Furthermore, the first anniversary of this blog is upcoming! I plan to have a special two-part blog post reflecting on this blog's first year coming out on Thursday, June 10th, which falls on the first anniversary of the Introduction page being published. Note that there will be no normal post coming out the following Sunday, June 13th, 2021, although there will be a normal one next Sunday, June 6th.
The Viability and Limitations of "Vaccine Lotteries"
Introduction: Since the COVID vaccine began rolling out in the United States late last year, millions of Americans have become fully-vaccinated. However, significant proportions of the American population remain hesitant to COVID vaccines for a variety of reasons, including concern over the R&D timeline, materials inside the vaccines, and unease over health inequities (Oshin; Owens; "Racial Disparities"). With that in mind, private institutions have begun offering free food-related rewards for those who have become fully vaccinated, such as donuts from Krispy Kreme, french fries from Shake Shack, popcorn from Ohio's Chagrin Cinemas, and even marijuana-based alcohol (Dickler; Dodd). Other institutions have been offering payroll incentives, free tickets to zoos and museums, and other similar incentives (Dodd; Scott).
In addition to free services at private businesses and institutions, recent talk has focused on the use of cash incentives for Covid vaccines given out by public institutions. Two weeks ago, Ohio Governor Mike DeWine (R) announced that Ohio would be starting a random cash lottery where 5 vaccinated citizens will be randomly selected to receive $1 million each. 5 teenagers have or will be selected to receive full-ride scholarships to any of the state's public universities (Deliso). Since then, other states and localities have proposed or announced implementation of similar monetary lotteries as a means to incentivize citizens to become vaccinated (Granda; Madini; Martichoux and Pena). Today's post will evaluate the strengths and weaknesses of public institutions using financial incentives to boost vaccination rates.
Evidence So Far: Last week, Ohio ran the first lottery drawing for both a $1 million prize and a full-ride scholarship. Since the announcement, reports have indicated that the number of Ohio residents who had received at least one vaccine dose had soared significantly, as the lottery requires eligible residents to only have gotten one dose (Hampton). However, it is notable that this spike coincided with the broadening of vaccine eligibility to include 12-15-year-olds (Mervosh). Furthermore, daily vaccination rates are not at the same level as a month ago, despite less than half of Ohio's residents having received any vaccine (Welch-Huggins). Concern has been communicated was that the lottery may be driving away non-vaccinated individuals from receiving a vaccine, especially those who are not undecided. The reasons behind this effect could be dislike of social pressure to receive a vaccine and concerns that the lottery program is an equivalent to gambling, something that is looked down upon by some communities (Mervosh).
Fiscal Costs of Vaccine Lotteries: One of the obvious downsides of the lottery program is the fiscal cost, especially considering the amount of money being given away through the programs. For example, Ohio's lottery program will give out $5 million to recipients in the end, in addition to the amounts that will later be given out as scholarships (Hampton). However, considering that vaccinating as many Americans as possible is a critical component to completely reopening the economy (Bomey), it can be argued that so long as there is sufficient evidence that cash incentives lead to increased vaccination rates, such money is well-spent. In particular, since the relatively small amount being spent on said lotteries represents relatively small fiscal amounts compared to state budgets (whose sizes are in the billions or more) ("Total State Expenditures"), vaccine lotteries do not have a significant impact on state-level fiscal health.
Can Cash Incentives Decrease Vaccine Hesitancy?
Racial Minorities: One of the most significant reasons among minority communities for "vaccine hesitation" are concerns over healthcare services and access. In particular, nonwhite Americans are more likely to work in jobs that do not give paid leave to receive and recover from the COVID vaccine (Artiga and Hamel). Furthermore, distrust of medical institutions as a result of historical inequities in healthcare and health research weigh on the minds of some nonwhite Americans, who still face many barriers to receiving equitable health care and access ("Racial Inequities"). I was not able to find any significant research or discussion regarding whether ongoing cash incentives (including lotteries) have reduced vaccine hesitancy among racial minorities and lead to higher vaccination rates among such groups. Yet, regardless of whether this is the case, it is important to note that other measures and policies must be implemented to help vaccine hesitant minorities receive the COVID vaccines, including paid leave and outreach efforts to minority communities. A relevant policy that was recently passed is California's SB-95, which provides 80 hours of paid leave to all California workers at workplaces with over 25 workers to cover COVID-related absences, including vaccine appointments (Ahmed and Strowhiro).
