The problem with Ohio's $1 million vaccine lottery

Five lucky Ohioans are about to become millionaires — all because they chose to get vaccinated.

The state's Republican governor, Mike DeWine, announced Wednesday that vaccinated adults will be eligible to enter a May 26 "Vax-a-Million" lottery that pays out $1 million each to five winners. Younger Buckeyes won't have to miss out on the largesse — the state will also choose five vaccinated teenagers to receive full-ride scholarships to one of Ohio's public universities.

"I know that some may say, 'DeWine, you're crazy! This million-dollar drawing idea of yours is a waste of money,'" DeWine wrote. "But truly, the real waste at this point in the pandemic — when the vaccine is readily available to anyone who wants it — is a life lost to COVID-19."

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DeWine's scheme is certainly attention-grabbing, and even understandable. By now, most Americans who really wanted a coronavirus vaccine have received at least one dose, but more than a few individuals are hanging back — either refusing outright to get the shot, or needing just a little more encouragement and persuasion. As a result, public health experts are skeptical of reaching herd immunity in the United States. A few communities have given out beer as an incentive; others have provided free donuts. One million dollars can be very persuasive. And who knows? The money the state pays out in lottery winnings and tuition might be more than recouped in savings from the reduced hospitalization rates that will result from increased vaccinations. We can only hope.

Ohio's plan could be problematic, though.

For one thing, it might not even be the most effective use of money as an incentive: A UCLA study found that giving out just $100 payments would make people more likely to get a shot, and West Virginia has followed suit by giving $100 savings bonds to young people who receive the vaccine. There is reason to believe that the guarantee of a small amount of money will be a greater inducement to potential vaccine recipients than the vanishingly tiny chance of winning $1 million in the lottery.

But medical ethicists worry that handing out cash in any amount may ultimately be counterproductive. "Payment may prompt suspicion, leading people to perceive payment as a sign that vaccine risk is higher than they are being told," the University of Washington's Nancy S. Jecker argued last month in the Journal of Medical Ethics.

Payments might also create some long-term problems for public health. "This could have implications for future vaccination efforts," Jecker wrote. "What happens if people need annual shots? What happens if the public starts to expect or demand payment for other vaccines, feeling entitled to have vaccine risk routinely offset? What happens after the COVID-19 pandemic subsides, and the next emerging infectious disease comes along? Payments to get shots in arms are short-sighted and unsustainable."

Others suggest that it's a bad idea to pay Americans to do something they ought to do anyway.

People "have a moral duty to be vaccinated, including a duty to promote their own health, a duty to others to promote the community benefit of vaccination, and a duty to society for individuals to do their fair share in putting a stop to the pandemic," the ethicists Emily Largent and Franklin Miller wrote in January for the Journal of the American Medical Association.

Admittedly, there is a tension between idealism and realism in these arguments. The notion that Americans have a sense of their moral duty, and that it includes things like "community benefits" and "fair share," has taken a real beating during the pandemic. It remains true, however, that individual choices about getting vaccinated have collective consequences — every person who receives a shot is one less person likely to end up hospitalized, or to pass on the virus to others, or to serve as an incubator for dangerous new variants. This means we can't simply leave the "vaccine hesitant" to their fates. There is a real need to do the difficult work of persuading them to get with the program. As in the case of Ohio's "Vax-a-Million" lottery, some of that work might even seem decadent to those of us who were eager to get jabbed at the first possible opportunity.

Still, I can't help but remember my long-ago sixth-grade teacher, who walked with a limp because she got sick with polio before the vaccine came along in the mid-1950s — her family probably wouldn't have needed a million-dollar inducement to save their daughter the lifelong challenges her illness left behind. And I can't help but think of Harvard political philosopher Michael J. Sandel, who in 2012 observed that in our capitalistic society market values have come to dominate our lives, even in non-economic realms. "Putting a price on the good things in life can corrupt them," he wrote.

The COVID vaccine is surely one of "the good things in life" for those who receive it. Thanks to the vaccine, though, I'm spending time with friends and family again — no longer quite as frightened that I'll unexpectedly leave my son without a father, or die alone in a hospital gasping for air. I won't get rich, but I will get to live my life. So will tens of millions of other Americans. That seems like reward enough.