It’s one thing to talk about vaccinating the majority of people living in the United States to stop the Covid-19 pandemic. It’s another thing to do it — and pay for it.
Epidemiologists tell us we need 75% or more of Americans to be immune to Covid-19 to create herd immunity. Much of that immunity will come from vaccinations. Recent polls show only about 60% of Americans are willing to take the vaccine. Visualize a line of people willing to take the shots: As of now, it’s much too short.
A vaccine program will also be expensive, even though recipients are told they will get vaccinated for free. One thing I’ve learned in life is that “free” is rarely a good price for anything. Especially something of great value, like protection from a deadly disease.
Leveraging the difference between price and value with creative approaches can nudge more Americans to get vaccinated and simultaneously fund the vaccination program. I propose a citizen-led program with three basic objectives:
- Entice a broad array of social influencers to help drive vaccination rates
- Raise $50 billion to subsidize vaccinations
- Provide various businesses with certainty
Influencers and paying to be vaccinated
The first two parts of the proposal are linked: Have the wealthiest and most influential Americans donate large sums of money to get to the front of the vaccine line, and use that money to fund the broader effort to vaccinate people against Covid-19. While some may donate because it is the right thing to do, I’d expect a substantial portion of the money raised to come from businesses that want greater certainty for themselves in a very uncertain world.
Donations would come from five tiers. For each tier, the mechanism is the same. People (or businesses on behalf of their people), donate money to get to the front of the Covid-19 vaccine line. There are limited available slots and getting the vaccine must be publicly documented so others can be motivated by these influential figures.
In the first tier, 100 of the wealthiest Americans each donate $100 million to be first in line for a vaccine, getting it within the first weeks of availability. This raises $10 billion.
In the second tier, 1,000 people each donate $10 million to get vaccinated within the first month. This raises another $10 billion.
You can see where this is going: The third tier requires a $1 million contribution for up to 10,000 people. The fourth, $100,000 for up to 100,000 people. The fifth and final tier requires a $25,000 donation from up to 400,000 people. Everyone participating in the program is vaccinated within the first two months of vaccine availability. The bigger the donation, the further toward the front one goes.
All told, this raises $50 billion for the cause by vaccinating just 511,000 people.
What would this $50 billion be used for, since the federal government has said it (thanks, taxpayers) is paying for the vaccines? A lot. I don’t pretend to know the optimal ways to spend this money, but I do know there are plenty of places it can help.
At the highest level, it can cover some of the government’s vaccination costs and save taxpayers some debt. But I think it will be more useful if it aids states and localities in filling voids in their vaccine distribution processes, essentially creating flexibility where it is needed. That can mean everything from better serving those in remote locations to providing information in languages other than English. It can mean funding for vaccine programs where standard channels struggle, such as for people who are homeless or undocumented. Perhaps it means paying for child care so health care workers can put in overtime, allowing people to get vaccinated more hours of the day. And for those who’ll have a tough time going to a clinic, it can pay for programs to bring the vaccine to people’s homes.
In short, it can help get past the multitude of barriers to vaccine access, big and small, that exist in the U.S.
Is this morally acceptable?
Paying to get to the front of the line might seem obscene. But with 331 million people in the United States, this donor group is just 0.17% of the population. If the program seems too aggressive, removing the lowest tier still raises $40 billion with 111,100 vaccinations, which I estimate is less than one hour’s worth of anticipated peak vaccine capacity.
This whole idea fails if it interferes with getting vaccines into the arms of the people who need it most. The program is designed to ensure a maximum delay of no more than 24 hours for anyone, anywhere, at any point. The maximum average delay is under eight hours. Having a comparatively small numbers of donors makes this work.
A lot of vaccinations can be funded with $50 billion. At about $150 per U.S. resident, the money raised from the 0.17% can cover the cost of most — perhaps all — vaccinations for Americans.
