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You can solve a lot of problems by throwing money at them. But where to throw the money?

Take the stubbornly low vaccination rate in the United States. The share of Americans with at least one shot – 50.5 per cent as of Monday – is more than six percentage points behind Canada.

That cross-border gap is rapidly widening, with Canada in recent weeks jabbing about one per cent of the population daily. In the U.S., the pace of first shots has slowed to a crawl.

The American response has been to go full game-show mode.

Ohio took the lead, creating the Vax-a-Million lottery. It is giving away a US$1-million prize each week for five weeks to adults who get vaccinated, with scholarships for teens. Several other states are doing likewise, including California, which is spending more than US$100-million on a program called Vax for the Win. It includes 10 prizes of US$1.5-million, 30 prizes of US$50,000 and two million US$50 gift cards.

Money is a powerful incentive, so the get-paid-to-get-a-shot approach might just goose a low U.S. vaccination rate.

But monetizing things can also have perverse incentives. One has to think carefully about why someone is not doing something, and why paying them to do it might, or might not, change their mind. For example, Canadian health authorities have generally been opposed to paying for blood donations, owing to fears about a number of negative side effects, including undermining the altruism that motivates most donors.

However, Canada does need to start throwing a lot more effort, and money, at the challenge of the unvaccinated.

We’d suggest the main push should be on making it easier and more convenient for the still-unvaccinated to get a shot, including taking it right to their doors. The obstacle for that minority of Canadians appears to be not vaccine hostility – and if you really believe COVID-19 is a government hoax, will $50 from the government change your mind? – but basic barriers of language, mobility, information and technology.

The good news is that this country’s vaccination campaign is rolling at speed – thanks to Canadians. The vast majority of us are eager to get vaccinated.

However, though we’re on track to do better than the Americans, that still may not be good enough to avoid a fourth wave.

According to modelling from Caroline Colijn, a mathematician specializing in infectious diseases at Simon Fraser University, vaccinating 75 per cent of people over the age of 12 would still leave room for a virus resurgence. Last week, this page proposed a target of 90-per-cent vaccine uptake; the modelling suggests that would likely block any COVID-19 encore in the fall.

Canada is on track to end this week with around 70 per cent of eligible people vaccinated. But Canada’s first-shot vaccination rate is about to start plateauing – and among seniors, it already has.

For Ontarians aged 80 years and over, the vaccination rate on May 24 was a solid 82 per cent. But that number has barely risen in weeks. It’s a similar story among Ontarians in their 70s.

That Canada’s first-dose vaccination rate continues to gallop ahead is almost entirely due to rising uptake among the last people in line, namely the young. As their vaccination rates rise, uptake will start to drop off, as it has with seniors.

That’s part of the reason why provinces are beginning to shift from a focus on first shots to reserving second shots for seniors. The easy pickings of a spring harvest – Canadians with the time, know-how and resources to actively chase after their first jab – are almost exhausted.

Yukon, Canada’s most successful vaccinator, has given a first shot to nearly 80 per cent of the eligible population. But once the territory got to around 70-per-cent coverage, its campaign slowed, and nearly stalled. Over the past month, Yukon has given first shots to only about 1.5 per cent of the population per week.

In other words, though Canada is going to hit the wall later than the Americans, we are going to hit it, and soon. When that happens, at least a quarter of eligible Canadians, maybe more, will still be without a first shot.

Getting to the 90-per-cent goal means reaching more of the unvaccinated.

How to do it? More on that, tomorrow.

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