Cash incentives for vaccination have little impact

Over the past year, vaccine incentives have become a popular strategy among businesses and state and local governments. From free donuts to free Mets tickets, Americans have had opportunities to get bonus rewards along with protection from the coronavirus. And one particularly common incentive is cash, offered through small payments accompanying vaccinations and lotteries that only vaccinated people can enter.

While politicians at all levels have praised cash incentives, research has shown that this strategy has little impact on actually convincing Americans to get vaccinated. A recent investigation I worked on (at the Documenting COVID-19 project and the Missouri Independent) provides new evidence for this trend: the state of Missouri allocated $11 million for gift cards that residents could get upon receiving their first or second vaccine dose, but the vast majority of local health departments opted not to participate in the program—and a very small number of gift cards have been distributed thus far. 

The Missouri program’s limited success fits into a national pattern. “It’s hard to tease out a causal effect of a program that’s not introduced with the purpose of a research experiment,” Dr. Allan Walkey, an epidemiologist at Boston University who’s studied vaccine incentives, told me. Still, Walkey said, the majority of research on these programs has found that cash incentives are not driving huge numbers of people to get their shots.

Walkey specifically studied a vaccine lottery in Ohio, the first state to set up such a program. While initial reports by state leaders suggested that a lot of people got vaccinated after the lottery was announced, Walkey found that, in fact, the new vaccinations were more likely caused by an expansion of vaccine eligibility. Two days before the lottery was announced, the Pfizer vaccine was authorized for children between the ages of 12 and 15.

The lottery “didn’t have a large effect on vaccine uptake,” Walkey told me. Studies of vaccine lotteries in other states have found similar results.

For this story, I also spoke to Ashley Kirzinger, a polling expert at the Kaiser Family Foundation (KFF) who helps run KFF’s Vaccine Monitor surveys. In these surveys, KFF sorts unvaccinated Americans into categories based on their vaccine attitudes: “wait and see,” “only if required,” and “definitely not.” Kirzinger told me that cash incentives, vaccine requirements for events, and other social pressures are more likely to “motivate the ‘wait and see’ or ‘only if required’” groups.

But for those Americans who “definitely” don’t want to get vaccinated, these incentives aren’t likely to move the needle. In fact, the people in this group may be angered by incentives, because they could see such programs as unfair pressure from the health system.

This was true in some Missouri local public health departments. For example, in Carter County—where the local agency did opt in to the state gift card program—a planned vaccination drive with the gift cards was canceled due to local opposition.

“​​So many parents and community members were upset, we were not allowed to hold the vaccination event at the school,” said Michelle Walker, the county health center administrator.

Overall, out of 115 local public health agencies in Missouri that were eligible to participate in the incentive program, just 20 opted to get gift cards. Most departments purchased $50 gift cards, so that residents could get $50 at their first vaccine dose and $50 at their second dose.

Through surveying the local agencies that participated, my colleague Tessa Weinberg and I obtained data from 10. Out of 6,378 gift cards that the agencies were able to purchase with state funding, we found that just 1,712 had been distributed so far, as of late November.

Read the full story for more on why many departments didn't participate in this gift card program, and how it's going for the departments that did opt in.

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