Republicans and Trump Supporters: While initial evidence from Ohio indicates that the announcement of the vaccine lottery was associated with an increase in new vaccinations, an argument could be made that even monetary incentives are enough to overcome vaccine hesitancy. In particular, a significant portion of the American population remains hesitant to receive COVID vaccines due to concerns over perceived or real side effects from the vaccines (Oshin). As an extension of this, polls and studies highlight a partisan gap in vaccine acceptance, with many Republican voters and Trump supporters remaining hesitant to receive COVID vaccines due to conspiracy theories and/or distrust of governmental institutions, including the Biden administration and the 2020 elections (Keith; Wright). Like with the paragraph about racial-based vaccine hesitancy above, I didn't find any articles or news pieces talking specifically about whether cash incentives have led to declines in vaccine hesitancy among Republicans and Trump voters. Yet, as noted under "Evidence So Far," vaccine lotteries may not be very effective incentives to get mistrustful vaccination-hesitant Americans (including Republicans and Trump voters) to receive their vaccine. Research suggests that this may be because such incentives may be interpreted as coercion on behalf of public authorities, which could be significantly amplified among those who are mistrustful of public and health institutions (Bernstein).
Conclusion: While huge strides have been made in vaccinating the United States, there remains a significant number of Americans who are still hesitant to receive COVID vaccines. Because mass vaccination is critical to completely reversing all COVID-related measures, figuring out how to maximize the number of vaccinated Americans is critical. Recently, states and localities have announced cash lotteries as a means to incentivize more people to receive a COVID vaccine, with the justification being traditional economic theory on nudging. Despite some of the potential downsides and limitations of cash-based COVID incentives, such programs also have potential to significantly close the hesitancy gap through the possibility of receiving free cash.
Works Cited:
Ahmed, Saniya, and Michelle S. Strowhiro. "California Expands COVID-19 Supplemental Paid Sick Leave." National Law Review, 1 Apr. 2021, www.natlawreview.com/article/california-expands-covid-19-supplemental-paid-sick-leave. Accessed 30 May 2021.
Artiga, Samantha, and Liz Hamel. "How Employer Actions Could Facilitate Equity in COVID-19 Vaccinations." Kaiser Family Foundation, 17 May 2021, www.kff.org/policy-watch/how-employer-actions-could-facilitate-equity-in-covid-19-vaccinations/. Accessed 21 May 2021.
Bernstein, Leandra. "$1M for a shot: Why states are turning to vaccine lotteries to boost uptake." NBC Montana, 27 May 2021, nbcmontana.com/news/nation-world/1m-for-a-shot-why-states-are-turning-to-vaccine-lotteries-to-boost-uptake. Accessed 30 May 2021.
Bomey, Nathan. "How Pfizer vaccine could help lift economy out of COVID-19 pandemic rut." USA Today, 9 Nov. 2020, www.usatoday.com/story/money/economy/2020/11/09/pfizer-vaccine-coronavirus-covid-19-economy/6219512002/. Accessed 30 May 2021.
Deliso, Meredith. "Ohio will give 5 people $1 million each in COVID-19 vaccine lottery." ABC News, 12 May 2021, abcnews.go.com/US/ohio-give-people-million-covid-19-vaccine-lottery/story?id=77656133. Accessed 21 May 2021.
Dodd, Sophie. "How to Get Promotions, Prizes and Freebies with your COVID-19 Vaccine." People Magazine, 18 May 2021, people.com/health/covid-19-vaccine-freebies-incentives-rewards/. Accessed 21 May 2021.
Dickler, Jessica. "Free with Covid vaccine: Krispy Kreme, marijuana, beer and more." CNBC, 31 Mar. 2021, www.cnbc.com/2021/03/31/free-with-covid-vaccine-krispy-kreme-marijuana-beer-and-more.html. Accessed 21 May 2021.
