Cash for Vaccination: Is it Effective? Is it Good Policy?

Terry Brenneman, MD

Before the COVID-19 pandemic I cannot remember any governmental cash incentives to boost vaccine receipt rates. It didn't happen with the 2009 new pandemic flu strain, nor with the various measles outbreaks that have occurred in the past decade.

However, the number of deaths attributable to COVID-19 dwarfed those during the 1957, 1968, and 2009 influenza pandemics. Despite the rising number of deaths and crowded hospitals, initial COVID vaccine uptake was surprisingly underwhelming in the minds of public health physicians.

The reasons were multiple.

The CDC's indecision on mask use led to some loss of trust in that previously respected and apolitical organization. Likewise, contradiction of messaging from the CDC by the executive branch and vice versa may have reduced public faith in advice from the “experts.” The pandemic response overall became a political lightning rod resulting in large discrepancies in vaccination rates across the country and even within the states.

In an effort to boost COVID-19 vaccine uptake, many state governments decided to offer cash and other incentives to individuals who received a vaccine. Some offered direct cash payments. In 11 states, vaccine recipient's names were entered into a lottery for a cash payout of a million dollars or more and some included a variety of additional prizes. For example, West Virginia's lottery had hunting rifles, pickup trucks, and college scholarships as prizes in addition to the million dollar pay out.

A study in JAMA looked at these 11 states with a control group of 28 states that did not offer an incentive program. Try these 4 questions on the results. (Please click arrow to move to next slide)