Now that several COVID-19 vaccines are thankfully here, the US is having problems getting some people to take them. While the precise percent of the population that needs to be vaccinated to get the pandemic under control, i.e., to achieve “herd immunity,” is not precisely known, estimates tend to range between 70 and 80 percent. Yet many predict that the US may fall short of that — not only due to shortages or bottlenecks — but sheer refusal. Incredibly, for example, one study found over 50% of frontline workers in some areas are reportedly turning down the opportunity to be vaccinated.
Israel is combating a similar problem, albeit on a much smaller scale. Although some 40% of Israelis overall have been vaccinated already, the percentage in Bnei Brak — a predominantly ultra-Orthodox city and one of the hardest hit in Israel — is only 9%. That appears to be changing, though, as they dish out the cholent.
Cholent (pronounced “tsholnt”) is a traditional Jewish slow-cooked stew of beans, potatoes, barley, and meat, traditionally eaten on the Sabbath. Of course, being a traditional Jewish dish — and a peasant dish at that — it comes with a side of humor. For example, it has been said that “if you eat cholent for 120 years, you’ll live a long life.” An older man, Irving loved to overeat cholent — at his annual checkup his doctor sternly warned him that his health was poor and that the best thing for him to do for his health was to give up the cholent. Irving thought a minute, and replied: “OK, Doctor, what’s the next best thing?” If life gives you potatoes? Make cholent.
But for some Israeli health officials, cholent is no joke. “We want to make the [vaccination] a real happening,” said a spokesman for the Bnei Brak Municipal Council, “so there is a lot of excitement, a lot of drama, it’s going to be a very friendly, very pleasant cultural event.” That includes a bowl (or two) of free cholent.
I don’t think this is the moment to try to make cholent a “thing” in America. It took so many years for yogurt to catch on and it is still only fairly recently that burritos became mainstream. But these Israeli health officials are likely on to something. Instead of relying only on “the usual suspects” to talk people into trusting something they don’t trust (in the US, that would be celebrities, experts, and online influencers), the Israelis are frankly offering a free “spoonful of sugar to make the medicine go down.”
In the US, communities of color have been disproportionately affected by COVID-19, yet they are also disproportionately resistant to the vaccine. Pew, for example, found that as few as 42% of Black Americans intend to get the vaccine and an Axios-Ipsos poll found fewer than 30%, compared to 51% of White people. How does this make any sense? The Tuskegee syphilis experiment is how. For 40 years (1932–1972), a group of African American men were told they were getting free medical treatment for syphilis, which can be deadly, but in fact were deliberately not treated, so doctors could study the progress of the disease. This was a government program — run, in fact, by the CDC — conducted by doctors. And now, the white men in their white coats are back, saying we need you to get this shot — it’s for everyone’s good.
Public health officials — worried and somewhat baffled — have turned to “building trust.” This has involved senior scientists publicly “empathizing” with the many historical and contemporary reasons for mistrust (Tuskegee isn’t the only one, it’s just one of the most vile). Media campaigns prominently feature Black people, including clergy, encouraging vaccination and highlight prominent Black scientists’ involvement in vaccine development. Officials are working with Black churches, but many Black people don’t go to Black churches and, even if they do, don’t necessarily take medical advice from the pulpit.
How about dishing out some cholent — in the form of money? Economic incentives worked to speed up the development of the vaccines; tens of billions of dollars were spent to “incent” pharmaceutical companies. It worked. So why not use economic incentives again to speed up the public’s lagging adoption? (Some places have experimented with this approach in the past, offering gift cards and coupons to encourage people to get their flu shots.)
With the prospect of herd immunity in sight, if still on the horizon, we must combat vaccine hesitancy using all tools. Can we, in fact, just pay people to get vaccinated? What, for example, if a portion of the proposed $1,400 government payment were tied to getting vaccinated? In a way, vaccinations are perhaps the most robust economic stimulus, since they will allow many types of business activity to start up again or get closer to the scale they had a year ago. And if modest payments help us beat this pandemic even just a single week sooner, that translates to tens of thousands of lives saved.
Research shows that economic incentives like checks will not work equally well for all kinds of health behaviors. But they do seem to work particularly well for more immediate, short-term action — exactly what’s needed now. And if we find out that we need people to keep getting their shots for the next 120 years — there’s always cholent.