Vaccine incentives do not backfire – policymakers take note

Close-up in soft focus of Swedish Krona banknotes and coins

A trial in Sweden showed that absorption rates rose slightly if people were given 200 kroner ($24) to get a COVID-19 vaccine.Photo credit: Karol Serewis/SOPA Images/LightRocket/Getty

Around the middle of 2021, some governments around the world are starting to get creative with their COVID-19 vaccination programs. Eager to get vaccines into as many guns as possible, they began offering unusual incentives: in San Luis, Philippines, vaccinated residents could enter a sweepstakes to win a cow; In Hong Kong, the windfall was an apartment; In West Virginia, it was a hunting rifle, among other prizes.

The evidence about the effectiveness of such efforts is mixed1And research conducted indicates that guaranteed instant payments are more effective than scams and sweepstakes2. A randomized trial in Sweden in 2021, for example, showed that a cash payment of 200 kronor (US$24) to those who receive their first dose of the COVID-19 vaccine was enough to raise vaccination rates by 4.2 percentage points.3.

However, people and policymakers remain concerned that such incentives may have unintended negative consequences. People might expect to pay for future vaccinations, for example. Or they may think the payments are compensation for something that is insecure or potentially annoying. Now, the results of two trials have been published in a research paper on January 11 in the nature She points out that simple cash payments have no such unintended effects4. The research team took the important step of designing studies to test the null hypothesis. This gave them the statistical power to detect no effect, not simply document a lack of evidence for negative outcomes. Such studies (including the null score test) add to the discussion about financial incentives for immunization and highlight the value of robust research to policy questions.

Financial incentives — and disincentives — have long been used to achieve public health goals, but as a general rule, they have mostly targeted unhealthy behaviors. Take, for example, taxes on cigarettes to discourage smoking. Randomized trials suggest that direct cash payments can be effective for smoking cessation during pregnancy5.

But there has been a longstanding concern that offering vaccination payments could reduce people’s confidence in the safety of vaccines, undermine their sense of altruism and make it difficult to implement future vaccine programs without payments. Although these concerns are largely theoretical, they have led some policy advisers to recommend that programs that offer funds to promote healthy behaviors not be implemented. Authors nature This research, a team of economists from Europe and the United States, addresses such concerns head-on by analyzing data from randomized studies of more than 2,700 people participating in Sweden’s monetary stimulus program and 3,000 people in the United States.

In addition to collecting data on taking the second dose, the Swedish study also surveyed attitudes toward vaccines and other healthy behaviours. The US study looked at whether participants’ reporting that there were incentive programs offering public funds for COVID-19 vaccines affected their perception of product safety or efficacy, their sense of civic responsibility or their intention to get a flu shot or donate blood. . Overall, there was no difference in any of these parameters. Nor did the participants report feeling compelled by the stimulus.

No single trial can completely answer questions about unintended consequences, and this study, like any other, has its caveats. Ethical requirements dictated that all participants know they are part of an experiment, and it is possible that this knowledge colored their responses to the survey questions. The results also may not apply to other countries or other vaccines: The COVID-19 pandemic is unique in its preeminence as well as its politicization, and both of the regions studied are high-income Western countries. Nor does this study address broader, more fundamental ethical questions about paying people to get vaccines.

And although the findings support the idea that financial incentives can be deployed without unintended negative consequences, they do not suggest that such approaches should be prioritized over improving access to vaccines when there are insufficient resources to do both. Efforts to build trust or make it easier for people to get vaccines—by translating information about immunizations into different languages, for example, or bringing vaccination centers closer to populations most in need—are well-established ways to boost vaccination rates, and in some cases may cost less than offering financial rewards. .

But for communities with the resources to promote access and provide incentives, recent work brings important data and a rigorous approach to a discussion that has been deeply affected by untested assumptions about hypothetical negative outcomes. More such studies on effective approaches to policy-related questions are needed. In the case of vaccines, this information can be harnessed to help healthcare providers design alternative ways to boost vaccination — before another pandemic draws governments back in to push science and innovation forward.

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