You don’t need conspiracy theories or misinformation to explain why we may not reach the high vaccination rates the public-health community wants for herd immunity. The later stages of the COVID-vaccine rollout will involve (mainly younger) people weighing the small probability of (for most) a flu-like infection against the uncertainty about — and lack of evidence on — long-term side effects of a vaccine yet to be definitively approved by the FDA. Indeed, the flu-like side effects associated with taking the vaccine are not substantially different from the COVID-19 disease for many. In this connection, it’s worth noting that less than half of the adult population, primarily the high-risk demographic, take the opportunity to receive regular flu vaccines, and that’s with well-proven vaccines and an absence of side effects. Many of those planning not to take a COVID shot raise side-effects concerns.

The recent American Rescue Plan Act was a missed opportunity to confront the impact of the rollout itself on lowering future demand. It only allocated a few percentage points of the funding to the rollout, which is currently by far the most important issue for the economy.

The public-health community’s ignorance of the role that incentives can play in establishing an appropriate response to a disease predates COVID. Indeed, in response to this shortcoming, the field of economic epidemiology emerged decades ago to address how incentives drive disease occurrence and what those incentives imply for the effects and value of government intervention. The experiences with COVID mirror many major past lessons of this field.