Paying a price for choosing not to be vaccinated

The time has arrived for those who choose to not be vaccinated against COVID-19 to pay a price for their choice. 

Just under one in five adults remain COVID-19 vaccine-resistant. Anytime a person consciously or unconsciously decides to avoid something, they are weighing the balance between risks and benefits. Those who have forgone the vaccine due to hesitancy have decided that the personal vaccine risks outweigh the personal vaccine benefits.  

But vaccines are more than just about the individual. They are a public good. Childhood vaccines have demonstrated this role and benefit for decades, with numerous diseases that they prevent and lives that they save. 

If a person chooses to not be vaccinated against COVID-19, this begs the question: Should there be a price to pay?  

Health insurance is pooled risk. If people opt-out of getting vaccinated, they are willingly exposing themselves to risks that those vaccinated are not assuming. As such, should they be paying the same health insurance premiums for their coverage? There is a precedent for differential health insurance costs, which exists between smokers and nonsmokers. 

One way to manage this in the short term is to have unvaccinated people immediately be required to pay a higher deductible for any care that is primarily due to COVID-19. Cruel? Perhaps. But COVID-19 is cruel, and anyone who does not take precautions to protect themselves and others is being cruel — even unintentionally.  

Life insurance is pooled risk. Given that the majority of people dying now from COVID-19 are unvaccinated, should they either be paying significantly higher premiums or have reduced benefits? Though the former is impractical in the short term, the latter is doable.   

When an insurance policy is redeemed for someone who has died from COVID-19, if proof of vaccination cannot be provided, their policy value payout could be reduced accordingly.  

Both these financial adjustments are unrealistic to implement (and likely illegal). However, balancing risks and benefits based on personal choices is consistent with assessing and pricing pooled risk products.   

That is why higher-risk drivers pay higher automobile insurance rates, and smokers pay higher life insurance premiums. Personal choices have financial consequences. 

If rewards are available to those vaccinated, then penalties make sense for those who choose not to be. For example, companies could provide paid sick leave for those who become ill from COVID-19 if they are vaccinated, but not provide such a benefit for those who chose not to be vaccinated. Cruel? Perhaps. But, again, COVID-19 is cruel. 

As a public good, COVID-19 vaccines have tremendous value. Vaccines are going to waste in the United States as they expire, while many parts of the world are unable to access vaccines for their populations. The widespread availability of vaccines in our nation is a luxury that we cannot afford to squander.  

The self-help group, Alcoholics Anonymous (AA), has traditions that guide how they function. Their first tradition, “Our common welfare should come first; personal recovery depends upon AA unity,” has been used with great success to keep the organization intact for over 85 years. Committed to helping those addicted to alcohol to recover, they know that if the organization’s wellbeing is not protected, then the individual’s wellbeing is threatened.  

Vaccination represents a first tradition moment for our nation. Moving forward on full approval from the Food and Drug Administration (FDA) as well as mandating vaccination among government and industry employees and college students are first tradition actions.  

In 2020, hundreds of thousands of deaths occurred prematurely, directly or indirectly due to COVID-19. The surest pathway to avoid such deaths in 2021 is vaccination.   

The welfare of our nation demands it, our friends and family deserve it, and our wellbeing depends on it.       

Sheldon H. Jacobson, Ph.D., is a professor of computer science and the Carle Illinois College of Medicine at the University of Illinois at Urbana-Champaign. He applies his expertise in data-driven risk-based decision-making to evaluate and inform public health policy.