How to increase vaccination and mask-wearing to defeat COVID-19

By any reasonable metric, the United States has failed miserably to defeat the coronavirus (COVID-19) pandemic. The United States’ 20.6 million infected and over 351,682 deaths as of January 4 is, by far, the world’s worst. But by using tax incentives and the disbursement or denial of federal funds, the Biden administration can better incentivize state- and individual-level compliance with public-health measures and motivate people to get vaccinated — both critical for containing the disease.

Despite their inappropriately slow distribution, the two COVID-19 vaccines now approved in the United States are a vital lifeline. Yet at least 75 percent of people need to accept vaccination to establish community (herd) immunity. And for the next few months, the vaccines alone are insufficient: stopping the spread remains key. The Centers for Disease Control and Prevention (CDC) and public health leaders such as Dr. Anthony Fauci continue to provide consistent guidance for stopping the spread —wear a mask, avoid close quarters with others and frequently wash hands. Yet widespread compliance with this simple “to do” list remains wickedly elusive.

As a start, the Biden administration should undertake determined efforts to re-establish the CDC’s credibility. Long the crown jewel of the international public health world, the CDC has been pervasively undermined by the Trump administration’s politics. Biden’s administration should make it a point to embrace fact- and science-based public health recommendations and encourage states and local authorities to do the same.   

Restoring the CDC’s credibility is all the more important as politically-motivated misinformation campaigns to deter people from getting vaccinated are under way from Trump’s supporters and others. Such narratives need to be loudly countered by the president, his Cabinet and public authorities and influential leaders.

Even with a credibility booster shot, the CDC alone is ill-equipped to address the full spectrum of the pandemic’s societal impacts. For that, the expertise and perspectives of other government agencies and close, ongoing coordination from the White House, are needed. But until there is a marked reduction in the virus spread, the federal government’s action should lean heavily toward the CDC’s advice. 

Second, the Biden administration should seek to expand the number of people complying with CDC’s guidance — with respect to both public health and vaccination.

Just as the Biden campaign capitalized on the middle of the American political spectrum to achieve election victory, it needs to flip some of those who are currently not complying with the public health measures but may be willing to do so, if given the right incentives. Those already practicing protective measures will likely continue to do so, even though they may need some leadership reinforcement through the long, dark illness-ridden winter months when access to the outdoors shrinks and the burden of social distancing gets heavier. Then there are those who, regardless of recommendations from public health experts and political leadership, will always refuse. But an important portion of the U.S. population is likely susceptible to behavior change, with proper incentives.

Let’s start with vaccination. The Biden administration should work with Congress to subsidize most, if not all, of the cost of vaccines for at least the first 180 days after their release to get them into the arms of as many Americans as possible — regardless of income, insurance coverage or employment. Unhampered access to vaccines is also critically important to America’s racial and ethnic minorities, who have been disproportionally impacted by the virus. Putting an initial time limit on when vaccination is free should help drive demand, with the possibility of an extension. 

Further, tax incentives should be provided for getting vaccinated. A proof of vaccination could result in, say, a $500 tax refund per person vaccinated. After all, by getting vaccinated, you are contributing to the public good and restarting of the economy.

Next let’s turn to masks. A federal mask mandate is simply unrealistic because even if such a mandate were established, it is not feasibly enforceable by federal law enforcement agencies, who are neither staffed nor funded to engage in widespread street-level policing. Moreover, public health measures in the United States are largely a function of states.

The federal role in the pandemic response should be focused on federal functions —addressing the adverse effects on the broader U.S. economy and the federal workforce, including the U.S. military, using federal emergency authorities to assist the states’ responses, managing interstate impacts and shaping global efforts. 

But that still leaves a lot to work with. The federal government has long conditioned federal aid and grants to states on certain, rationally-related criteria. Thus, the Biden administration could condition the provision or continuation of appropriate federal aid to states on strong mask and other public health mandates. Reviewing the status of the 50 states’ Stafford Act emergency declarations and the federal funding for National Guard Forces through the Federal Emergency Management Agency is a good place to start.  In short, if a state wants the benefit of federally subsidized aid, it must do what is reasonably necessary to check the virus spread. 

Linking the first initiative with the second is also possible: For example, the amount of the tax refund available to residents for getting vaccinated could be increased in states that achieve and maintain a certain improvement in the rate of infection.     

Of course, the Biden administration would need to establish objective, transparent and achievable criteria to avoid charges of arbitrariness, capriciousness and political retribution. But such measures could help reduce the gap between states and residents adopting the right measures to contain the virus and those that don’t. Closing this gap is important to avoid heavy-handed and fraught approaches such as the likely legally-available option of imposing certain interstate travel restrictions.

And reducing the spread of the infection is critical for saving U.S. lives and our economy and restoring America’s global leadership.