Nudging others to get vaccinated
Involving influencers is an essential part of this program, much as the federal government tapped Elvis Presley to promote the stalled 1956 polio vaccination program. As these influencers share their vaccinations on traditional and social media, virtually everyone unsure about getting a Covid-19 vaccine will see someone they admire getting it. The line for people wanting a Covid-19 vaccine will grow.
Success depends on a good sales pitch. This isn’t the logic-driven scholarly pitch that you can find on a daily basis. Instead, it is a pitch that reaches the reluctant and recalcitrant. In marketing parlance, influencers “reach people where they are.”
Nothing reinforces the idea that getting a vaccine is a good idea like someone paying big money to move up in line. Seeing people motivated to get to the front of the line creates a perception of value, which is always a useful part of a sales pitch — a phenomenon we’ve seen ranging from “Hamilton” tickets to new PlayStations.
Few things offer more actual value than a vaccine against a rampaging deadly disease. But for too many people, the perception of value is missing here. Having influencers from most every segment of society get vaccinated alters this perception and changes the game for the U.S.
Adding certainty for businesses
How might this work? I’ll offer sports as an example.
U.S. professional sports leagues like the NFL, NBA, National Women’s Soccer League, and MLB currently have little or no certainty around their business. The same is true for the 2020 Olympics, to be held in Tokyo in the summer of 2021. The availability of vaccines changes that.
Vaccines mean no canceled games and more time to practice. They mean the ability to travel without expensive and frustrating bubbles. A team’s performance will no longer turn on Covid-19, as happened when the Denver Broncos football team was unable to field an experienced quarterback against the New Orleans Saints and lost 31 to 3.
There are about 5,000 athletes in these team sports, with another 5,000 first-line staff members. Teams could pay $100,000 per person for early access to vaccines, generating $1 billion for vaccination efforts. The Tokyo Olympics has no shortage of wealthy stakeholders: team sponsors, the media, and others have a vested interest in making the games work.
Some leagues might even decide it’s worthwhile to fund lower-level operations. For example, the NHL might choose to fund the American Hockey League in the lowest tier, or MLB might fund its farm teams.
Athletes are likely to be last on the official list of vaccine recipients as they constitute one of the lowest-profile risk groups: very healthy people under age 40. But in return for the sort of money that can vaccinate millions of people, these organizations get business certainty while their employees get paycheck certainty.
Equally important, athletes are influencers. Or put another way, 83% of Americans know who Tom Brady is.
A nonpolitical solution
My proposal is neither conservative or liberal — or it can be portrayed as both.
For conservatives, it is a free-market solution: People and businesses are making a choice on how they use their money. Liberals can view it as a wealth tax: People who can afford it pay for early access to a vaccine and, in doing so, pay for others to get vaccinated.
I believe that the concept is inherently nonpolitical. Instead it is a solutions-oriented approach to concerns that have been raised about U.S. vaccination programs. Are wealthy individuals finding ways to move forward in the vaccine line without offering up anything for the rest of society? Princeton sociology professor Shamus Khan says it is happening now and he is concerned this will grow dramatically.
We need solutions.
Pricing a vaccine
By establishing one price for the vaccine — free — we artificially constrain ourselves to that price and exclude other pricing models able to deliver better results for society.
One other program idea I’m aware of assigns a cost to the vaccine. Former Congressman John Delaney offered this solution: pay each American $1,500 to get a Covid-19 vaccine.
His intriguing idea has two notable deficiencies compared to my plan. One is that it costs an enormous amount of money — nearly $400 billion to vaccinate enough people for herd immunity — compared to collecting money for vaccination programs. The second is that it does nothing to bring influencers into the equation, but assumes that money is a sufficient influencer on its own. Delaney offers what some will see as a bribe, bound to increase skepticism in the quarters where there is already a lot of skepticism.
