Study: NC’s $25 perk helped boost COVID-19 vaccinations; lottery prize fell flat

RALEIGH, N.C. — What works and what doesn’t when it comes to encouraging people to get vaccinated against COVID-19? A new study in North Carolina shows that offering $25 to people getting their first shot was an important factor, while long odds at a big lottery prize made little difference.

The study released on Monday examined a pilot program offering $25 to residents in four counties. Of the 401 vaccine recipients surveyed, more than two-fifths cited the prepaid cash cards as an important reason they went in for a shot.

The $25 summer card program operated by NCDHHS was the subject of a research letter authored by NCDHHS, NCCU, And UNC-Chapel Hill researchers. The letter, published in JAMA Internal Medicine Monday, was one of the first to provide data on guaranteed financial incentives for COVID-19 vaccination.

“Within a week, this well-designed incentive program halved the drop in COVID-19 vaccination that North Carolina was experiencing,” said Dr. Noel T. Brewer, PhD, UNC Gillings School of Global Public Health. “Using guaranteed cash incentives is a best practice, recommended by the CDC. It builds on 70 years of psychological research showing that rewards are most effective when delivered immediately after the behavior.”

The program guaranteed a $25 card to those who got the first dose of the vaccine and also to those who drove someone to one of the participating locations in Mecklenburg, Guilford, Rowan and Rockingham counties.

2,890 cards were given out to vaccine recipients and 1,374 cards were given to drivers.

During the one-week review period, clinics offering the $25 cash cards saw a slower rate of decreased vaccinations (26%) whereas the rate of vaccination dropped by 51% elsewhere in the four counties where the program was tested.

Hispanic people, other racial minorities and residents making less than $40,000 a year were more likely than white and wealthier residents to view the cash cards as a key reason to get the vaccine, according to the report published online in JAMA Internal Medicine .

Roughly 1 in 11 respondents said they would not have come in for a COVID-19 shot if the $25 perk was not being offered at participating sites in Mecklenburg, Guilford, Rowan and Rockingham counties. About 1 in 7 people surveyed said they waited to get vaccinated until they learned they could get a cash card or other incentive.

The $25 cash card program switched to providing $100 cards after the evaluation was conducted, and data on the $100 summer card program are not included in the research letter.

“Providing guaranteed small financial incentives is a promising strategy to increase COVID-19 vaccination uptake,” said Dr. Charlene Wong, NCDHHS Chief Health Policy Officer for COVID-19. “The design of our $25 incentive pilot program in North Carolina helped alleviate transportation and other cost barriers to vaccination, particularly for low-income, Latinx and Black individuals.”

Of 401 vaccine recipients surveyed, 41% of people said the $25 card was an important reason why they decided to get vaccinated. The cards were more important to respondents who were not white as well as respondents with lower incomes.

Additionally, “someone driving me here today” was an important reason for 49% of respondents who received the vaccine and cash card. The answer was more common among Black, Hispanic and lower-income respondents. Lower-income and older individuals were especially more likely to have been brought by a driver who received a cash card.

“With hundreds of millions of dollars being spent to accelerate COVID-19 vaccine uptake, these study findings suggest that this strategy for increasing vaccination merits greater investment,” the authors wrote.

Less successful, however, was North Carolina’s rollout of a $4.5 million lottery package ultimately won by just eight residents. Four kids aged 12 to 17 who got vaccinated each qualified for $125,000 college scholarships, while four adults 18 or older each got $1 million before taxes.

Within the first two weeks of the state announcing the lottery in June, about 118,000 residents got their first shot, but weekly vaccination counts were flat throughout much of June and July before rising in late-July and early-August amid substantial spread of the more contagious delta variant.

“These large but uncertain financial prizes benefit only a few lucky winners and do not broadly address access barriers to vaccination,” the authors wrote, adding that financial rewards should be considered in conjunction with other methods to promote an equitable distribution of shots.

All research articles published in JAMA Internal Medicine are made available via free public access for 12 months after publication here.

The Associated Press contributed to this article.

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