Opinion

Vaccine hesitancy? Follow Krispy Kreme’s lead and give people a reward

After a rocky start, Canada is vaccinating people at an increasing pace. While we are still well behind many other countries, the pressure is on to have individuals line up for the jab as quickly as circumstances permit.

However, there is a level of hesitancy about the shot that must be addressed. Multiple strategies need to be employed. One that needs further thought is rewarding people for getting vaccinated.

Many people are eager for inoculation’s protections. But for society as a whole to enjoy as much shielding as possible, we must strive for herd immunity, with up to 80 to 90 per cent being vaccinated. There is some evidence of decline in resistance, especially in England and the United States. Yet there remain many troubling indications of hesitancy to take the jab in this country and elsewhere, including the U.K. and the U.S. There are many reasons for this indecision. Part of the story is the history of discrimination toward Indigenous and Black people that has led to concern that a disproportionate number are suspicious of this remedy. There are other pockets of hesitancy among the general population as well. Twenty-five per cent of those over 80 in Ontario have not received the vaccine or even made arrangements to get it: reasons range from language barriers to worries about interactions with prescribed medications. The fears about the safety of AstraZeneca have not helped matters.

There are a number of prescriptions to counter this indecision. A nonstarter seems to be mandatory vaccination: too difficult to enforce and at odds with a longstanding right to refuse medical treatment. (But there is some pressure to require employees to be vaccinated in some workplaces.) 

One straightforward response is to make the vaccine easier to access: bring it to the elderly and disabled. More generally, education is seen as the most positive way to persuade people that vaccination is right for them. This campaign of persuasion is being conducted in a number of ways to address the different needs of various groups and communities, including deploying “norm entrepreneurs“: influencers with large public profiles who could help people decide to be inoculated by being vaccinated in public while urging others to get the jab. One example, from the U.S., is a charming video of Dolly Parton gently coaxing folks to take the jab. 

But the campaign cannot be limited to education. There may be consequences for failing to be inoculated that will make people decide that taking the jab is the thing to do after all. One such consequence may be the failure to have a vaccine passport/certificate: documents that are reliable evidence that an individual has been fully vaccinated. There is widespread agreement that they could be necessary for foreign travel. They may be relevant for activities within the country (going to restaurants, theatres, etc.), though the prospect of this latter use has generated controversy.  The possibility that activities may be curtailed may be enough to persuade some of the hesitant to decide to be inoculated. 

There is one more way: we could pay people. A debatable strategy but one that needs to be fully considered. To start, let’s remind ourselves that payments/subsidies have long been used to shape behaviour. The government provides incentives for lots of basics: owning a home (no capital gains tax); saving for an education (tax breaks on educational funds); saving and investing, especially for retirement (RRSPs/TFSAs). The private sector has its own programs, from paying employees not to smoke to underwriting exercise programs.

How much to pay is a matter of conjecture but it would have to be enough, by itself, to incentivize the doubters to take the jab.

Not surprisingly, this proposal has run into a lot of opposition. It’ll cost too much. We shouldn’t pay people to do the right thing for themselves and for the common good. If they have to pay us to take it there must be something wrong with it. 

A more modest form of financial compensation focuses on providing employees with time off with pay (say three hours). These programs are already underway in some large corporations in the U.S. and by law in New York State and in Saskatchewan.

Krispy Kreme has its own, unique incentive strategy: The company will give everyone who presents proof of vaccination a doughnut every day for the rest of 2021. (Those not vaccinated, including the unwilling, can get a free doughnut but only on Mondays from March 29 to April 24). Encouraging people to eat doughnuts is a nonstarter from a nutritional perspective. But if, in fact, these sweet caloric treats move some people to get the shot they may, in this one instance, serve a noble purpose.

There are valid concerns about using rewards as part of the campaign to persuade people to get the jab. But they have to be weighed against the prospect of those who refuse to do so getting and giving COVID-19. The significant costs associated with those who become seriously ill and of a society continuing to struggle against the plague because herd immunity is unattainable are sobering. The pandemic battle is far from over. All reasonable strategies to have people vaccinated and to conquer the contagion must be considered. 

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27 Comments
  • Edward H C Graydon says:

    Home | Israel News
    Israeli Group to Research Link Between Menstrual Changes and COVID Vaccines
    Studies in Israel and abroad get underway following growing anecdotal evidence of menstruation being affected by COVID vaccines

    • Edward HC Graydon says:

      A little over a week after S., 34, received her second vaccination against COVID, at a time when she was menstruating, she was surprised to discover that she had begun menstruating again.