Putting it to the test
When I have a new idea and want to test it, I’ll often call a specific family member and run it by him. Paraphrasing John F. Kennedy from a very different context, I do this “not because it is easy, but because it is hard.” In many respects, especially politically, this family member and I couldn’t be more different. I’m well to the left, he self-describes as “to the right of Genghis Kahn.” For me, he is the very definition of a hard sell.
So I asked him if he’d be willing to pay $10,000 to move up in line for a Covid-19 vaccination. He responded that he’d pay $100,000. His reasoning? He’d done well in the stock market this year and would be happy to both move up and help. He’d spent a career in uniform defending America against military threats. Defending Americans against a deadly disease didn’t seem much different. He could afford it and he’d do it.
To be sure, one person’s opinion isn’t proof a program like this would work, but it did clear a high hurdle for me.
As happens with my family and me, when enough elements come together we find agreement. With the pandemic, by understanding goals correctly and ditching artificial constraints, we build a vaccination program that better serves the nation.
Alan Levine is a technology executive for Wright Williams and Kelly, which specializes in optimizing complex manufacturing environments for products such as integrated circuits and solar cells.
Normally I would be offended that the rich are given priority for a fee. I mean like other people have said, they can afford to stay home, they don’t have to go out, but they have also benefited the most from this pandemic. This pandemic has hurt the economy, but stocks are fine. Offering the vaccine to the rich for a fee, is like taking that money, and being able to distribute it to the people who can’t afford to pay. Their money can be used to pay for the vaccine program for the rest of the country. They should not be allowed to jump in front of essential workers, and older people in living facilities. Essential workers do not have an option of staying home, and older Americans in facilities can not social distance, they need assistance. Also if it helps encourage more people to get vaccinated because their favorite sportsman or celebrity was vaccinated, then it would be worth it.
The author here. Part 1 of 2
I’ll offer up some responses to various comments. I’ll start by saying this, there were several comments which seemed more eager to torch the headline than deal with the actual plan. I’ll not respond to them.
There was a lot of underlying analysis which didn’t make it to the article. One of the most important is this. The current forecast has about 60% of then people in America becoming immune, whether via vaccine or post-disease immunity. This leaves about 130million people in America without immunity — roughly the population of Britain+France. The consequences of having population this large without immunity in a society as mobile (and sadly, as uncaring about others) as ours, is very troubling.
As a point of reference, the cumulative total of cases in America so far is 18 million. If, after vaccinating everyone who wants one as of now, we’ll still have 130 million vulnerable to covid-19, that means we’ll still be a very long way from ending the pandemic.
The ‘vaccine line’, those who are likely to get vaccinated, as it appears now, is at 50-100 million people short of what’s needed. We need every possible salesperson to change this — and this program recruits half a million salespeople.
I’ll also offer up this. I don’t much care whose sales pitch converts the reluctant into vaccine takers. If it is Katy Perry, Tom Brady or Loren Gray or Bernie Sanders or Donald Trump. Whether it is the leader of a university or a business or a religious institution or a union, all these influences need to be exerted into their respective communities. If there’s a leader in the field of quilting who can influence their followers, I’m good with that too.
I’ll get to specific issues in my next comment, but safe to say, if you haven’t figured out a way to massively increase the number of people who’ll get the vaccine, you lose the “moral” argument. There will be a staggering amount of people harmed, and deaths, if we don’t substantially increase the number who’ll sign up for vaccinations.
If all this wasn’t enough, I’ll offer up a recent addition to my lexicon courtesy of Professor Ravi Gupta of the University of Cambridge. He discussed the risk associated with mutations. “This virus is potentially on a pathway for vaccine escape, it has taken the first couple of steps towards that.” Vaccine escape happens when the virus changes so it dodges the full effect of the vaccine and continues to infect people. If ‘vaccine escape’ occurs, its like hitting the restart button, because it is, in effect, a new pandemic. Having 130 million potential hosts (just in America) without immunity where covid-19 can continue to mutate may make today’s nightmare look tame.
To say the path we’re on now is incredibly risky is an understatement. The biggest and best things we can do involve getting more people vaccinated across society.
