Can’t we just offer incentives or lotteries to give reluctant folks an extra reason to get their shot?


Q: If vaccine demand is waning, can’t we just offer incentives or lotteries to give reluctant folks an extra reason to get their shot?

A: Lotteries and other incentives could be really effective for promoting vaccine take-up. There are some potential pitfalls, too.

Even before there were COVID-19 vaccines, there were pitches and proposals for incentivizing vaccination.

🤑Back in November, former Maryland Congressman John Delaney suggested sending every American a $1,500 check after they got vaccinated (link below).

🍩Krispy Kreme donuts famously started offering a free daily donut to anyone with a completed COVID-19 vaccination card (link below).

🍺New York City is offering free tickets to major attractions like the Brooklyn Botanical Garden and the Bronx Zoo (link below), while across the river in New Jersey, the “Shot and a Beer” promo offers a free beer if you get your first vaccine dose during May (link below).

✉️West Virginia Governor Jim Justice announced a program to give $100 to residents age 16-34 who get vaccinated. (And yes, you’re eligible even if you got vaccinated before the giveaway started.) While the original plan was to issue a $100 US savings bond (which Governor Justice hoped would have a “patriotic flair”), the incentive may now just arrive in the form of a gift card (link below).

💰A voucher for a free lottery ticket is Kentucky’s way of “injecting a little fun into the process” (see what they did there?). KY Gov. Andy Beshear kept up the punning with: “I hope this shot at $225,000 will be the incentive needed for more Kentuckians to get a vaccine” (link below).

So, vaccination incentives: Terrific or terrible idea?

👍🏽An argument in favor of vaccination incentives is their effectiveness. Incentives work! For lots of reasons, people respond to incentives like money, free tickets, lotteries, and, yes, donuts. Prior evidence from other health behavior change efforts is solid: incentives do a good job of focusing attention on a behavior, shifting some of the future benefits of the behavior into the present, and generally helping with follow-through or procrastination. This is true even when the incentive is small compared to the effort required for the behavior (like a donut), or when there’s a tiny probability of a big payout (like a lottery).

But many people argue that incentives are a bad idea, for ethical, psychological, and financial reasons:

⚖️Ethical: Why should we pay people who have waited this long or are reluctant, when the people who already stepped up and did their duty don’t get rewarded? Is that fair?

🧠Psychological: If we offer an incentive for this vaccine, won’t people then expect an incentive next time when we want them to get a booster shot or their flu vaccine? Economists call this “motivation crowd out” — does the extrinsic reward “crowd out” your intrinsic motivation next time? Evidence is mixed on whether and when to worry about motivation crowd out.

💸Financial: Is this the best use of limited public health dollars? If the incentive is offered to everyone who gets vaccinated in a given city or during a given month, you’re paying the incentive to a lot of people who didn’t necessarily need the incentive in order to get vaccinated. Would those dollars be better spent on an education campaign, a targeted outreach effort, or a mobile van to bring the vaccine to hard-to-reach populations?

While there are no clear right or wrong answers to this, here are three things to keep in mind about vaccination incentives:

1️⃣ Incentives can work in a couple of different ways: They can actually change your motivation or intention to get vaccinated, or they can close the “intention-to-behavior gap” — meaning they reduce the chances that someone who plans to get vaccinated just never follows through due to procrastination, forgetfulness, or distraction. It helps to know which route to behavior change you’re trying to affect.

2️⃣ Incentives don’t have to be financial. In addition to the lottery ticket voucher, Kentucky is also offering a non-financial incentive for getting vaccinated: Easing capacity restrictions will happen once 2.5 million Kentuckians are vaccinated. Limiting access to sporting events or concert venues based on vaccination status is also a form of incentive.

3️⃣ Getting good data about the effect of incentives is crucial. (And we’re not just saying that because we’re scientists!) As different companies, cities, and states try out incentives programs, they should also do evaluations to find out if the program worked overall, if it worked for specific people, and if there were any intended or untended consequences. (For example, it matters if an incentive program works really well for men but not for women; or if it does indeed crowd out motivation for the next time you need to get vaccinated.)

👂Tell us in the comments below what you think about incentives schemes for vaccination. Have you heard about any particularly creative or effective incentives? Have you been offered or responded to an incentive? We want to hear from you!

~Those Nerdy Girls


John Delaney proposal

Krispy Kreme offer

New York City incentives

New Jersey “shot and a beer”

West Virginia $100 incentive

Kentucky incentives

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