      “It was strange because my period is as regular as a Swiss watch. At first, I didn’t give it any thought, but two weeks later I got my period again for seven days. Two weeks after that, bleeding that lasted four days. It turned out that for almost six months there were more days when I bled than when I didn’t. After I talked to my friends, I realized the phenomenon is much more widespread,” she said.

      Growing evidence from Israel and abroad is showing that the phenomenon extends much beyond S.’s social circle. In February, shortly after women of childbearing age began receiving the second shot, many of them posted on social media that they were experiencing changes in their menstruation shortly after the shot, such as irregularity and increased bleeding. Other women reported that they had begun bleeding years after menopause.

  • Edward HC Graydon says:

    The natural immune protection that develops after a SARS-CoV-2 infection offers considerably more of a shield against the Delta variant of the pandemic coronavirus than two doses of the Pfizer-BioNTech vaccine, according to a large Israeli study that some scientists wish came with a “Don’t try this at home” label. The newly released data show people who once had a SARS-CoV-2 infection were much less likely than vaccinated people to get Delta, develop symptoms from it, or become hospitalized with serious COVID-19.

  • Edward HC Graydon says:

    Hey Bogart! Do you still believe in the idea of free donuts as a prize of inoculation?

    Aug. 25, 2021
    The Pfizer-BioNTech Covid-19 vaccine is associated with an increased risk of myocarditis, an inflammation of the heart muscle, a large new study from Israel confirms. But the side effect remains rare, and Covid-19 is more likely to cause myocarditis than the vaccine is, scientists reported on Wednesday.

    The research, which is based on the electronic health records of about two million people who are 16 or older, provides a comprehensive look at the real-wold incidence of various adverse events after both vaccination and infection with the coronavirus.

    Although the study did not break down the myocarditis risks by age or by sex, the median age of people who developed the condition after vaccination was 25, and 19 of the 21 cases were in males, the researchers reported.

    In addition to myocarditis, the Pfizer vaccine was also associated with an increased risk of swollen lymph nodes, appendicitis and shingles, although all three side effects remained uncommon in the study. Coronavirus infection was not associated with these side effects, but it did increase the odds of several potentially serious cardiovascular problems, including heart attacks and blood clots.

  • Edward H C Graydon says:

    doctors4covidethics.org
    Dear colleague:
    Six months ago, we laid out the reasons for our fears that gene-based vaccines were potentially dangerous [1]. These concerns were based primarily on the expectation that the vaccine would through lymphatic transport soon enter the circulation, where it would be taken up by the endothelial cells. These cells would then start producing the spike protein, which would cause them to be attacked and destroyed by cytotoxic T- lymphocytes. The resulting lesions would give rise to platelet activation and blood clot formation.
    Since then, clotting abnormalities have indeed taken center stage as propagators of adverse events following vaccinations. Rapid entry of the vaccine into the bloodstream has been confirmed, as has rapid appearance of expressed spike protein in the bloodstream. Activation of clotting is very common even in those without characteristic or lasting symptoms, but the number of grave adverse events caused by this mechanism—heart attack, stroke, cerebral sinus venous thrombosis, and others—is very high.
    With this letter, your attention is directed to a second autoimmune pathway that will be triggered simultaneously with the activation of cytotoxic T-lymphocytes. We predict that this pathway will cause damage to and leakiness of blood vessels, with consequences that are far-reaching and profound, particularly upon repeated vaccination. This second autoimmune pathway will render booster shots uniquely dangerous.
    1. The proposed mechanism
    The first injection will induce the expression of spike protein, and the formation of specific antibodies to it. Re-vaccination will lead to a second round of spike protein production, including in endothelial cells. The antibodies, now already present, will bind to these spikes and will direct attack of the complement system to these cells. Neutrophil granulocytes, too, will be activated by antibodies bound to the endothelial cells. Vascular damage and leakage will ensue.
    1.1. Evidence that SARS-CoV-2 spikes provoke complement attack on vessels
    Investigations published last year by Jeffrey Laurence and colleagues [2] have establishedthat spike proteins direct complement attack to the inner vessel lining. The authors showed that spike proteins released from the lungs of COVID-19 patients travelled via the circulation to attach at distant sites to the inner vessel lining, i.e. the endothelial cells. Leukocytes and the complement system became activated precisely at those sites, which resulted in damage and leakiness of the vessels.
    Why this occurred became evident only recently, through several discoveries that we have discussed in a previous letter to physicians [3]. Specifically, the immune system of all individuals is already primed to respond to coronaviruses including SARS-CoV-2, most likely through cross-immunity with widespread respiratory human coronavirus strains. This immunological memory causes antibody production to commence early on during SARS-CoV-2 infection [4–7]. Thus, antibodies will already be there to bind the spike proteins when these become stranded in the vessel linings. This inevitably triggers activation of the complement cascade.

