Remember potty training your children? That was fun, wasn’t it. Chasing them around the house, their diapers dragging behind, praying you got them on the throne before they made a deposit on your hardwood floors. Remember when they succeeded? Short of confetti and balloons dropping from the ceiling, there was dancing, hand-clapping, an extra story at bedtime. Often, there were M&Ms. Different colors for different deposits. You’d think they had won Olympic gold! Cue the national anthem.

This may sound like an exaggeration, but not by much. It is an example of what psychologists call external gratification. Children are not mature enough to defer rewards for a job well done. They need an immediate, concrete incentive to behave in a particular way. They are not motivated by an intrinsic sense to do good simply because it is good. They poop in the potty for that yellow M&M, not because it makes Mom’s job a little easier.

With maturity, one hopes, comes the understanding that virtue and goodness are their own reward. We don’t need stuff to do what’s right. We simply know and do. And that, in itself, is the reward. That is internal gratification.

Unfortunately, the events of the past few months have shown us that many Americans have not moved much past their potty-training days. According to the CDC, on April 1^st, nearly 4.3 million new doses of vaccine were administered, but the numbers have steadily declined since then. Between April 11th and May 11th, the average number of weekly vaccinations dropped nearly 50%. As of July 15^th, a total of 160,408,538 or 49% of eligible Americans have been fully vaccinated.

And yet Americans continue to die of COVID-19. More than 608,000 as of this writing.

According to data from Johns Hopkins University and the CDC, U.S. vaccination rates and COVID cases show 463 counties across the United States with high rates of infection, reporting at least 100 new cases over the last week per 100,000 residents – more than twice the U.S. rate. 80% of those counties have vaccinated less than 40% of their 23 million residents. Indeed, nationwide cases are once again on the rise as the highly transmissible Delta Variant is now the dominant strain in the United States. The seven-day average of newly confirmed COVID cases has climbed to about 23,300 a day, almost double the average from a week ago, according to Johns Hopkins data. 

Virtually all COVID hospitalizations and deaths, 99.5%, are occurring among unvaccinated people, U.S. officials say. 

In mid-May, many governors instituted incentives to increase the number of vaccinated citizens in their states. Individuals are being induced – or is it seduced – into protecting themselves and those around them by external rewards ranging from beer to college scholarships. You can drive a couple of laps around the Talladega superspeedway in Alabama, have dinner with New Jersey’s governor, or get free weed in Washington State.

But Mississippi, which ranks last in vaccination rates, isn’t even trying.

Within a week since Mike DeWine first announced his state’s Vax-a-Millions program in May, Ohio Health Director Stephanie McCloud reported a six percent increase in vaccination rates among people between the ages of 30 and 74, after three weeks of a steady decline in rates for that age group. Nevertheless, according to a National Governors’ Association memo released on July 1^st, “vaccination incentives are a relatively novel topic in public policy, and it is not known to what extent incentives can drive increases in vaccinations.”

Rolling Stone concludes that “[b]ecause these types of state-sponsored vaccine incentives haven’t been offered before on this scale, there is no existing data pointing to which rewards are more effective at increasing vaccination rates than others. Even after the COVID-19 vaccine rollout concludes and we do have that state-level data, several other factors come into play – including personal preferences and geographic differences – that may make it difficult to identify specific strategies that would be the most successful on a national level.”

Except maybe cash. Individuals surveyed by the New York Times reported they would be vaccinated for $25.

Data collection isn’t the only problem these incentives pose. They obscure the need for better community outreach and education on vaccine safety. They inadvertently encourage further distrust of a system that must pay for compliance. They discourage any sense of civic responsibility among those who just haven’t gotten around to being vaccinated – to do good because it is the right thing to do, not because there is a lottery ticket dangling at the end of the vaccination needle.

By incentivizing COVID immunizations, we have regressed as a nation to the potty-training stage, obstinately waiting for the yellow M&M instead of doing the obvious to save ourselves and those we love.

Perhaps we should follow Utah’s lead. Their only incentive? You don’t die.