To gauge whether financial incentives might encourage unvaccinated Americans to receive a COVID-19 vaccine, the Cato Institute and YouGov conducted an internet survey of 2,000 adults aged 18 and up from September 2 to September 13. The results show the vast majority of unvaccinated Americans report that financial incentives in the form of higher health insurance premiums will not persuade them to vaccinate.

Here are the main results on vaccination status and attitudes toward vaccinating:

• 67 percent of respondents report they had already gotten at least one dose of the vaccine

• 16 percent reported they are open to vaccinating

• 17 percent replied they would “definitely not” vaccinate

Of the 16 percent of respondents who reported they are open to vaccinating (totals do not add to 100 percent due to rounding):

• 24 percent reported they are planning to get vaccinated

• 57 percent reported they are adopting a “wait and see” approach

• 20 percent reported they will vaccinate only “if required”

In other words, four-fifths of the unvaccinated—a group that accounts for 12 percent of the full sample—either already want to vaccinate or are waiting on more information. This suggests the United States could achieve an 80 percent vaccination rate via persuasion alone. The remaining fifth of the unvaccinated might choose to vaccinate if subject to a requirement, such as a financial incentive.

The survey next sought to find out how the unvaccinated group would react to financial incentives in the form of health insurance premium surcharges for failing to get vaccinated. It successively asked whether a monthly increase in health insurance premiums of $50, $100, $200, $400, or $1,000 would spur unvaccinated respondents to vaccinate.

The survey found:

• 14 percent of the unvaccinated said they would would vaccinate if the alternative were a $50 monthly increase in health insurance premiums

• a further 5 percent said they would vaccinate if they faced a monthly surcharge of $100

• a further 3 percent said they would vaccinate if they faced a monthly surcharge of $200

• a further 2 percent said they would vaccinate if they faced a monthly surcharge of $400

• a further 2 percent said they would vaccinate if they faced a monthly surcharge of $1,000

• 74 percent said that not even a monthly surcharge of $1,000 would affect their decision to vaccinate

Remarkably, 74 percent of unvaccinated Americans responded that premium surcharges as high as $12,000 per year would not affect their decision to vaccinate.

Taken together, these results suggest 80 percent of unvaccinated Americans are open to persuasion but 74 percent are not open to financial pressure. These results drive home the importance of consistent, transparent, respectful, persuasive messaging to increasing vaccination rates.

Full survey questions and results are available here.

The Food and Drug Administration’s scientific advisory panel recommended against approving Pfizer/​BioNTech booster vaccinations for the general population aged 16 and above. The boosters are currently only approved for immunocompromised individuals and patients in nursing homes—patients who are more vulnerable than the general population to get breakthrough infections that result in hospitalization or death.

Concluding that the vaccines offer the general adult population robust protection against severe disease that can possibly result in hospitalization or death, the committee decided the protection provided by the two-dose mRNA vaccine regimen is good enough for them.

The decision was not unanimous. For example, one panel member, Dr. Peter Marks, urged the committee to consider the spread of the disease, not just the severity of the illness.

As Michael F. Cannon and I have written here, the FDA often tramples on the fundamental right to self-medicate, and it looks as if it is about to do it again. I stated in an interview on The National Desk this morning that the FDA should stick to the question of whether a booster is safe and effective. The decision as to how much protection is good enough protection should be left up to patients, who are encouraged to consult with their health care providers.

Many people may be comfortable knowing that the vaccination protects them against severe illness and are willing to take their chances on a breakthrough infection that is likely to be mild to moderate. But others may make different risk/​benefit assessments. For example, some may not want to risk giving it to their children and having to keep them home from school. Others may not be able to afford quarantining at home and missing work.

Alas, the FDA panel has made the decision for them.

This is one of the dangers of concentrating all decision-making authority in a government monopoly agency. It invites inevitable politicization of the process and violates individual autonomy.

The panel decision next goes to the FDA Commissioner, who is not obligated to follow the recommendations. Let’s hope the FDA overrules the panel and lets autonomous adults decide if they want to get a booster.

While the press was understandably preoccupied with the White House commandeering private businesses to enforce a COVID vaccine mandate on September 9, it gave little attention to the Food and Drug Administration’s strike against an effective form of tobacco harm reduction on the same day. The FDA was under a court order to review 6.5 million applications from over 500 companies to market nicotine-containing e‑cigarettes and rejected 90 percent of them, while it delayed deciding on applications from Juul, which commands an overwhelming share of the vaping market. One can be forgiven for having a cynical view of the delay.

Ironically, a spokesperson for the American Lung Association, which should be promoting nicotine-based vaping products as a proven way to help adults quit smoking tobacco products, was “deeply disappointed” that the decision about Juul’s fate was delayed. The association is concerned about what it sees as an “epidemic” of vaping among youth. Yet it is against the law to sell vaping products to people under age 18, and one would think the American Lung Association would support tobacco harm reduction for adults.

