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COVID-19, Public Health and the Use of Sanctions and Incentives

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Ben Tafoya
December 4, 2021

As these words are written around Thanksgiving 2021, two sets of numbers keep climbing in concert; COVID-19 infections and vaccinations. This is somewhat counterintuitive, as the expectation was that with higher numbers of people vaccinated, there would be declining infections. In Massachusetts, the number of infections is almost precisely where they were last year on this date despite one of the highest rates of full vaccinations among adults. Happily, the number of hospitalizations is down by roughly 25% and deaths are down by half.

As promised, vaccinations work by lowering the rate of infection and preventing many serious illnesses. With over 11 million doses administered in a state of 7 million people, the impact is clear. Yet there are still large numbers of adults, teens and now children (through parents) that question the effectiveness and safety of the vaccines. So, what can be done to increase the rate of vaccination and use of the mask as an extra layer of protection?

Broadly speaking, government has two sets of tools to channel human behavior. These measures, known as incentives and sanctions, cover a wide range of actions that we see daily. Incentives are inducements to encourage a particular act. For example, our society values home ownership and offers an incentive through the mortgage interest tax deduction. Another example is the tax credit for electric vehicles, which significantly lowers the cost of such a purchase. Incentives are available broadly to those who take the actions. Typically, they are used in situations where it is easy to identify the behavior and reward precisely what is targeted.

Sanctions, on the other hand, are punishments because of an act that is proscribed by society. Criminal behavior is a classic example where punishment comes from the act of stealing a car, or a physical assault. Frequently, sanctions are used to discourage behaviors which are hard to catch. Driving your car above the speed limit is not caught most of the time. So, when it is caught, it is punished, and in some cases with such a harshness that it acts as a (theoretical) deterrent for others to repeat the same act.

In the COVID-19 experience, we have seen the use of both forms of behavior management. In the initial stages of pandemic in the United States, after a false start, the use of masks and social distancing was encouraged, then required, by governments as well as proprietors. The sanction was to prohibit those who would not abide by the restriction from participating in the activity, such as dining or shopping. This intensified as “lockdowns” shut all except those businesses deemed essential. The arc of action varied among countries but involved prohibitions on activity punished by severe fines.

Months into the pandemic, as the vaccine appeared, the use of these sanctions waned. Early adopters rushed to get inoculated, at least in the United States where there were ready supplies of the vaccine. As the pace of shots slowed, both government and private firms took actions to increase the numbers of the vaccinated. Interestingly, some firms used incentives, by offering bonuses or paid time off to reward those who take advantage of the preventative measure. Governmental jurisdictions declared a mandate for vaccination sometimes with a testing option in order to nudge the numbers higher. The mandates are resulting in increased numbers of the vaccinated and some dismissals for non-compliance.

Which approach is more effective? The circumstances required high levels of vaccinations to protect the individual, as well as the group. As time went on, the hope of using incentives to drive the positive behavior was weakening. The use of sanctions, backed by enforcement, continues to slowly increase the numbers of the vaccinated. Unfortunately, the numbers vary widely across the country for vaccinated adults and the availability of the vaccine for children is in its early stage of adoption. Booster shots are available and that adds another layer to the process.

While the pressure is underway and some persuasion occurs, the spread of the virus continues. We are experiencing another winter inspired uptick in the United States. Other countries, including Austria, Germany and Portugal are seeing surges that are resulting in some form of lockdown. A new variant has been discovered in concentration in southern Africa. Despite this, some still protest even the simplest of preventions in masks. Even the Biden Administration had a premature ending of the routine wearing of masks, indicating that it was an inconvenience that was not necessary given the vaccine.

It is not surprising then that there are ongoing discussions of how to encourage safe behaviors through vaccination, masking and social distancing. Perhaps our leaders should have said that they want us to be able to live without masks, but we can’t until 80% of all eligible people are fully vaccinated. That would have offered an interesting incentive for those reluctant to get the shot and those around them an additional incentive to provide positive support. As new threats appear, it is more important than ever that public administrators get the right mix of the incentives and sanctions.


Author: Ben Tafoya is an adjunct faculty member at Northeastern University where he earned his doctorate. Ben is the author of a chapter on social equity and public administration in the recently published volume from Birkdale, Public Affairs Practicum. He can be reached at [email protected] or Twitter as @policyben.

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The American Society for Public Administration is the largest and most prominent professional association for public administration. It is dedicated to advancing the art, science, teaching and practice of public and non-profit administration.

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