“Vaccine for lollapalooza!!” Are monetary incentive programs the answer to low vaccine uptake?

Image Credits : ABC News | Anthony Behar/Sipa USA via AP, FILE

A study at the Boston University School of Medicine has not found evidence that the lottery based incentive in Ohio led to increase in vaccinations. Though the rate of decline of vaccinations was arrested. In another study, researchers from University of Pennsylvania and University of Chicago in a recent study did not see any significant difference in vaccination trends between states with and without incentives, measured 14 days before and after the incentive program announcement.

Though incentives like these are a step in the right direction, the question still remains: Are these enough? Is/Was just the absence of an incentive the reason behind an individual’s hesitancy or refusal towards vaccine? Can such economic incentives help in preference re-ordering and thereby human behavior? Delving into what is hesitancy and what it looks like, and what do we know about lottery and incentives as enablers of social choice might be helpful in understanding these recent splurge of incentives and also their effectiveness.

Hesitancy as a Spectrum

Vaccine hesitancy is defined by WHO as “the reluctance or refusal to vaccinate despite the availability of vaccines “. Vaccine hesitancy could prove to be a crucial roadblock in United States path to achieving herd immunity quickly and putting the COVID pandemic behind. The recent spike in COVID cases in American states with low rates of vaccination highlights the seriousness and urgency that this challenge must be dealt with.

  1. Distrust Begets Distrust: Vaccine confidence is being adversely affected by widely proliferating information (often misinformation) raising concerns about the vaccines’ side-effects and their degree of effectiveness. But the information content per se cannot be seen in isolation from the source of the information. Trust in the source of information contributes significantly to the consumption and integration of the information itself. Trust involves an individual’s confidence towards agents of vaccinations (the government, the big pharma, local authorities) and the information sources. Trust in such institutions and agents has taken a hit during the pandemic due to reasons such as perceived mismanagement, perceived disproportionality of response and inconsistencies in communication (e.g., mask mandate, lab leak hypothesis). This then shapes the individuals outlook towards the vaccine. Lack of trust is also amplified by an individual’s or community’s historical experiences such as those of the African American community, which perceives many public institutions to be unfair and discriminatory towards them. In uncertain times like these, where there is an widespread crisis of trust, the influence of weaker social ties and external agents tends to diminish, and individuals start gravitating towards strong ties like family, friends and colleagues. The beliefs and sentiments within these strong networks are favored over external information, creating echo-chambers. These echo-chambers can lead to clusters of hesitancy if the dominant preference within the strong ties is to go against the vaccination, which tends to be the case in less urban communities which did not experience high caseloads even during the peaks of COVID.
  2. “What are the rewards? I don’t see any. “ : The feelings of risk and rewards is the other gear that powers the action tendency towards a vaccine. When President Biden informs the nation that vaccinated individuals can stop wearing masks, it signals that getting vaccinated can be the key to resuming one’s pre-covid life. But as we know, covid appropriate behaviours are now advised even after one gets vaccinated, if one is indoors or is among crowds. Thus, a positive vaccine action does not carry any immediate, definitive visible reward for the individual (a hesitant one). During our research we saw a variety of emotions towards the vaccines and the vaccination drive, such as indignation, confusion, resentment, being harboured among the different hesitant cohorts. These diverse set of emotions occur because different individuals use different ways to cope, assess risk and rewards, evaluate urgency, and have different mental models which they use while making the decision. Some individuals have low-risk perception regarding covid due to perceived adequacy of other covid appropriate behaviors, absence of COVID in their communities and a perceived sense of superior immunity. Others perceive high risk of side-effects from the vaccine due to perception of rushed development and trials, lack of FDA approval, personal history of adverse reactions, and reports of severe adverse events following immunization. Hence, vaccine hesitancy should not and cannot be seen as a uni-dimensional phenomenon and a one-size-fits-all solution like monetary incentives cannot address the diverse concerns and barriers within the hesitant populations.

Incentive Vs Incentive Compatibility

Now that we have explored the dynamics of COVID vaccine hesitancy, let’s try to understand the mechanics behind incentives and preferences. The theory of rational choice centres around the idea that individuals have preferences and choose accordingly. But sometimes these preferences (e.g. savings over expenses) may not be aligned to a pro-social goal such as filing taxes, purchasing EVs etc. or in the context of vaccine, the desirable goal of taking the two doses of vaccine.

Can incentives work for all?

As our research indicates, hesitancy should not be seen through a simplistic binary lens: people who are vaccine confident vs people who are hesitant. The different cohorts present within the hesitancy spectrum have distinct preferences, and require bespoke interventions to help move them towards vaccine confidence and uptake.

  1. https://www.theguardian.com/us-news/2021/jun/05/vaccine-us-states-america-covid-coronavirus
  2. Bowles, Samuel, and Sandra Polania-Reyes. 2012. “Economic Incentives and Social Preferences: Substitutes or Complements?” Journal of Economic Literature, 50 (2): 368–425.
  3. Shen SC, Dubey V. Addressing vaccine hesitancy: Clinical guidance for primary care physicians working with parents. Can Fam Physician. 2019;65(3):175–181.
  4. https://www.nbcchicago.com/news/local/chicago-giving-away-1-day-passes-to-lollapalooza-as-covid-vaccine-incentive/2538803/
  5. Walkey AJ, Law A, Bosch NA. Lottery-Based Incentive in Ohio and COVID-19 Vaccination Rates. JAMA. Published online July 02, 2021. doi:10.1001/jama.2021.11048
  6. Thirumurthy, Harsha and Milkman, Katherine L. and Volpp, Kevin and Buttenheim, Alison and Pope, Devin G., Association between statewide financial incentive programs and COVID-19 vaccination rates (August 27, 2021).

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Final Mile

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Final Mile is a research and consulting firm solving tough and relevant behavioral problems across the globe