Writing in the American Journal of Public Health last month, fourteen academic public health experts point out “the National Academies of Science, Engineering, and Medicine concluded that e‑cigarette use is likely far less hazardous than smoking,” and warned that “Policies intended to reduce adolescent vaping may also reduce adult smokers’ use of e‑cigarettes in quit attempts.” They added:

Because evidence indicates that e‑cigarette use can increase the odds of quitting smoking, many scientists, including this essay’s authors, encourage the health community, media, and policymakers to more carefully weigh vaping’s potential to reduce adult smoking-attributable mortality.

Studies show flavored e‑cigarettes, while popular with teens, are preferred by adults trying to quit tobacco and are not associated with an increase in youth tobacco smoking initiation. And a recent study in the Journal of the American Medical Association found that San Francisco’s ban of flavored vaping products may have unintentionally increased teen tobacco smoking.

With a few exceptions, such as Boston University School of Public Health Professor Michael Siegel, most anti-smoking activists paint vaping with the same brush as tobacco smoking. Perhaps it is because tobacco and many vaping products contain nicotine. Yet nicotine is much less harmful than the carcinogens and other ingredients in tobacco smoke. Perhaps it is due to irrational, zero-tolerance of any activity that resembles smoking. Whatever the reason, it runs counter to the evidence, and counter to their stated goal of reducing tobacco smoking.

CVS Caremark, a benefits management company pursuing cost containment, introduced rules that require patients using specialty drugs to pay higher prices if they go outside the company’s in-house distribution system, specifically its home-delivery service or pickup at a CVS pharmacy.

Five John Doe HIV/AIDS patients who use specialty drugs with employer-sponsored healthcare plans sued CVS claiming, firstly, that CVS’s policy change amounts to discrimination under the Affordable Care Act (ACA) by treating consumers of specialty drugs differently from consumers of non-specialty drugs. Secondly, and crucially for our purposes, they claim that the ACA, by incorporating Section 504 of the Rehabilitation Act of 1973, creates a cause of action for discrimination based on this so-called disparate impact. (Like the later and better-known Americans with Disabilities Act (ADA), Section 504 bans discrimination on the basis of disability, but each law applies in some situations in which the other doesn’t.)

The question presented is whether Section 504 creates a cause of action for so-called disparate impact. The Ninth Circuit ruled that it did, finding that “practices that are not intended to discriminate” can still have a “disproportionately adverse effect” that can give rise to a Section 504 claim. But this holding rests on dubious statutory interpretation.

In deciding whether to recognize disparate impact claims, courts consider the differing wording found in each discrimination statute. For example, the Court found the intentionally broad language of “otherwise adversely affect” in Title VII of the Civil Rights Act of 1964 to open the door to disparate impact claims. Section 504 was patterned after a different part of the law, Title VI, which prohibits a person’s “be[ing] excluded from participation in, be[ing] denied the benefits of, or be[ing] subjected to discrimination”. Significantly, Section 504’s language limits coverage further by including the word “solely”.

Cato has joined the Washington Legal Foundation in an amicus brief urging the Supreme Court to overrule the Ninth Circuit and instead adopt the Sixth Circuit’s reasoning in Doe v. Blue Cross Blue Shield of Tenn., Inc, where on materially identical facts the Court held the benefit plans did not discriminate on the basis of disability because they were “neutral on [their] face.”

Today’s Supreme Court also shuns the creation of implied causes of action not clearly authorized by a statute. Such creation endangers the separation of powers by arming judges with effectively legislative—rather than judicial—power.

Every facially neutral cost-management policy affects beneficiaries differently. Affirming the Ninth Circuit’s ruling would open the floodgates for such challenges, create a vast administrative burden for providers and lead to increased premium costs for employers and employees alike. The Court can avert these foreseeable consequences by giving the statute’s language its most natural meaning.

The Washington Post reports that President Biden will announce this afternoon that he will require all government employees to get vaccinated against COVID-19 or face possible termination. They will not be exempt from the requirement if they agree to frequent testing.

The administration also plans to mandate that all businesses with 100 or more employees require their employees to get vaccinated or take weekly COVID tests. Finally, it will use its leverage to mandate that all hospitals receiving Medicaid or Medicare funds vaccinate their workers.

I don’t believe the government has the right to force individuals to get vaccinated. However, employers have the right to require their employees to get vaccinated. Just as business owners have the right to say to customers, “No shirt, no shoes, no service,” so too they have the right to say, “no vax, no service.” The same principle applies to the terms of employment. This is an extension of property rights and the right to freedom of association. Therefore, I don’t have any problem, in principle, with the government requiring its own employees to get vaccinated.

I am not a legal or constitutional expert, but I suspect the federal government probably can use the carrot-and-stick approach with health care facilities that receive federal Medicaid and Medicare funds because it has leveraged federal funding to get state and local acquiescence in the past. But I can’t speak to the constitutionality of the federal government mandating that private businesses require their employees to get vaccinated or tested for COVID. I will defer to my colleagues who have expertise in that area.

Aside from legal concerns, I find it disheartening that the Biden administration is ignoring the role of natural immunity. Several studies, including this recent one from Israel, show people with prior COVID-19 infections acquire immunity that is equal to or better than those with vaccine-induced immunity. That’s why Israel, the U.K., and most European countries give entry passes to people who prove prior COVID-19 infection in lieu of vaccination. Many researchers believe people with natural immunity don’t need to get vaccinated or, at the most, just need one of the two mRNA vaccine doses. Alas, the presidential order doesn’t take any of this into account. One of the problems with one-size-fits-all top-down edicts is that they don’t do nuance very well.

