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Do vaccine incentives actually work?

The short answer, research suggests, is a qualified yes.

This article was originally published in the Montreal Gazette

In recent days, the question has become how we get our vaccination rate up high enough to avoid a fourth wave come the fall. While it is hard to know for sure what threshold will be necessary, we will need high vaccination rates to withstand the more infectious variants and prevent another wave.

While most people have got their vaccines, a still sizeable minority have not — and motivating them to do so is a tricky business. Vaccine lotteries have been rolled out in both Canada and the U.S. President Joe Biden recently urged states to offer $100 incentives to people who get vaccinated. Prizes like trips and vacations are being used to entice the fence-sitters to go out and get their shots.

The question becomes: Do these programs work? The short answer is a qualified yes. Incentives have been used and studied in many different fields of medicine and have been used to get people to quit smoking, exercise more and eat better. For example, a study in the BMJ, published by the British Medical Association, found that pregnant smokers who got financial incentives on top of a regular quit-smoking program were nearly three times more likely to quit. Not every incentive program is so successful, and long-term change — like dieting and weight loss — is harder to accomplish. But even healthy eating can be achieved with a financial nudge like a sugar tax.

Whether any of these strategies would work in the current pandemic is hard to say. Financial incentives to improve vaccination rates have worked before for other vaccines, and lotteries have been used to boost uptake of HIV treatment, though whether lotteries will push people to get vaccinated against COVID-19 remains to be seen. Unfortunately, we can only know whether some programs work after the fact. Unfortunately, you can never be fully certain that something will work until you try it.

There has not been enough time to see whether any of these programs will boost vaccination rates, but a recent research letter has suggested that simple interventions do help, even if to a small degree. Researchers looked at health care workers in Pennsylvania and examined whether a simple email reminder could nudge them to get vaccinated. How any health care worker could live through the past 18 months and not see the dire need for vaccination is beyond me, but in this Pennsylvania hospital system, 41 percent of employees had not been vaccinated despite having received 36 email reminders over the past five weeks. Researchers, therefore, designed an experiment to see if personalized emails, rather than mass emails, could get more employees to register for a vaccine. They designed two email templates, one that framed the risks of vaccination against the much higher risks of COVID-19, and another that highlighted the societal good that comes from vaccination.

Over a three-day period, the personalized emails boosted vaccination rates by three percent, with both versions performing equally well. While a three percent increase might seem like a small number, it is actually a significant boost in vaccination rates, and we should remember that incentive programs often work together. Thus, financial rewards coupled with a no-appointment pop-up clinic at La Ronde, for example, might work for someone who has no major opposition to vaccination but for whatever reason was not motivated to go online and schedule an appointment.

Convenience, simplicity and the promise of money or prizes are not negligible factors, especially for younger people who make up most of the unvaccinated at this point. While it is easy to turn your nose up at some of these programs and write them off as silly or unlikely to succeed, the reality is that they do work. They have small but incremental benefits. And when it comes to the vaccine roll-out, every little bit helps.


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