COVID-19 Vaccine Incentives: From Free Tacos to a Million Dollars

Philadelphia Mayor Jim Kenney recently unveiled the Philly Vax Sweepstakes, which will give three dozen residents cash prizes of up to $50,000, with three drawings this summer. (The first is Monday, June 21.) But there's a catch: to win, you have to be vaccinated for COVID-19.

If your name is randomly chosen from a list of every adult in Philadelphia, you'll be contacted by lottery officials. Exciting! But if you haven't been vaccinated, you'll lose your chance and someone else will take the money.

Everything about Philly's lottery matches the structure of Ohio's Vax-a-Million program with one difference. In Philadelphia, everyone is entered into the drawing. In Ohio, you're only entered if you've been vaccinated. This means that when you win there, there's no catch — five adults will win $1 million each and five youth (ages 12-17) will win a full-ride scholarship to an Ohio state college or university.

But in Philadelphia, if you win, you might still lose — if you haven't been vaccinated.

This detail makes all the difference, said Alison Buttenheim, an associate professor of nursing and health policy at the University of Pennsylvania School of Nursing. She shared her insights with journalists during a webinar sponsored by the USC Center for Health Journalism.

"Anticipated regret ... is very motivating," Buttenheim said. Philadelphia's lottery plays on our natural aversion to regret — the whole FOMO (fear of missing out) culture. It's a true FOMO lottery: you might think, I would've won, if I had just gotten vaccinated.

Nationwide, just over half — 55% — of adults have been fully vaccinated for COVID-19, according to the Centers for Disease Control and Prevention. Vaccination rates are higher among older adults: 77% of people 65 and older have been fully vaccinated for the coronavirus.

That means about half of American adults remain unprotected, including a significant number of older people who may, for several reasons, be most at risk.

What's keeping some older adults from getting vaccinated? Well, it's a bit complicated.

"The one thing we learned really fast — we learned it from other vaccines and other health behavior changes — is that there's no one single method that will work for everyone," Buttenheim said. "It really depends [on] what your reasons for hesitancy are."

Some older adults across the country are still struggling to access vaccines — essentially, it can be difficult to not just find a clinic, but to take time off work and find transportation to get it done, with one or two visits spaced three weeks apart. Amid the pressures of daily life, a vaccine might not seem within reach.

An estimated 30 million Americans are in this boat: they're willing to get vaccinated for COVID-19, but haven't made it happen — yet.

Many people don't regularly interact with the health care system (or even have a primary care physician), so the whole process can seem like too much work.

Living in a rural community can also be a barrier to getting vaccinated. Language issues can be, too.

"I have a fantasy where the Mr. Softee ice cream trucks in Philadelphia would have vaccines and nurses on them, and you could flag down the truck for your ice cream cone and flag down the truck for your vaccine," Buttenheim said.

Ice cream trucks aren't just a Philly phenomenon, of course: every summer, they make their way through neighborhoods, blasting treacly jingles.

It's meant to catch your ear, to make you pay attention — all the better, perhaps, to motivate you to go get a vaccine.

Practical concerns aren't the only barrier. Some people are skeptical about, or wary of, COVID-19 vaccines and this belief runs so deep that they're not willing to get vaccinated — even if it's convenient, even if there are incentives.

For some people, nothing will be convincing enough.

"We don't spend a lot of time thinking about messaging that will persuade people. It's just not time well spent," Buttenheim said. "But for folks whose set of concerns are around trust, usually hearing the message content is much less important than the messenger."

Some of the hardest-to-reach people feel a deep sense of mistrust about health care, period. The effort to bring services, including vaccines, to disadvantaged communities is an even tougher task because some wariness stems from an ugly history. 

"People of color may be skeptical or afraid of the medical system due to a long history of abuse," said Dr. Saralyn Mark, COVID-19 lead for the American Medical Women's Association.

This is not a new story: millions of Americans have weathered decades of being left out of public health programs, due to a broad lack of investment in communities.

"It's important to ensure that there is equity and access in regard to vaccine distribution and to understand the motivations for why someone would and would not get a vaccine," Mark said. "Trusted officials such as doctors, clergy or local leaders may play a more effective role in helping to educate communities."

As vaccination rates have stagnated nationwide, state and city governments, schools and businesses are starting to get creative with incentives, from a $50 prepaid card for anyone who drives someone to a vaccination site in Detroit to free beer in New Jersey to a free box of Girl Scout cookies in Indiana to a free ticket to Six Flags in Illinois.

Taco Bell has offered free tacos. Krispy Kreme has offered free doughnuts. Various cities and states are offering $100 gift cards, which seems to be effective, a new study suggests.

In addition to the sweepstakes in Philadelphia and Ohio, California is offering lottery prizes (plus $50 cash cards and Six Flag tickets) to encourage vaccination. Massachusetts is launching a lottery that is similar to Ohio's: there are five $1 million prizes for adults who register after they've been vaccinated and five $300,000 college savings plan scholarships for youth between 12 and 17 years old.

Incentives aren't perfect, of course: it turns out that some people are a bit annoyed that they got vaccinated early and weren't eligible for bonuses or rewards.

For people who face practical barriers, incentives simply might not be enough. A special bonus, even if it's attractive, won't fix real issues like finding the time to get a vaccination done or understanding how to do it — or where to do it or when.

In some cases, financial incentives might actually do more harm than good.

In a December 2020 article published in JAMA, Buttenheim and her colleagues argued that non-financial bonuses will be more effective in motivating people to get vaccinated. For one thing, financial incentives can be inefficient. And some people might view a bonus offer with skepticism — basically, if you have to pay me, maybe that means the vaccine is not good.

"What else might we do with that money?" Buttenheim wondered. One place to start, she suggests, is to create more vaccination sites to blanket towns and cities, because the closer you are to a site, the easier it is to get jabbed.

"Doing a better job of meeting people where they are (attitudinally and physically) is important," she said.

"We are very social creatures," Buttenheim added. "Some of the most persuasive messaging and other interventions are just about making people realize that people like them have gotten vaccinated."

It may also help to know how many people in your city, neighborhood, school, workplace, house of worship, sports team or even book club have been vaccinated — whether that's friends, family, colleagues, acquaintances or strangers. Without this information, getting vaccinated can feel like a weird behavior for some people.

"Once you realize that seventy percent or eighty percent have [gotten vaccinated], that tends to be pretty persuasive," said Buttenheim.

Jeanette Beebe is an independent, data-driven journalist who covers public health, science, and technology. She supported The COVID Tracking Project at The Atlantic as a reporter and editorial/comms team member for a year, soon after its launch in March 2020. Her reporting has appeared in TIME, The Daily Beast, Scientific American, Consumer Reports, Fast Company and elsewhere. She also works as an audio storyteller, from reporting for NPR/WHYY to producing for Darknet Diaries, a cybercrime podcast. Her work as a freelance recordist/producer has been broadcast by the BBC, Gimlet Media and NPR/ProPublica’s “Lost Mothers” series, which was a finalist for the Pulitzer Prize for Explanatory Reporting. She holds an A.B. in English from Princeton, and she writes a daily newsletter for the Center for Cooperative Media. www.jeanettebeebe.com.
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