The author here. Part 2 of 2
1. Several comments cite a delay in vaccinations. I address this in the article, so feel free to read it instead of just the headline. But we’re talking worst case delays of 1 day, and the likely average will peak at 2-3 hours, diminishing quickly from there. So yes, there is a delay. But it is not a meaningful delay. If your vaccine appointment is rescheduled from 9am to 11am, it doesn’t change your risk. This is the delay this program creates. Viewed another way, if a vaccine clinic runs 100 people thru per day, they’ll add in one additional person every 3-5 days under this program.
2. Expect the money to accelerate vaccinations. Like the delay, it’ll be modest — also on the order of hours. There is an assumption that vaccine availability is the lone rate-limiting step. This isn’t even the case today, as vaccination deliveries are currently being held up. When we get to millions of vaccinations per day, perhaps in March or April 2021, the rate-limiting step may well be other things. One which jumps out at me is having sufficient qualified personnel to handle this sort of volume. Could this money pay for a program which trains more people in the various aspects of vaccination? Certainly. This will accelerate vaccinations. Even small things can make a difference. Help pay for a worker’s childcare so that worker can stay on the job and keep a vaccination clinic open a few more hours. These all require money, doing these things speeds up the line.
Another way to accelerate vaccinations is to reduce time the distribution time. There are a ton of logistics. Adding trucks, adding localized storage, even keeping an airport open late at night so a flight can get in, all these things shortened the time vaccine spends between being ready to leave the manufacturing site and being injected in people’s arms. Whether these sorts of time savings are greater than the delays isn’t clear to me. But with arrows going in both direction, the net result is that delays will be very minimal.
3. Several comments touched on alternatives ways to get this money and uses for it. No, we will not get a wealth tax thru Congress. Whether one likes the idea or not, it isn’t happening anytime soon.
I’ve noticed, you may have also, that state and local jurisdictions are having major money problems. Lots more going out than coming in. Adding this money into the equation helps fund issues which won’t otherwise get addressed.
4. There’s plenty of comments which think this will cause more people to die, especially among the more vulnerable. This is flat out wrong. There are two major mechanisms for saving lives in this. One is this helps drive herd immunity faster. My earlier comment put out some numbers and they are sobering to the point they are hard to comprehend. We’re saving on the order of 100,000 lives, and that’s probably a very very conservative estimate.
As i wrote in the prior comment, even the most optimistic of the current vaccination scenarios leaves well over 100million Americans without immunity. We’ve seen 18million covid-19 cases to date and 300,000 dead. Compare those numbers and let it sink in. We may not even be close to halfway thru this, the vaccine needs the best possible sales pitches.
The second mechanism for saving lives is in getting vaccines into harder to reach communities, often very vulnerable communities. I discuss some of these groups in the article. While some envision a world with unlimited resources, this simply is not the case. An example. The money can be used to hire and provide support for social workers going into these ‘hard and costly to serve’ communities. States have very limited resources now and they’ll be hard-pressed to hire people to do this work. I suspect it’ll require perhaps 10x the resources to vaccinate the homeless on a ‘per person’ basis as compared to the general population (especially with the 2 shot vaccines). The money helps get past this sort of barrier.
5. The moral objections fall flat for the most important of reasons. The program reaches far more people and will save an enormous number of lives. The lives lost to delays will be small because the delays are small. But the lives saved will be much much greater, especially among those who require much greater resources to vaccinate.
6. One thoughtful comment went into length about anti-vaxxers. I’ll offer that this population is not monolithic. A key part of this program is to have broad array of influencers. Reaching a logger in Idaho is different than reaching an attorney in Boston which is different than reaching a non-English speaking shop owner in an ethic neighborhood in Texas. While the comment mocks celebrity, if they take a vaccine and create more people wanting to take the vaccine by doing this, it serves the public good. That said, this really is about the breadth of influencers reaching into all sorts of nooks and crannies of society, as opposed to a reliance on a few high profile sorts.