The presidential order regarding government and private employees is also unlikely to make the vaccine-resistant change their minds. I worry it might have the opposite effect, causing them to dig in harder and seek relief in the burgeoning black market in CDC vaccination cards, many of them counterfeit. Businesses might wind up having a significant number of their workers lacking immunity and risking the spread of the virus to coworkers.

Vaccinations are the most effective harm reduction tool in the COVID-19 harm reduction toolbox. We should encourage and persuade people who do not already have acquired immunity to get vaccinated. But the president’s latest approach is too heavy-handed and might be counterproductive as well.

President Biden’s Department of Health and Human Services has issued a report proposing to reduce the prices government pays for prescription drugs (good) and proposing government price controls on private drug purchases (bad).

The optimal price government should pay for medical care, including prescription drugs, is $0.00. Lowering the prices government pays for drugs reduces government spending and the burden that Medicare and other government programs impose on taxpayers. Everyone who supports smaller government (read: Republicans) should support reducing the prices Medicare pays for prescription drugs—and should insist the government return those savings to taxpayers, rather than spend them elsewhere. Anything that moves the actual prices government pays for prescription drugs in the direction of $0.00 is a good thing.

Instead, government imposes various policies that drive higher both the prices it and private purchasers pay for prescription drugs. Many Republicans oppose any attempt to reduce the prices Medicare pays for drugs—hypocritically, because doing so increases the size of government.

Yes, reducing drug prices might reduce innovation. But evidence suggests drug prices are so inefficiently high that they are encouraging inefficient innovation. So reducing drug prices is likely the right thing to do on the innovation front, too. If the drug companies that push this line worry so much about barriers to drug innovation, they should lobby to eliminate the Food and Drug Administration or at least to reduce its powers. (And yet they don’t. Weird.)

The Biden proposal would reduce the prices Medicare pays for prescription drugs, which is good. Unfortunately, it does not stop there. It would also take the prices Medicare sets to govern its own purchases and impose those prices on private payers in the form of price controls. It would impose additional price controls on private transactions by limiting how much drug companies could increase their prices from year to year.

Government should not impose price controls on transactions to which it is not a party. Imposing binding price controls on private transactions would lead to (more) drug shortages and reduce desirable, efficient innovation (because market prices would not be able to signal need), just as allowing government to raid the patents of select drugs would. Another mark against the Biden proposal is that it would not return the savings to taxpayers, but would spend the savings elsewhere.

A better strategy would be for Biden to implement Trump’s Medicare Part B drug-pricing proposal, which would limit the prices Medicare pays for those drugs without any of this accompanying nonsense.

The fact that President Biden ordered agencies to encourage competition in health care and HHS responded with price controls—which eliminate price competition—indicates that Biden needs to clean house at HHS.

After calls from members of the scientific, public health, and medical community—myself included—the Food and Drug Administration finally overcame bureaucratic inertia and granted full approval to the Pfizer-BioNTech mRNA COVID-19 vaccine—ahead of its self-imposed deadline of January 2022. This is good news. Pfizer will now market the vaccine under the brand name Comirnaty.

Hundreds of millions of doses have been administered over the course of nearly a year and the safety profiles of these vaccines have been remarkably good. Now the FDA should move quickly on the other mRNA vaccine made by Moderna. The company submitted its application for full approval in June, a month after Pfizer’s application. Johnson and Johnson, makers of the one-dose adenovirus-based vaccine has not yet applied for full approval.

It is important to stress that, while the vaccine does not prevent 100 percent of infection, it is highly effective against severe disease—severe enough to require hospitalization and/​or death. The health care news site MedPage Today reported that Peter Marks, MD, PhD, Director of the FDA’s Center for Biologics and Research issued the following statement:

Our scientific and medical experts conducted an incredibly thorough and thoughtful evaluation of this vaccine. We evaluated scientific data and information included in hundreds of thousands of pages, conducted our own analyses of Comirnaty’s safety and effectiveness, and performed a detailed assessment of the manufacturing processes, including inspections of the manufacturing facilities.

Full approval of the Pfizer vaccine hopefully will reduce vaccine hesitancy. Claims, especially by those in the “anti-vax” community that the vaccine is “experimental” influence many of the vaccine-hesitant. Ironically, many who oppose the so-called “experimental” vaccine instead urge the off-label use of the anti-inflammatory/antimalarial drug hydroxychloroquine or ivermectin, used to treat parasites in animals, to prevent or treat COVID-19 infections. Yet the use of those drugs for COVID-19 is truly experimental.

Hopefully, full approval of the Pfizer vaccine and, before much longer, the Moderna vaccine, will alleviate much of the vaccine hesitancy. While politicians and public health officials have employed various approaches to the pandemic—from lockdowns to stay-at-home orders to elective procedure moratoria to mask mandates—the evidence shows that immunization is clearly the most effective and least damaging form of COVID-19 harm reduction.