It is hardly difficult to make a case against the proposals that drug addicts might be paid to complete a course of hepatitis B vaccination.
First, there is a moral issue about public money indirectly subsidising a heroin habit. Then there is the obvious unfairness in offering incentives to one group while the rest of us receive nothing for taking our statins, say, or having a smear test. There is also the simple matter of cost to consider, given the intense pressure on the public purse. And finally, there are broader questions about where this slippery slope might lead; if financial incentives are deemed acceptable in one area of public health, what about others?
While such concerns are not unreasonable, still the idea is one that ought to be pursued. The single strongest counter-argument is that pecuniary incentives really do appear to work. According to the latest research, as little as £30 can make the difference between a drug addict finishing the course of vaccinations or not. Where fewer than one in 10 completed the month-long schedule with no payment, almost half of those given supermarket vouchers continued to the end, the majority of whom were also more punctual for their appointments.
Given that hepatitis B infects more than one in five of Britain’s 250,000-plus injecting drug users, and that up to a quarter of untreated chronic cases of the virus die, any mechanism for controlling it must be explored. In the less-squeamish US, incentives for addicts are more common and with positive results.
True, there is a broader question about where to draw the line. After all, similar trials targeting breast-feeding mothers and abstinent smokers have also proved effective. But to pursue a policy of proven effectiveness with regards to one, limited problem does not mean it should be a blanket response to every area of public health. While the majority of the population – with more concern for their health and less chaotic lives – need no incentives, drug users are a very specific group who do.
For too long, responses to drug addiction have been hampered by moralising, to the detriment of both the individuals and the NHS. It is time to explore all options with an open mind.