Is a Million Dollar Lottery the Best Way to Get People Vaccinated?

Ohio officials are running a weekly $1 million lottery for 5 weeks. Stephen Zenner/Bloomberg via Getty Images

Ohio is offering state residents who are vaccinated against COVID-19 a chance to win big.Many experts think these tactics may…

Ohio officials are running a weekly $1 million lottery for 5 weeks. Stephen Zenner/Bloomberg via Getty Images
  • Ohio is offering state residents who are vaccinated against COVID-19 a chance to win big.
  • Many experts think these tactics may help, but there’s also a potential downside to cash incentives.
  • Some people may see cash incentives as a reason to distrust the safety of vaccines.

While some businesses are offering free beer or donuts to people who have gotten their COVID-19 vaccine, Ohio Gov. Mike DeWine is banking on an even bigger prize to encourage more people to roll up their sleeve.

A chance to win $1 million.

The state will hold five weekly drawings starting May 26, giving away millions to vaccinated state residents who opt into the lottery. Those under 18 who opt in will be entered to win full scholarships to any of Ohio’s state colleges and universities.

But will this or other incentives work?

Cash incentives may increase vaccination rates

The goal of state incentives is to protect as many people in the community from COVID-19 as possible by increasing vaccination rates.

This includes indirectly protecting those who can’t be vaccinated right now — such as children under 12 — and the immunocompromised who may not benefit as much from the vaccines.

A study done by the UCLA COVID-19 Health and Politics Project suggests that offering cash incentives might help get us there.

The project involved surveys of more than 75,000 people over the last 10 months. Unvaccinated people were randomly assigned to groups so researchers could see how participants responded to different incentives.

Researchers found that around one-third of people said they would be more likely to get vaccinated if offered $100, reports The New York Times.

When the incentive was $25, this dropped to 28 percent.

Several states and cities are trying this kind of approach. Maryland is offering $100 to state employees who get vaccinated. West Virginia is offering a $100 savings bond to 16- to 35-year-olds who choose to get vaccinated.

Detroit is going one step further, offering $50 prepaid debit cards to people who drive someone to their vaccine appointment.

Dr. A. Mark Fendrick, director of the University of Michigan’s Center for Value-Based Insurance Design (V-BID) in Ann Arbor, Michigan, said he’s glad some states are opting to give incentives to people who get vaccinated, rather than emphasizing what they can’t do if they skip the vaccine.

“I prefer that they’re using ‘carrots’ as the predominant intervention, as opposed to ‘sticks,’” he said.

With childhood vaccinations, states use more of a stick approach, where children can’t attend school unless they're vaccinated.

Many experts think that states may be on the right track, but there’s also a potential downside to cash incentives. 

The UCLA Project found that when offered a monetary payment, around 15 percent of people were less likely to get vaccinated. This was the same whether you offered them $100 or $25.

An earlier study found something similar. 

Researchers offered people a cash payment to participate in a hypothetical clinical trial. People who were offered higher amounts were more likely to think the study was riskier — even though the description of the procedures was the same for all groups.

“Paying people to be vaccinated might, similarly, lead them to infer that it is riskier than they would otherwise assume,” wrote the authors recently in The New York Times.

Best type of incentive still to be determined

So what about a lottery?

“It is my belief that financial incentives will be appealing to low-income people, more so than to higher income people,” said Fendrick.

“Also, the idea of a bigger windfall payment, as opposed to a smaller guaranteed one, is likely to move more people off the needle,” he said.

Another thing to be sorted out is the best time to give people an incentive for being vaccinated.

The Pfizer-BioNTech and Moderna-NIAID vaccines require people to receive two doses for full protection. In contrast, the Johnson & Johnson vaccine is a one-dose regimen.

If you give people an incentive after the first dose of one of the mRNA vaccines, they might not come back for the second dose.

“I would really like to see people become eligible [for an incentive] only after they complete the full vaccine course,” said Fendrick. “Or that additional incentives are provided to make sure that people who received their first shot completed the two doses.”

Maryland’s incentive program for state employees is only open to people who are fully vaccinated. People in Ohio are entered into the lottery after their first dose.

We won’t know how well these incentives work until health policy researchers take a look at the data. 

Fendrick said this might involve comparing vaccine rates across comparable states, such as Ohio and Michigan — one with a vaccine lottery, the other without.

“It's really going to come down to figuring out: Given that incentives work, which one works best?” he said.

Many people face other barriers to vaccination

As of May 18, 60 percent of American adults had received at least one dose of a COVID-19 vaccine.

Many people who were eager to be vaccinated lined up as soon as they were eligible, even without the promise of cash incentives.

There’s also a group of people who want to get vaccinated, but haven’t done it yet. In April, about 9 percent of Americans fell into this category, according to a poll by the Kaiser Family Foundation.

“These [incentive] programs can give them that nudge that they need to go out and finally get vaccinated,” said Robert Bednarczyk, PhD, assistant professor of global health and epidemiology at Rollins School of Public Health at Emory University, during a media briefing Tuesday.

“But individuals may not always be swayed by a giveaway,” he added.

The KFF poll also showed that about 34 percent of Americans don’t plan on getting vaccinated or will “wait and see.”

“For individuals who don't have confidence in the vaccine or in the vaccination program, these giveaways are not likely to overcome these concerns,” said Bednarczyk.

“[Public health workers] still need to work with and speak with our communities to understand their concerns so that we can help answer questions about the vaccine,” he said.

Some people also face barriers to getting vaccinated, such as those who can’t take time off from work, are the primary caregiver for another family member, or don’t have reliable transportation.

Bednarczyk said multiple approaches are needed to ensure these people aren't left behind.

“We need to ensure that vaccination clinics are open at hours that are going to be convenient to everyone,” he said. “We need to make sure that there is adequate supply of vaccine across the population, in rural areas, for example.”

He pointed out that in one community, the county board of health had partnered with a cab company so people without transportation would be able to get to a vaccination site. 

“We need to really be creative and think outside the box in those types of ways to increase access to the vaccine,” he said.