    1.2. The effect of booster shots
    Repeat injections of gene-based “vaccines” are bound to intensify and reproduce this basic event wherever the newly expressed spike protein appears on the vessel lining. Spike protein-induced complement attack on vessels has been shown to evoke a plethora of skin lesions in COVID-19 patients [8]. These show a striking resemblance to some of those which are now being reported in vaccinated individuals [9]. Complement- mediated vascular injury occurring at multiple sites throughout the body will have potentially devastating effects not only on the health of the vaccinated individual, but also on pregnancy and fertility.
    Complement will also likely potentiate coagulation abnormalities via yet another pathway. Spike protein molecules, known to be released into the bloodstream shortly after vaccination [5] will bind to platelets, marking them as targets for antibody binding. Subsequent attack by complement must be expected to cause platelet destruction, possibly culminating in immune thrombocytopenic purpura. This, too, has been clinically observed after vaccination [10–13].
    With regard to long term effects of re-vaccination, what will happen when the “vaccines” seep out of damaged blood vessels and reach the organs of the body? Will gene uptake and spike production then mark each and every cell type for destruction by killer lymphocytes? Are we about to witness the birth of an entirely new world of autoimmune disease?
    1.3. Conclusion
    It is beyond question that repeated vaccinations carry serious and unprecedented risks as outlined above. While government officials, authorities and vaccine manufacturers may remain ignorant of the medical implications of such findings, any physician in possession of this knowledge cannot administer repeated COVID-19 vaccination in good conscience, nor in good faith.
    Under no circumstances is it acceptable for a doctor to knowingly inflict harm on a patient.

  • Edward HC Graydon says:

    Bill do you still believe a shitty donut is worth it?

    A higher-than-expected number of young men have experienced heart inflammation after their second dose of the mRNA COVID-19 shots from Pfizer/BioNTech and Moderna, according to data from two vaccine safety monitoring systems, the U.S. Centers for Disease Control and Prevention (CDC) said on Thursday.

    The CDC and other health regulators have been investigating heart inflammation cases after Israel’s Health Ministry reported that it had found a likely link to the condition in young men who received Pfizer’s COVID-19 vaccine.

    The agency said it is still assessing the risk from the condition and has not yet concluded that there was a causal relationship between the vaccines and cases of myocarditis or pericarditis.

    Coronavirus Coverage
    Tracking every case of COVID-19 in Canada
    Coronavirus vaccination tracker: How many people in Canada have received shots?
    ‘Welcome to Stage 2, Alberta’: Province moves ahead in reopening plan, 2nd dose delivery ramped up
    Heart inflammation in young men higher than expected after Pfizer, Moderna vaccines: U.S. CDC
    Ontario will begin accelerating second COVID-19 vaccine doses in 7 delta variant hot spots
    Manitoba unveils reopening plan to have ‘One Great Summer’
    Ontario on track for good summer despite small risk of fourth wave, modelling suggests
    B.C. not ruling out vaccine incentives, premier says after Manitoba announces lottery
    Feds aim to end hotel stay, 14-day quarantines for fully vaccinated Canadian travellers in July
    Doctors call for Canada to adopt airborne transmission protocols for COVID-19
    Canada to receive 7M Moderna vaccine doses in June: Anand
    Vaccination status cards may be the ticket to reopening the Canada-U.S. border
    Tracking variants of the novel coronavirus in Canada
    Full coverage at CTVNews.ca

  • Eva says:

    As usual, very interesting reading!! Food for thought. (Krispy Kreme would certainly me an incentive for me to be vaccinated!!!)

    • Bill bogart says:

      Eva
      Thanks for the comment.
      The Krispy Kreme example was provocative. Handing out donuts could be patronizing. But maybe offering a cup of coffee and a donut while discussing persons’ situation and why they may be hesitant might be appropriate and effective.
      You are obviously a fan of these Krispy Kreme! :)
      Bill

    • Edward HC Graydon says:

      You seem to come cheap?

  • Edward HC Graydon says:

    Personally I have found the rhetoric around the need to be vaccinated outrageous, condescending and unbearable repetative . It seems more a sales job on the public regardless of country or where you happen to reside . I have never sensed any altruism from Canadian prim minister Justine Trudeau ! In fact I sensed he was selling a bigger issue and the pandemic was a means to an end.

