Vaccinating the unvaccinated: An economic incentive may be the solution | GUEST COMMENTARY

These past two years have taken a terrible toll on the world at large and the United States. In the first year of the COVID pandemic, this was overwhelmingly due to COVID-related illness and death, accompanied by health care provider burnout and very serious disparities in this country in terms of risk of infection. With the closure of innumerable workplaces and schools, there was also tremendous social and economic dislocation. At that time it was absolutely appropriate to impose a variety of restrictions on our populace, to protect as many as possible from contracting the virus, as there was very little that could be done to diminish the severity of COVID infections.

However, starting in the spring of this past year, highly effective vaccines against COVID became widely available. Although a significant percentage of Americans got vaccinated (and boosted), the uptake of vaccine became inexplicably linked to political bent. The resulting lower rate of immunizations pose two major continuing threats to Americans. First, the lack of immunizations among a sizable portion of our populace allows the COVID virus to mutate, likely leading to new variants, some of which may be dangerous. Second, this significant unvaccinated segment of our population remains vastly more susceptible to serious infections from COVID, which are more likely to result in utilizing precious Intensive Care Unit beds — or death. This also contributes to further provider burnout.


A variety of efforts have been made to encourage the unimmunized to get vaccinated, with little effect. Yet, until we get to almost full immunity, the entire country is at increased risk for contracting the viral infection and for passing it along. This will result in continued constraints on the country’s economic recovery by requiring repeated partial shutdowns of society, ongoing mask wearing and the extended isolation from social contact that is so harmful to so many.

It is important to point out that a small portion of the unimmunized population has refused vaccination due to an understandable lack of trust in the health care system. This small segment, to their great credit, is now overcoming their lack of trust. However, the vast majority of those remaining unimmunized do so for either political reasons or plain obstinance, and they are now responsible for most of the negative consequences from the ongoing pandemic: long hospital stays, shortages of ICU beds and loss of health care providers, all of which are extremely costly to the health care system.


So, how to get the vast majority of the unimmunized vaccinated? Requiring it may be possible at the state level and has even been supported by a Supreme Court decision from 1905 (Jacobson vs Massachusetts). However, many predominantly red states would not follow this path, leaving the problem largely intact.

The solution will come in the form of personal economic incentive: Private U.S. insurance companies need to impose a surcharge on anyone who remains unvaccinated. There are similar add-ons imposed by insurance companies. For example, both life and health insurers charge smokers more than nonsmokers. President Biden will need to advocate for this policy change using the bully pulpit, and he and public health experts will need to point out that the vaccinated and masking majority have done their part and that the burden now belongs on the unvaccinated.

Let me be clear: This is not penalizing those with preexisting conditions. Rather, it is covering the increased, overall medical costs due to a certain chosen behavior going against all the evidence. It does not require people to get vaccinated; it is simply helping to recoup the costs of this misguided behavior. It is a financial incentive to bring relief to the economic and social lives of all Americans. Some may say that this is a slippery slope — for example, why not impose a surcharge on obese people? The difference is that there are many causes of obesity beyond a specific behavior. Insurance companies can and should charge extra for those not immunized against COVID because the sole criteria used to determine the surcharge is that of being immunized or not.

With the COVID pandemic now dragging on for two years, it is time that COVID becomes an endemic infection (part of the viral ecosystem), rather than remaining a pandemic (a worldwide outbreak). The only way to do this is by dramatically increasing our immunization rates among the currently unvaccinated. The best and quickest way to accomplish this is by making them choose between paying significantly higher insurance premiums or getting immunized.

Dr. Peter Beilenson ( is the former CEO of Evergreen Health and a former Baltimore City Health Commissioner.