The best vaccine incentive might be paid time off

Free doughnuts. Tickets to see the Los Angeles Lakers. Video visits with loved ones for people in prison. The chance to win a million-dollar lottery.

States, cities, and private companies are dangling anything they can think of to convince Americans to get a covid-19 vaccine. The idea is to nudge people who are open to a vaccine but just need an extra push-but so far, there's little evidence these programs have had the impact some had hoped.

As infections with the delta variant rise across the country, giving everyone paid time off work could boost vaccination rates and protect frontline workers and their communities. It may seem like a small perk for the kind of salaried, remote worker who can easily disappear from Zoom for a few hours to get a shot. But for millions of hourly shift workers, it could be the one thing that finally gets them vaccinated.

The pandemic workplace

While much of normal life came grinding to a halt during the pandemic, many Americans had to continue in-person labor, often without hazard pay.

Surveys conducted by the Kaiser Family Foundation in June found that 65% of workers were encouraged by their employer to get a covid-19 vaccine, but only 50% actually received paid time off to get the shot or recover from side effects. Workers in that group were more likely to be vaccinated-even when controlling for age, race, income, and political party.

Nearly 20% of workers said they haven't gotten vaccinated because they're afraid of missing work or because they're too busy. That proportion jumps to 26% for Black workers and 40% for Hispanic workers.

That leaves half of workers without financial support or compensation. If more employers encouraged workers to get vaccinated-especially with paid time off for the appointments-vaccination rates could increase, according to the study.

That could be even more true for Black and Hispanic workers, who were already more likely to catch covid, and are more likely to work low-wage jobs like those in the retail or service sectors. In the KFF survey, nearly 20% of all workers said they haven't gotten vaccinated yet because they're afraid of missing work or because they're too busy. That proportion jumps to 26% for Black workers and 40% for Hispanic workers.

Some companies have already offered bonuses or other incentives. Target provides free rides to vaccine sites, Dollar General will give employees four hours of wages to go to their appointment, and Instacart is giving $25 stipends to workers who get vaccinated.

Instacart declined to tell me how the company settled on the stipend amount but said that nearly 100,000 workers have requested and received it.

No clear guidance for workers

The federal government has tried some ways to encourage employers to offer paid time off for vaccinations. Under the American Rescue Plan, companies that offer PTO for getting a vaccine or recovering from side effects can claim payroll tax credits. But it's voluntary, and we don't yet know how many companies have offered PTO to workers this way.

Meanwhile, New York and a handful of other states have their own laws to guarantee paid time off for covid vaccinations.

But state laws are a piecemeal approach, and workers' protections or benefits largely depend on what employers will give. Ifeoma Ajunwa, an associate professor of law at the University of North Carolina at Chapel Hill, says employers operate as their own private governments, with free rein over how they run their business. Covid exposed the limited power that the government can exert over employers," says Ajunwa. The pandemic really laid that bare, especially when it came to covid-19 precautions or covid-19 procedures for operation."

That means it's largely up to workers to research and understand their rights.

If you're part of the 94% of private sector workers who are not in a union, you may not know that a benefit exists," says Justin Feldman, an epidemiologist at Harvard who has written about covid-19 and the workplace. And even if you do know that exists, it doesn't mean you're going to be able to exercise it without retaliation."

In a statement, the New York Department of Labor told me it has received various complaints" about violation of the covid-19 vaccination leave law and says that it attempts to collect unpaid wages, or restitution for those who were not paid for the time off as required."

But even laws that appear, on paper, to support workers could neglect those in the most precarious jobs. The New York Department of Labor has said any worker denied vaccination leave should file a complaint but declined to say specifically if so-called gig workers are covered. (Ajunwa at Chapel Hill says that because the law uses the word employee," it would not cover gig workers, who also don't get health insurance through work.)

A national emergency"

Public health experts stress that there isn't just one foolproof tactic for getting people vaccinated. The government could create a series of paid days off for workers in different sectors to get shots, but we'd still need to combine that with other public health strategies like going door to door, Feldman says.

Misconceptions about covid-19 need tackling, too: younger workers may believe they're not susceptible to severe effects of the disease, Feldman notes, especially if they've already worked in person with minimum precautions throughout the pandemic and haven't gotten sick. It may be particularly hard to change their minds after hearing peers, media, or commentators downplaying the risk.

We need to treat getting people vaccinated as a national emergency, and that means not treating it like an individual failing," he says. We need to do a lot of different things at the same time and see what works."

Once folks have the information they need, based on the science, it makes other carrots more like the icing on the cake."

Rhea Boyd, founder of The Conversation

Rhea Boyd, a pediatrician in the San Francisco Bay Area, says that people need more information before they can be persuaded by incentives. She founded The Conversation, in which Black and Latino health-care workers deliver credible information about covid-19 vaccines to their communities.

A major incentive is personal self-interest," Boyd said in an email. Once folks have the information they need, based on the science, it makes other carrots' more like the icing on the cake."

What would that look like?

We will only know what is enough once everyone is vaccinated," she says.

In the meantime, frontline workers' level of protection on the job continues to rely on shifting public health recommendations, their employers' own policies, and the whims of customers who can choose to abide by safety measures-or not.

And although public health officials have taken vaccine clinics to public parks, churches, and Juneteenth celebrations in an attempt to change minds, workers are watching what their bosses say and do.

Workers of every stripe take cues for what they should be doing from their employers," Ajunwa says. I think this points to an oversize influence that employers have on employees' lives in America."

This story is part of the Pandemic Technology Project, supported by The Rockefeller Foundation.