    ” I believe this to be true” I cannot believe a man who stated in the very early stages of the pandemic “We must prepare for at least a few years or more of lock downs” While his health minister Teresa Tam stated “ I have no problem with ankle bracelets ,in order to monitor Canadians” This was stated back in 2019! What kind of approach to governence does this instil into Canadians but one of fear ! The fact that Blood clots and the death rate associated with them is quite high and taking into account that each Vaccine now seems to have the same side effects being Blood clots I think the risks of vaccination for some that fear dying from blood clots to be real.

    When the Ontario government shuts down all surgery’s and all none medical emergencies making access to medical treatment difficult ! It will be harder to treat those that do in fact develop blood clots as a side effect of taking the vaccine. Blood clot death is very fast and access to treatment is essential should you get one but good luck on that during covid and the current state of medical care in Canada .

    • Bill Bogart says:

      Edward –
      Whatever you make of Canadian government officials I hope you’ll make your own decision to get vaccinated for your own sake and those you hold dear.
      COVID is not fundamentally about politics but about health. Don’t give it. Don’t get it
      Best wishes
      Bill

      • Edward HC Graydon says:

        WHO does not back vaccination passports for now – spokeswomanThe World Health Organization does not back requiring vaccination passports for travel due to uncertainty over whether inoculation prevents transmission of the virus, as well as equity concerns, a spokeswoman said on Tuesday.

        “We as WHO are saying at this stage we would not like to see the vaccination passport as a requirement for entry or exit because we are not certain at this stage that the vaccine prevents transmission,” WHO spokeswoman Margaret Harris said.

        “There are all those other questions, apart from the question of discrimination against the people who are not able to have the vaccine for one reason or another,” she told a U.N. news briefing.

    • Edward HC Graydon says:

      More than half Canada’s AstraZeneca vaccine came from U.S. plant accused of quality-control problems
      Controversy first erupted in March when it was revealed that cross-contamination at the Baltimore plant had ruined 15 million doses of the J&J product

  • Randy Filinski says:

    I find this article very unsettling for many reasons.

    1. We have a press Corp and selected “experts” who are interviewed daily and have caused a hesitancy in the public even with supply constraints. This includes healthcare workers that I interact with.
    2. We have created the myth of “get a shot and wait four months” but stay totally isolated and all will be fine.
    3. We are struggling to redeploy essential workers (nurses, allied healthcare workers) to critical covid floors with the same mentality with their first shot but wait for four months for the second.
    4. My neighborhood is full of people wanting the vaccine (high risk postal code) and yet, have no idea how to proceed.

    So, let’s scrap incentives for now and identify the real priorities first for those who will take the shot and create vaccine ambassadors with these people (workers and the public) and use their voice to carry forward into the areas of hesitancy.

    To me, this is not about a donut or an incentive but using human compassion and empathy in a very trying time. Help those who can, then help others to get to herd mentality and lead by example.

    • Bill Bogart says:

      Thank you for your thoughtful and clearly laid out comment.
      I certainly agree with your views about compassion and empathy.
      I did try to make clear that addressing vaccine hesitancy requires multiple strategies. Rewards may be one. But, yes, how they are used, where and when, needs careful consideration. Allowing people time off of work with no loss of benefits may be one fairly straightforward initiative. The Krispy Kreme venture calls for close examination
      Bill

      • Edward H C Graydon says:

        WHO does not back vaccination passports for now – spokeswomanThe World Health Organization does not back requiring vaccination passports for travel due to uncertainty over whether inoculation prevents transmission of the virus, as well as equity concerns, a spokeswoman said on Tuesday.

        “We as WHO are saying at this stage we would not like to see the vaccination passport as a requirement for entry or exit because we are not certain at this stage that the vaccine prevents transmission,” WHO spokeswoman Margaret Harris said.

        “There are all those other questions, apart from the question of discrimination against the people who are not able to have the vaccine for one reason or another,” she told a U.N. news briefing.

    • Margaret says:

      I support Randy’s thinking that we “scrap incentives for now” and make more of an effort to simplify the process to get the shot. Many of the people I connect with, who are in their late 50s and up, are interested and willing but aren’t computer savvy or are unsure of how to register. Randy’s idea of creating vaccine ambassadors is one way and widespread promotion of phone lines is another. As you may know from years of September newspaper stories about student school suspensions, many parents don’t get around to getting their kiddos the annual vaccinations that are mandatory to allow kids to go to school. So perhaps public health can share lessons learned in reaching out to encourage and assist parents.

