It started in Alaska tribal villages, where health officials held parties featuring raffles in early April to get more people vaccinated against COVID-19 as demand began petering out.
But it was when Ohio Gov. Mike DeWine, a Republican, announced a month later that any adult resident who had received a shot could win $1 million in a series of five weekly drawings, that other states took notice.
Since then, California, Colorado, Maryland, New Mexico, New York, Oregon, Washington state and West Virginia have launched million-dollar lotteries of their own. And governors, mayors and state health departments nationwide have been one-upping one another with bigger and more inventive vaccine incentives to try to win over the ambivalent and stop community spread of the disease.
Alabama is offering a chance for residents to drive their personal vehicle around the famed Talladega Superspeedway. West Virginia is offering a chance to win a slew of prizes including trucks, custom rifles, scholarships and savings bonds. And Alaska recently upped its incentives to include free airline tickets and $500 to use on groceries, gas or an all-terrain vehicle.
People who get a COVID-19 shot in New Jersey can sign up for a chance to have dinner with Democratic Gov. Phil Murphy and first lady Tammy Snyder Murphy at the governor’s residence.
Most states are offering prizes to anyone who has received a COVID-19 vaccine, to avoid complaints that they’re only rewarding laggards.
As of June 4, 29 states and Washington, D.C., were sponsoring some type of incentive program to encourage residents to get a shot, according to Stateline research. From free coffee, beer and doughnuts at pop-up clinics to block parties with live entertainment to free state park passes, fishing licenses and baseball tickets, states are offering a wide variety of incentives to get more people inoculated.
Private businesses also are offering incentives, some in partnership with state and local health departments. In March, for example, Krispy Kreme announced that anyone who showed their vaccination card could get one free glazed doughnut every day through 2021. Kroger and Walmart vaccine clinics in Kentucky are offering free lottery tickets with a shot. NASCAR announced in May a chance to win tickets to the 2022 Daytona 500 race.
The goal, set by President Joe Biden in May, is for 70% of all adult Americans to have at least one COVID-19 shot by July 4.
Twelve states already have met that goal: California, Connecticut, Hawaii, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New Mexico, Pennsylvania, Rhode Island and Vermont.
Anheuser-Busch announced June 2 that it would provide a free beer to all adults who have had one shot as soon as the entire country reaches the goal. As of June 2, 63% of adult Americans had received at least one shot, according to the federal Centers for Disease Control and Prevention.
“Somewhere along the line, local health officials got the idea that incentives were needed and a lottery or a chance to win something big was going to be more persuasive than a simple giveaway,” said Claire Hannan, executive director of the Association of Immunization Managers, a nonprofit that represents state public health agencies.
Will incentives work?
“This is unchartered territory,” Hannan said. “There’s no formula for using incentives of any kind. We’re looking at poll data and intelligence from other industries about what moves the dial for behavioral change.
“It’s really all about efforts to move that vaccination level to get to 70%, and anything we can do right now is worth a try,” Hannan said. “We’re throwing things at the wall to see what sticks.”
DeWine announced the Ohio lottery May 12; by May 20 the state had declared it a success. According to a news release from the state health department, the Vax-a-Million drawings boosted vaccine uptake by 28% among adults from May 14 to May 17, the weekend after the announcement.
“This dramatic increase in vaccinations indicates that the Vax-a-Million drawing has been impactful in creating momentum for vaccinations throughout Ohio,” said Stephanie McCloud, director of the Ohio Department of Health, in the release.
It’s unclear whether lotteries in other states will have the desired effect, and whether freebies such as beer, doughnuts and coffee will boost COVID-19 vaccination rates.
Two experts in health incentives and behavioral economics at the University of Pennsylvania argued in a May 26 article in the New England Journal of Medicine that cash incentives may be particularly appropriate for low-income people who may be ambivalent about getting a shot.
“There is a certain logic to providing financial incentives, which may be used to offset the indirect costs of vaccination — including time spent planning appointments, traveling, or waiting; lost income for workers paid hourly; or expenses such as childcare,” the authors wrote. “These costs disproportionately deter low-income people from getting vaccinated, and payments could ensure that vaccination is indeed ‘free’ to all.”
Incentives, they noted, have been used by governments in the past to steer individual actions that may affect other people. For COVID-19 vaccination, the authors argued, “the positive return on incentives may be considerable: in the United States alone, the cumulative financial costs of the pandemic are estimated at more than $16 trillion.”
DeWine made similar arguments in an opinion article published in The New York Times: “I thought about how much money the country had already spent fighting the virus, including millions of dollars in health care costs, the lost productivity and the lost lives. Frankly, the lottery idea would cost a fraction of that — about $5.6 million, according to our estimates.”
The CDC approved state use of COVID-19 supplemental funding for incentives beginning May 26. In a document sent to state health departments, and obtained by Stateline, the agency wrote that “ … new strategies like direct appeal, via incentives, to potential vaccine recipients will be needed to reach the White House goal of vaccinating at least 70% of adults by July 4, 2021.”
DeWine said his state is paying for the $5 million-plus vaccine lottery with relief money appropriated by Congress under the CARES Act. And according to Ohio Republican Attorney General Dave Yost, "It doesn’t appear to violate state law, though it depends on how it’s designed."
Public health experts agree that now is the time to pull out all the stops in order to encourage more people to get a shot and move the country closer to herd immunity.
“We need any and all efforts to increase vaccinations,” said Dr. Leana Wen, a visiting professor of health policy and management at George Washington University’s Milken School of Public Health.
“Incentives can help. We also need to bring vaccines to people, including with vaccination drives at workplaces, schools, churches and community recreation centers.
“I'm very concerned that vaccination rates are dropping,” she added. “Some communities will reach herd immunity, but many others will be very far from it. We are at risk for outbreaks this summer and especially heading into the fall and winter.”
In six states, fewer than half of eligible adults have received their first shot. Only 44% have received a shot in Mississippi, followed by Alabama (46%), Louisiana (46%), Wyoming (47%), Tennessee (49%) and West Virginia (49%).
Incentives make a lot of sense, said Dr. William Schaffner, a professor of preventive medicine at Vanderbilt University School of Medicine and medical director and a former president of the National Foundation for Infectious Diseases.
In his 50 years in the field of infectious diseases, he said he’s never seen anything like the proliferation of incentives state and local politicians are offering to get people vaccinated.
They’re likely to be much more effective than scare tactics and onerous mandates, he said. “Approaching people with negative information is not the way to win their hearts and minds. We need to get more people vaccinated. Otherwise, we’ll have two Americas and the virus will continue to smolder in less vaccinated communities.
“Using carrots rather than sticks is absolutely the way to go.”
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