7. The attempt to parallel this to organ replacement is simply wrong.
8. A couple comments were concerned about the precedent it would set. I agree, at least in part. But I try not to be naive here. The wealthy have always bought their way into things and, as the link to the Washington Post article points out, we can expect more of the same now. For the most part, this is a continuation of the way society has worked for a long time — there is nothing new in this. The precedent here is actually getting contributions from the wealthy for the good of society. Those who want to make the case we should change society, go for it. I’m sympathetic to the argument, but unless you can overhaul society by March, it won’t help the issue we face here and now. We’re in a ‘can’t let perfect be the enemy of the good’ period. There is too much pain. Idealism, however noble, won’t address today’s very real, very large issue. We need actual solutions, ones that work in months, not years or decades.
This is some real crackpot stuff:
“In the first tier, 100 of the wealthiest Americans each donate $100 million to be first in line for a vaccine, getting it within the first weeks of availability.”
Guess what? If you have 100million to donate, then you can afford to live a life of luxury in your bug out bunker till kingdom come, or even throw a party every night with covid testing at the front door. There is literally no incentive for anyone to participate in this.
This reasoning is flawed and denotes lack of understanding of public health. It would make sense if there was unlimited supply of vaccine and people unwillingness to get vaccinated. But unfortunately the vaccine is still very limited. Allowing the wealthy to jump the line limits the availability for frontline workers, people at higher risking developing the disease and underprivileged communities, where the virus is taking a bigger toll. The wealthy are generally in a better position to protect themselves. Certainly it may be annoying not being able to gout for drinks with other wealthy friends or having to skip that great vacation in Mexico, but it’s even more annoying for a nurse to get sick and dye because she’s doing her job.
This may make sense if there was an unlimited supply of vaccine and not enough general public willing to accept it. But by the time we get there the wealthy will have lost the incentive to donate, because there are no more queues to jump.
WOW! I love your idea. Now which important influencer do you get to pitch your idea? Thank you for optimizing a solution to a worldwide pandemic.
This idea may seem rational, but in a rapidly destabilizing society, this will create even more uncertainty and will smash the idea of equality. Read studies of air rage. In addition, we clearly are not taxing the rich enough, they should be paying more for this anyway. Noblesse oblige and all that good stuff. They benefit the most for a healthy and stable society but seem to have forgotten.
Wow. Charge the wealthy, kick the people that are the poorest regardless of need out of the line! The wealthy can most afford to stay home because they have a home to help stop the spread.
I would like to suggest a small edit to the article. Change: “Paying to get to the front of the line might seem obscene.” to the far more appropriate: “Paying to get to the front of the line IS obscene.”
I don’t care if this will happen anyway. People rape, steal, and murder anyway, but that’s no reason not to have laws against rape, theft, and murder.
Go find some other form of rationalization for your expectation of privileged treatment just because you are rich.
Um…I believe a system like that exists, it’s called capitalism and it relies on supply and demand to equalize prices. It works really, really well. Then people complain it isn’t fair for the rich to pay more to get to the front of the line.
Excellent idea. It promotes the vaccine as valuable if you charge $1000 per injection and have rich lee endorse it with their money. If rich people and even middle class pay to play, the money can be used vaccinate marginalized communities with unreliable transportation. Herd immunity is achieved more rapidly and money for outreach and the ineffient use of vaccine vans and home delivery is provided
Thank you for this article. Everything has to be paid for by someone. Health care and vaccines are not free. Why we didn’t use supply and demand is beyond me. We were too entrenched in social justive? If the wealthy paid the highest price first and got to brag with photos it would help everyone else in the long run. Ask them to buy the refrigerators in return for the first vaccines stored in the refrigerator? The time will come when we don’t have to fight over the vaccine. But by then we will have lost the opportunity for the wealthy to help burden the cost. I think the quote is, “Don’t cut off your nose to spite your face.”
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