaccination a legal requirement. On the other hand, if we assume that rules and regulations in an organization provide similar informational influence as laws do in our society, it is fair to assume that rules requiring certain behavior can elicit that behavior even if the rule is not enforced. Rules likey have the same “expressive function” of providing the informational influence about the “right thing to do”. It can also provide a cover against reputational influence. Jill could justify to her family, "I had to get the shot because my job now requires it." With an FDA-approved vaccine available now, such rules are now more viable and we are starting to see some businesses do so.


Currently, instead of rules, many businesses are providing financial incentives to their employees for getting vaccinated. Such financial incentives can be effective in changing an individual's behavior, especially those that are on the fence. However, money often plays a counter-intuitive role in people’s behavior (for more on it, read Predictably Irrational by Dan Ariely). It may be viewed as cynicism and strengthen the resolve of those who are holding out. From the reputational influence perspective, using the cover of "I got the shot because they paid me $100" is not likely to be swallowed easily by Jill’s family. In the end, most of the money will be spent on those who would have gotten their jabs regardless of the reward, making a very little dent in the total number of vaccinated.


If businesses were to rely on the monetary reward to bring behavior changes, I think there is a better way to bring about the change than by just rewarding for their action. It is by giving the monetary reward to create information and reputational influence. If businesses gave a financial incentive to employees to voluntarily let the rest of the company know (perhaps by having their names includes in a list of vaccinated employees the company shares with others), it will likely create information and reputation influence and get others to do the same. When Jack sees the name of several of his close colleagues on the list, he is more likely to follow suit. The incentives to inform others of one’s vaccination can be much more effective than just the incentive to get vaccinated because of the informational and reputations influence of the former. Each $100 spent on incentivizing vaccination changes the behavior of one person but the same amount spend on incentivizing its announcement changes the behavior of many.


Whether not these two ideas suggested in this article, the vaccination rule and incentive to announce, can be effective in increasing the rate of vaccination is yet to be seen. Businesses have to consider their legal implications and need to consult their own legal counsel before implementing them. However, they illustrate how informational and reputations influences may be used to elicit behavioral changes for a safer workplace.

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