As most of us learned through both common sense and the evidence thoughtfully provided by anti-vaxxers in the form of measles outbreaks, the greater the number of individuals vaccinated, the greater the public health benefit. IV drug users (IVDU) are at a particularly high risk for hepatitis B. Fortunately, we have a vaccine for that. Unfortunately, IVDU generally have very low adherence to treatment and vaccination schedules. A recent British study found that paying IVDU a total of £30 (roughly $50) to receive the vaccine – delivered in 3 shots over 1 month – was a highly effective way of increasing vaccination rates in the population. And, this vaccine comes with 0% risk of autism!
Of the 210 participants, 70 were given no incentive (standard treatment), 70 were given £10 vouchers at each visit, and 70 were given vouchers of escalating value (£5, £10, and £15 over 3 visits). Less than 10% of unpaid participants completed the course of injections, whereas 45-49% of incentivized patients saw it through. They were also more likely to show up on time for appointments, which makes me think we should just pay everyone who ever goes to the doctor and maybe I won't have to wait 3 hours to see the damn ophthalmologist next time.
This seems like it would be intuitive – people are more likely to do things when they get paid, even if it's for their own benefit – but, in a world where evidence = funding, this is a promising discovery. There are some issues that arise here, however. Research wise, participants in the study were receiving opioid substitution therapy so they were already connected to care. That's a huge caveat. The study also leaves the lingering question of whether this can affect long term behavior changes or we would need to incentivize all care. But then we get into the ethics of it all.
Should we be paying patients to receive medical care, even if left to their own devices they may not do so? The logic of it seems obvious – people are dying (expensively) of cirrhosis, liver disease, and cancer, brought on by a preventable infection. If we can essentially bribe people into being healthier, shouldn't we? On the other hand, it's jumping right over all the systemic issues creating barriers to care and giving us a tempting but (probably) unsustainable way to solve the hepatitis B vaccine problem. What about care for all of the other issues facing at risk populations?
The study was funded by the National Institute for Health Research, but is the ultimate goal to get the government to fund a similar program? What color would the faces of Fox News Pundits turn if this was proposed on American soil? My odds are on something in the realm of late stage of Violet Beauregard.
I wanted to include a list of resources for substance abusers. Additionally, if someone chooses to use intravenous drugs, at the very least they should do so as safely as possible – this is a list of clean syringe exchange programs in the US. I know those recommendations are terribly US centric of me but I think I should get credit for listing places outside of NYC.