      • Sue McKeown says:

        Everyone I know late 50s and up possesses enough computer literacy to find a vaccination site or knows someone who can help her/him. Sheesh. We are not dinosaurs.

      • Bill Bogart says:

        Margaret
        Thanks for the comment.
        Thinking about comparisons to have kids vaccinated for schooling could be very useful.
        I was careful to say that rewards, if used, should be one of many strategies to promote vaccinations. We need to consider all reasonable possibilities.
        Bill

      • Bill Bogart says:

        Sue
        Thanks for your comment.
        We may not be dinosaurs but is giving someone a helping hand to encourage vaccinations such a bad thing? Each time we get vaccinated we protect ourslves – and others
        Bill

      • Edward HC Graydon says:

        A higher-than-expected number of young men have experienced heart inflammation after their second dose of the mRNA COVID-19 shots from Pfizer/BioNTech and Moderna, according to data from two vaccine safety monitoring systems, the U.S. Centers for Disease Control and Prevention (CDC) said on Thursday.

        The CDC and other health regulators have been investigating heart inflammation cases after Israel’s Health Ministry reported that it had found a likely link to the condition in young men who received Pfizer’s COVID-19 vaccine.

        The agency said it is still assessing the risk from the condition and has not yet concluded that there was a causal relationship between the vaccines and cases of myocarditis or pericarditis.

        Coronavirus Coverage
        Tracking every case of COVID-19 in Canada
        Coronavirus vaccination tracker: How many people in Canada have received shots?
        ‘Welcome to Stage 2, Alberta’: Province moves ahead in reopening plan, 2nd dose delivery ramped up
        Heart inflammation in young men higher than expected after Pfizer, Moderna vaccines: U.S. CDC
        Ontario will begin accelerating second COVID-19 vaccine doses in 7 delta variant hot spots
        Manitoba unveils reopening plan to have ‘One Great Summer’
        Ontario on track for good summer despite small risk of fourth wave, modelling suggests
        B.C. not ruling out vaccine incentives, premier says after Manitoba announces lottery
        Feds aim to end hotel stay, 14-day quarantines for fully vaccinated Canadian travellers in July
        Doctors call for Canada to adopt airborne transmission protocols for COVID-19
        Canada to receive 7M Moderna vaccine doses in June: Anand
        Vaccination status cards may be the ticket to reopening the Canada-U.S. border
        Tracking variants of the novel coronavirus in Canada
        Full coverage at CTVNews.ca

    • Edward H C Graydon says:

      WHO does not back vaccination passports for now – spokeswomanThe World Health Organization does not back requiring vaccination passports for travel due to uncertainty over whether inoculation prevents transmission of the virus, as well as equity concerns, a spokeswoman said on Tuesday.

      “We as WHO are saying at this stage we would not like to see the vaccination passport as a requirement for entry or exit because we are not certain at this stage that the vaccine prevents transmission,” WHO spokeswoman Margaret Harris said.

      “There are all those other questions, apart from the question of discrimination against the people who are not able to have the vaccine for one reason or another,” she told a U.N. news briefing.

      • Bill bogart says:

        Hi
        Thanks for this further comment.
        My article wasn’t really about vaccine passports/certificates. I commented that, if they are used, their employment might provide an incentive to get vaccinated for those otherwise hesitant.
        I don’t understand the reservation because of equity. The solution there is to ensure that *everyone* who wants to be vaccinated can be. For this who can’t be for recognized reasons there could be an exemption in terms of certificates/ passports.
        Bill

  • Larry W. Chambers says:

    Do nurses in Ontario receive pay for being vaccinated for COVID?

    • Bill Bogart says:

      Don’t think so. But they may need to be paid more given their crucial role, especially during COVID. B

    • Edward HC Graydon says:

      The issue is that the WHO does not believe it has been shown that the vaccine stops transmission or prevents the spread hence the reason many would rather forgo the cheap pastry as a prize of inoculation .

      The eats Krispy Cream ? And who would be tempted by such a low ball offer?

    • Edward HC Graydon says:

      The issue is that the WHO does not believe it has been shown that the vaccine stops transmission or prevents the spread hence the reason many would rather forgo the cheap pastry as a prize of inoculation .

      Who eats Krispy Cream ? And who would be tempted by such a low ball offer?

Author

W.A. Bogart

Contributor

W.A. Bogart is a Distinguished Professor of Law (retired), University of Windsor, and author of Off the Street: Legalizing Drugs and Regulating Obesity? Government, Society, and Questions of Health.

 

 

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