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Following the U.S. Food and Drug Administration’s emergency use authorization of the Pfizer and Moderna coronavirus vaccines in December, approximately five million Americans -- mostly front-line health care workers and nursing home residents -- have now received their first doses of the vaccine.
But achieving herd immunity may require as much as 75 to 80 percent of the population to be vaccinated, and encouraging enough people to take the vaccine will be a formidable challenge. Some recent polls show only about 60 percent of Americans plan to get the vaccine once it is available to them; the rest do not intend to get it or are unsure.
Once those people most at risk have been vaccinated, policy makers will need to design intervention strategies that effectively encourage vaccination among the rest of the population in order to achieve herd immunity. Our research suggests that one of the best groups to target with those strategies is young adults, particularly college students. They are rapid spreaders of the disease, are unlikely to get vaccinated and have been shown to be sensitive to relatively small financial incentives for vaccination.
College students spreading COVID is hardly news at this point. More than 1,000 institutions brought students back to campus for the fall semester. With young people living in close proximity to each other, group gatherings were inevitable -- especially considering the lower COVID mortality rate among younger people, their affinity for socializing and the well-documented peak in risk-taking behavior in late adolescence. Fueled by events like fraternity parties, college students quickly became significant spreaders of COVID in the United States, with people ages 20 to 29 accounting for over 20 percent of all cases in August and September. And unfortunately, the cases did not stop with the students. Outbreaks on campuses tended to be closely followed by spikes in cases among older community residents.
Along with being susceptible spreaders, young people are also among the least likely groups to get vaccinated. Compared to all other adults, a smaller percentage of college-aged people intend to get a vaccine when it becomes available. Even with a well-established and easily accessible immunization like the flu vaccine, our analysis of National Health Interview Survey data shows only 30 percent of 18- to 25-year-olds were vaccinated in 2018, compared to 50 percent of older adults.
Yet with the right approach, it is possible to encourage vaccination among young people. Like the decision to wear a mask, the decision to get vaccinated also confers benefits on others. That leads to a free-rider problem: people who do not get the vaccine still benefit from the immunity of others. Of course, if too many people adopt this free-rider mind-set, herd immunity may not be reached, and all of society will be less protected.
A straightforward solution is to monetize this additional benefit by simply paying people to get the vaccine. Economists N. Gregory Mankiw and Robert E. Litan have suggested subsidizing COVID-19 vaccination, proposing a payment as high as $1,000. Our own research on flu vaccination suggests that number could be much smaller, at least for young people. In fact, we find that $30 is enough to double flu vaccination rates among college students, indicating that they are sensitive to relatively small financial incentives for vaccination.
To be sure, the flu and COVID-19 vaccines have some serious differences. Years of evidence support the effectiveness and safety of the flu vaccine, while we will have only a few months of data on the COVID-19 vaccine as it becomes available. Thus, it will likely take more than $30 to convince many young people to get a COVID-19 vaccine, especially since it requires two doses. The novelty of the COVID-19 vaccine, coupled with the extreme polarization in national politics, is likely to engender reactance, skepticism and hesitancy among a wide swath of the population, similar to what we have seen with mask wearing.
As the vaccine becomes more widely available, governments are likely to prioritize older people, front-line health-care workers, those with pre-existing conditions and disadvantaged communities that have been hit hardest by the pandemic. That means it will be up to smaller, more localized institutions to increase vaccination among young adults -- something colleges are distinctly well positioned to do. We strongly encourage higher education institutions to utilize every tool of behavioral science and economics to accomplish that -- by promoting accurate information and clear messaging, reinforcing the autonomy of the targeted students, emphasizing the vital role they play in fighting the pandemic, and making it easy to get vaccinated by running clinics at convenient locations on campuses. Perhaps most important, they should also consider offering their students cold, hard cash.