Granda, Nathalie. "Gift cards for COVID vaccine? Fresno County to offer incentives to get more residents vaccinated." ABC30, 7 May 2021, abc30.com/fresno-county-health-department-covid-updates-vaccines-variants/10590230/. Accessed 21 May 2021.
Hampton, Deon. "Ohio sees boost in shots after it announces $1 million vaccination lottery." NBC News, 17 May 2021, www.nbcnews.com/news/us-news/ohio-sees-boost-shots-after-it-announces-1-million-vaccination-n1267648. Accessed 21 May 2021.
Keith, Tamara. "How Do You Reach Trump Voters Who Say They Don't Want The Vaccine? Try Doctors." National Public Radio, 19 Mar. 2021, www.npr.org/2021/03/19/978407316/how-do-you-reach-trump-voters-who-say-they-dont-want-the-vaccine-try-doctors. Accessed 30 May 2021.
Lopez, German. "Ohio’s vaccine lottery is a winner no matter what." Vox, 28 May 2021, www.vox.com/2021/5/28/22458637/ohio-covid-19-vaccine-lottery-incentives-coronavirus-pandemic. Accessed 30 May 2021.
Madini, Doha. "States are introducing vaccine lotteries — some with multimillion-dollar prizes — to combat slowing vaccination rates." NBC News, 20 May 2021, www.nbcnews.com/news/us-news/states-are-introducing-vaccine-lotteries-some-multimillion-dollar-prizes-combat-n1268048. Accessed 30 May 2021.
Martichoux, Alix, and Luz Pena. "Will California pay people to get vaccinated? Newsom teases announcement coming soon." ABC7, 20 May 2021, https://abc7.com/health/will-ca-pay-people-to-get-vaccines-newsom-teases-possibility/10669725/. Accessed 21 May 2021.
Mervosh, Sarah. "Who Wants to Be a Millionaire? In Ohio, You Just Need Luck, and a Covid Vaccine." The New York Times, 26 May 2021, www.nytimes.com/2021/05/26/us/coronavirus-ohio-lottery-vax-a-million.html. Accessed 30 May 2021.
Oshin, Olafimihan. "Vaccine-hesitant Americans list false side effects among concerns: poll." The Hill, 17 May 2021, thehill.com/homenews/administration/553966-vaccine-hesitant-americans-name-false-side-effects-among-concerns. Accessed 21 May 2021.
Owens, Catilin. "There's not just one kind of vaccine hesitancy." Axios, 3 May 2021, www.axios.com/coronavirus-vaccine-hesitancy-polling-d6c0044f-a339-45aa-afcf-66f0f26a2ab0.html. Accessed 21 May 2021.
"Racial Disparities in COVID-19 Vaccination: Is It Vaccine Hesitancy or Vaccine Deliberation?" Cleveland Clinic, 31 Mar. 2021, consultqd.clevelandclinic.org/racial-disparities-in-covid-19-vaccination-is-it-vaccine-hesitancy-or-vaccine-deliberation/. Accessed 30 May 2021.
Scott, Dylan. "Cash bonuses, on-site clinics, paid leave: How US companies are supporting the vaccine drive." Vox, 21 May 2021, www.vox.com/coronavirus-covid19/22444414/covid-19-vaccine-incentives-amazon-target-mcdonalds. Accessed 21 May 2021.
"Total State Expenditures (in millions)." Kaiser Family Foundation, www.kff.org/other/state-indicator/total-state-spending/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D. Accessed 21 May 2021.
Welch-Huggins, Andrew. "Ohio announces 1st $1 million Vax-a-Million lottery winner." Associated Press, 26 May 2021, apnews.com/article/ohio-vaccine-lottery-4c7a3728b79700faea66a6d5b57966fe. Accessed 30 May 2021.
Wright, Aallyah. "Republican Men Are Vaccine-Hesitant, But There's Little Focus on Them." Stateline, Pew Research Center, 23 Apr. 2021, www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2021/04/23/republican-men-are-vaccine-hesitant-but-theres-little-focus-on-them. Accessed 30 May 2021.
Nathan Parmeter
Author and Host, The Parmeter Politics and Policy Record
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